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2020, Number 1

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Rev Cubana Cardiol Cir Cardiovasc 2020; 26 (1)

Spironolactone as a pharmacological alternative for the prevention of bare metal stent restenosis

Gutiérrez LA, Leyva QAY, Ponte GG, Rodríguez BS, Aguilar MJM, Pérez YLM, Luperón LD, Hidalgo CT

Language: Spanish
References: 15
Page: 2-8
PDF size: 321.02 Kb.


ABSTRACT

Introduction: Ischemic heart disease is the leading cause of death in many countries, including Cuba. Percutaneous transluminal coronary angioplasty with metallic stenting is a therapeutic alternative, however intrastent restenosis is an unresolved problem. Theoretical elements indicate that the treatment with Spironolactona could be beneficial in this context.
Objective: To evaluate the effectiveness and safety of Spironolactone in patients treated by percutaneous coronary intervention with conventional metallic stent implantation.
Methodological design: A randomized, controlled and open clinical trial was conducted. A total of 189 adult patients treated by percutaneous coronary intervention with conventional stent implantation were included in the Cardiology service of the Hermanos Ameijeiras Hospital, from January 2016 to January 2017. The patients were randomly assigned to two groups ( with Spironolactone, without spironolactone).
Results: In the group with spironolactone the need for new revascularization of the target lesion was significantly reduced ( p 0,000 and RR 3,33) (6.4% versus 30.5%) and non-fatal infarction (p 0.023). and RR 2.2) (4.3% vs. 13.7%). In these patients, the survival free of new revascularization and non-fatal infarction was significantly higher.
Conclusions: Spironolactone is effective in patients with conventional stent because it reduces the need for new revascularization and non-fatal infarction, increases the free survival of these events and also constitutes a protective factor.


REFERENCES

  1. Armas Rojas NB, Dueñas Herrera AF, de la Noval García R, et al. Cardiopatía Isquémica en Cuba. Una puesta al día. 2015. Rev Cuba Cardiol Cir Cardiovasc. 2015;21(3).

  2. López-Palop R, Pinar E, Lozano I, et al. Comparación de parámetros de expanción de stents implantados con técnica convencional o directa. Estudio aleatorizado con ultrasonidos intracoronarios. Rev Esp Cardiol. 2004;57(5):403-11.

  3. Guarda SE, Fajuri NA, Martínez SA, et al. El colágeno de la reestenosis post angioplastia con stent: ¿se origina en la íntima o en la adventicia? Rev Med Chile. 2001;129(11):29-32.

  4. Álvarez González L, Almeida Gómez J, Méndez Peralta T. Variables asociadas a reestenosis clínica en pacientes con intervencionismo coronario percutáneo con stent convencional. Rev Cuba Cardiol Cir Cardiovasc. 2011;17(1):27-36.

  5. Deftereos S, Giannopoulos G, Raisakis K, et al. Colchicine Treatment for the Prevention of Bare-Metal Stent Restenosis in Diabetic Patients. JACC. 2013;61(16):1679-85.

  6. Gutiérrez López A, Ponte González G, Leyva Quert A, Valdés Recarey M. Aldosterona: sus implicaciones en las enfermedades del corazón. CorSalud. 2016;8(3):177-82.

  7. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/ STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease. JACC. 2017;69(17):2212-41.

  8. Ibáñez B, James S, Agewall S, et al. Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol. 2017;70(12):1082.e1-1082.e61.

  9. 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.

  10. Anderson effrey L, Morrow DA. Acute Myocardial Infarction. N Engl J Med. 2017;376:2053-64.

  11. Stefanini GG, Holmes DR. Drug-Eluting Coronary-Artery Stents. N Engl J Med. 2013;368:254-65.

  12. Palmerini T. Clinical Outcomes With Drug-Eluting and Bare-Metal Stents in Patients With ST-Segment Elevation Myocardial Infarction Evidence From a Comprehensive Network Meta-Analysis. JACC. 2013;62(6):496-504.

  13. Byrne RA. Bioresorbable Vascular Scaffolds—Will Promise Become Reality? N Engl J Med. 2015;373:1969-70.

  14. Tamargo J, Solini A, Ruilope LM. Comparison of Agents That Affect Aldosterone Action. Semin Nephrol. 2014;34:285-306.

  15. Hamdan Suleiman N. Stents Coronarios y Prevención de Reestenosis: Primera Parte. Medicrit. 2006;3(3):68-77.




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