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


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.


RESULTS
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.
Farell Campa
Javier
J
Departamento de Hemodinámica, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
Palomo Villada
José Antonio
JA
Flores Flores
Jesús
J
González Díaz
Belinda
B
Astudillo Sandoval
Raúl
R
Montoya Silvestre
Armando
A
Estrada Gallegos
Joel
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D017023:Coronary Angiography; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003627:Data Interpretation, Statistical; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents