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ISSN 0188-2198 (Impreso)

2004, Número 3

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Rev Mex Cardiol 2004; 15 (3)


Tratamiento intervencionista en el paciente diabético con angina inestable: Stent vs balón

Muñiz GA, Palacios RJM, Reyes DS, Cruz OR, Jáuregui RO

Idioma: Español
Referencias bibliográficas: 39
Paginas: 106-112
Archivo PDF: 88.70 Kb.


RESUMEN

El propósito del presente estudio es un análisis retrospectivo del impacto de la utilización de stent en los resultados angiográficos así como en la evolución clínica inmediata como a seis meses de los pacientes con diabetes mellitus y angina inestable. Material y métodos: se analiza la base de datos del Servicio de Hemodinamia de nuestro hospital, de octubre de 1995 a diciembre 2003 de donde se seleccionan los pacientes diabéticos con angina inestable y se dividen en dos grupos: 1. Los sometidos a colocación de stent, y 2. A los que se les realiza angioplastia con balón en forma convencional, ambos grupos son comparados en los resultados inmediatos así como su evolución intrahospitalaria y a seis meses. Resultados: se analizaron un total de 2,841 pacientes, de los cuales encontramos 263 pacientes diabéticos con angina inestable, de éstos, 118 se les realiza angioplastia con balón y a 145 se les coloca stent coronario. En las características demográficas de base de ambos grupos eran muy similares excepto por el hecho de que los pacientes sometidos a angioplastia con balón presentaban más pacientes con infartos previos así como una mayor proporción de pacientes con angina pos-infarto (p ‹ 0.05). Con respecto a los datos angiográficos de base, encontramos que los pacientes que fueron sometidos a la colocación de stent presentan un mayor diámetro de referencia (3.17 vs 2.93 p = 0.0013) así como un porcentaje de lesión del vaso culpable (71.74% vs 79.65% p 0.028) y la longitud de las lesiones eran más largas en los pacientes sometidos a stent (15.18 vs 12.90 p = 0.035). En los resultados inmediatos los pacientes sometidos a colocación de stent presentan un mayor diámetro luminal mínimo del vaso tratado (3.13 ± 0.26 vs 2.28 ± 0.12) así como una lesión residual menor (1.89 ± 1.30 vs 17.82 ± 6.92) ambos estadísticamente significantes. Así mismo la tasa de éxito fue mayor en los pacientes con stent (97.24 vs 90.67% con una p 0.030). La evolución intrahospitalaria de los pacientes es muy similar en ambos grupos. Con respecto a la evolución a seis meses observamos que los pacientes que fueron sometidos a angioplastia con balón presentan una mayor incidencia de angina recurrente 44 (56.41%) vs 25 (27.17%) así como una menor sobrevida libre de eventos 58.63 % vs 39.83% ambas estadísticamente significantes. Conclusión: en el grupo de pacientes diabéticos con angina inestable que fueron sometidos a revascularización coronaria percutánea la utilización de stent se asoció a un mayor diámetro del vaso tratado así como una menor estenosis residual, lo que se asoció a una menor tasa de angina recurrente y una mayor tasa libre de eventos combinados en su seguimiento a seis meses.


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