[From complex multivessel disease to cardiovascular health].
The development of drug-eluting stents has raised great hopes that percutaneous coronary intervention has a potential role in the revascularization of patients with three-vessel disease and left main coronary artery disease. However, recent results from the SYNTAX clinical trial have shown that, compared with drug-eluting stents, bypass surgery is associated with a lower restenosis rate and a reduced incidence of major cardiovascular events. This study used an index that quantifies the severity of coronary artery disease on the basis of a number of anatomical criteria of lesion complexity (i.e. the SYNTAX score). The study results indicate that the higher the index (i.e. the more complex the lesion), the greater the benefits of surgery. Other recent studies (e.g. PROSPECT and FAME) have used imaging to investigate the natural history of acute coronary syndrome, or the role of functional parameters in identifying vulnerable plaque that can lead to complications during follow-up. The sum of the evidence available shows that therapeutic approaches to complex disease should take into account both the anatomical and structural characteristics of lesions, as well as functional parameters, and that high-resolution imaging techniques are essential for establishing both an individual's risk profile and the potential benefits of treatment. In diabetic patients with multivessel disease, the results of the FREEDOM study (currently ongoing) could be crucial for incorporating this new knowledge into practice and for defining the optimum management for this group of high-risk patients.
Fuster
Valentín
V
Mount Sinai Medical Center, Nueva York, Estados Unidos.
D003327:Coronary Disease / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000188:drug therapy; D054855:Drug-Eluting Stents; D006801:Humans; D016032:Randomized Controlled Trials as Topic