[Results after placement of coronary stents in protected and not protected coronary trunk vs revascularization surgery].

INTRODUCTION

We analyzed the clinical and angiographic results, as well as the follow-up of patients with left coronary trunk disease (LCT) subjected to percutaneous transluminal coronary angioplasty (PTCA) with stenting and compared them with those subjected to myocardial revascularization surgery (MRV).

MATERIAL AND

METHODS

From May 1998 to October 2003, 3,680 procedures were performed in 2,900 patients; 30 of them were selected to form group PTCA, 17 protected with stenting and 13 not protected, as they were not suited for surgery due to inappropriate bedding and rejection by the patient. Another group of 30 patients (MRV) with coronary bypass, average of 3.2 grafts. Age ranged from 45 to 74 years (65.7 +/- 11.5) for the PTCA and for MRV from 49 to 77 years (66.9 +/- 7.1); 25 men (83%) in the PTCA group and 23 men (76%) in the MRV group. Systemic arterial hypertension in both groups: 10 (33%), smoking in both groups: 17 (56%); diabetes mellitus PTCA: 11 (36%) and MRV: 3 (10%); hypercholesterolemia PTCA: 19 (63%), MRV 9 (30%); unstable angina according to the Canadian Society of Cardiology (CSC) for PTCA: 17 (56%), MRV; 16 (53%); multivascular disease in both groups: 20 (66%). Average percentage of obstruction was of 90 +/- 6.3%. FE for PTCA, 30 to 55% (40.3 +/- 8.7) and for MRV, 38 to 67% (48.6 +/- 6.1).

RESULTS

Immediate success in 26 patients (87%) for the PTCA group and in 28 patients (90%) for the MRV group.

COMPLICATIONS: PTCA, 4 (13%) and MRV, 20 (66%). Perioperative IAM for PTCA, 2 (6%) and for MRV, 8 (26%). Mortality in the PTCA group was of 4 patients (13%) and in the MRV group of 3 (10%). Follow-up for PTCA, 19.4 months, for MRV of 20 +/- 3, obtained in 26 of the whole group. Late survival adverse events (DEATH or IAM): PTCA, 25 (83.3%), one patient with IAM; MRV, 20 (66.6%), one patient died during the follow-up period.

CONCLUSIONS

Placement of stents in the left coronary trunk disease is a feasible procedure as an alternative for myocardial revascularization, with a low rate of complications in cases of conserved ventricular function despite their higher risk profile.