López RM, Abi-Resk MN, Leyva QA, Gutiérrez LA, Tamargo BTO, López RD, Peña FNE

Language: Spanish
References: 18
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ABSTRACT

Ischemic heart disease is among the leading causes of death in Cuba and worldwide; Coronary interventionism (PCI) and coronary surgery (CABG) are pillars of the treatment of myocardial revascularization. Objective: To determine the results of multivessel PCI in patients with multivessel coronary artery disease. Method: prospective cohort study in the Cardiocentro of the "Hermanos Ameijeiras" hospital, between January 2011 and January 2013 for revascularized patients under PCI and from March 2012 to March 2014 for revascularized patients by surgery. The sample consisted of 87 patients from the PCI group and 91 patients with CABG. The results were presented in percentages, Kaplan-Meier method was used to estimate survival. Results: revascularized patients with PCI 3.4% died due to heart failure, 2.3% had non-fatal infarction, and 10.3% required new revascularization. Event-free survival per year was 89.2%. Patients revascularized by surgery had a 6.6% cardiac cause mortality, 16.5% presented non-fatal MI, and 5.5% required revascularization. In the RCM, overall survival at 93.3%, the probability of dying from cardiac causes was 6.7%, and event-free survival (IMA / RV / Death) was 88.7% And the probability of having events was 11.3%. Conclusions: Myocardial revascularization surgery showed similar results regarding event-free survival with respect to coronary interventionism, the probability of death was very low and the frequency of revascularization was lower.

REFERENCES

1. Ferreira-González I. Epidemiología de la Enfermedad coronaria. Rev Esp Cardiol. 2014; 67(2):139-44.

2. Ministerio de Salud Pública. Anuario estadístico 2015. Ciudad de La Habana: MINSAP; 2016.

3. Grupo de Trabajo de la Sociedad Europea de Cardiología sobre diagnóstico y tratamiento, de la cardiopatía isquémica estable. Guía de práctica clínica de la ESC 2013 sobre diagnóstico y tratamiento de la cardiopatía isquémica estable. Rev Esp Cardiol. 2014; 67(2):e1-81.

4. Grupo de Trabajo de Revascularización Miocárdica de la Sociedad Europea de Cardiología (ESC), y la European Association for Cardio-Thoracic Surgery (EACTS). Guía de práctica clínica de la ESC sobre revascularización miocárdica, 2014. Rev Esp Cardiol. 2015; 68(2):e1-95.

5. Tong BC, Huber JC, Ascheim DD, Puskas JD, Ferguson TB Jr, Blackstone EH et al. Weighting composite endpoints in clinical trials: essential evidence for the Heart Team. Ann Thorac Surg 2012; 94:1908–13.

6. Obregon Santos AG. et al. Manual de cardiología intervencionista. La Habana: Editorial CIMEQ; 2010.

7. Grupo de Trabajo para el manejo del síndrome coronario agudo (SCA) en pacientes sin elevación, persistente del segmento ST de la Sociedad Europea de Cardiología (ESC). Guía de práctica clínica de la ESC para el manejo del síndrome coronario agudo en pacientes sin elevación persistente del segmento ST. Rev Esp Cardiol. 2012; 65(2):e1-55.

8. Grupo de Trabajo para el manejo del síndrome coronario agudo (SCA) en pacientes sin elevación, persistente del segmento ST de la Sociedad Europea de Cardiología (ESC). Guía ESC 2015 sobre el tratamiento de los síndromes coronarios agudos en pacientes sin elevación persistente del segmento ST. Rev Esp Cardiol. 2015;68(12):1125.e1-e64.

9. Grupo de Trabajo para el manejo del infarto agudo de miocardio con elevación del segmento ST, de la Sociedad Europea de Cardiología (ESC). Guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol. 2013; 66(1):e1-46.

10. Hickey GL, Grant SW, Murphy GJ, Bhabra M, Pagano D, McAllister K et al. Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models. Eur J Cardiothorac Surg 2013; 43:1146–52.

11. Windecker S, Stortecky S, Stefanini GG, da Costa BR, Rutjes AW, Di Nisio M et al. Revascularisation vs. Medical Treatment in Patients With Stable Coronary Artery Disease: A Network Meta-Analysis. BMJ. 2014; 348:g3859.

12. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A et al. Coronary artery bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow up of the randomised, clinical SYNTAX trial. Lancet 2013; 381:629–38.

13. Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM et al. . Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 2009; 373:1190–7.

14. Bravata DM, Gienger AL, McDonald KM, Sundaram V, Perez MV, Varghese R et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med 2007; 147:703–16.

15. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M,et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367:2375–84.

16. Cutlip DE, Chauhan MS, Baim DS, Ho KK, Popma JJ, Carrozza JP et al.Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials. J Am Coll Cardiol. 2002; 40:2082-9.

17. Sripal Bangalore, M.D., M.H.A., Yu Guo, M.A., Zaza Samadashvili, M.D., Saul Blecker, M.D et al. Everolimus-eluting stent or bypass surgery for multivassel coronary disease. NEJM 2015; 13:1213-22.

18. Kristian Thygesen , Joseph S. Alpert , Allan S. Jaffe , Maarten L. Simoons , Bernard R. Chaitman Harvey D. White Documento de consenso de expertos. Tercera definición universal del infarto de miocardio. Rev Esp Cardiol 2013662132e1-E15.