Asunto(s)
Angiografía/métodos , Imagenología Tridimensional , Placenta Previa/diagnóstico , Placenta/irrigación sanguínea , Ultrasonografía Doppler en Color/métodos , Ultrasonografía Prenatal/métodos , Cordón Umbilical/anomalías , Adulto , Endosonografía , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Placenta Previa/fisiopatología , Embarazo , Resultado del Embarazo , Flujo Sanguíneo Regional/fisiología , Cordón Umbilical/diagnóstico por imagen , VaginaRESUMEN
BACKGROUND: Prior studies have suggested that women are at higher risk for morbidity and mortality during coronary angioplasty, although long-term prognosis is similar after successful procedures. OBJECTIVES: To examine the role of gender in coronary stenting, including immediate procedural success as well as early and late outcomes. METHODS: The study group comprised 560 consecutive patients (119 women and 441 men) who had undergone stenting over a 3 year period. RESULTS: The indications for coronary stenting were similar among women and men, and stents were successfully deployed at similar rates without complications (92 vs. 90% respectively). Cardiac death or myocardial infarction within 30 days of the procedure was observed in 5% of women and men, whereas none of the women, compared to 1.4% of men, had early revascularization. Bleeding complications occurred in 4% of women and 2% of men. During 10 +/- 2.8 months of follow-up, 58% of women and men underwent repeat cardiac catheterization, revealing similar rates of restenosis, 36 vs. 32% respectively. During the study period, 3.3% of women as compared to 0.9% of men had a cardiac death (not significant). Cardiac death or myocardial infarction was observed in 7% of women and 8% of men, and the combined endpoint of death, myocardial infarction or revascularization, was noted in 24% and 26% respectively. Multivariate Cox analyses of the clinical, angiographic and procedural characteristics revealed that multiple stent deployment was the only predictor of major adverse cardiac event among men, whereas none of these characteristics predicted outcome in women. CONCLUSION: Coronary stenting is performed with similar success rates among women and men, with similar restenosis rates as well as early and late major adverse cardiac events.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Stents , Anciano , Análisis de Varianza , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Israel/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Morbilidad , Infarto del Miocardio/etiología , Selección de Paciente , Hemorragia Posoperatoria/etiología , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Recurrencia , Factores de Riesgo , Caracteres Sexuales , Distribución por Sexo , Factores Sexuales , Stents/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Patient and procedural characteristics associated with major adverse cardiac events following balloon angioplasty have been identified. Factors predictive of angiographic restenosis following coronary stent implantation have been reported, although patient variables associated with adverse clinical outcome are not well defined. HYPOTHESIS AND METHODS: To identify predictors of adverse clinical outcome following NIR stent implantation, clinical and angiographic characteristics of patients enrolled in the FINESS Trial were subjected to stepwise logistic regression analysis. From December 1995 through March 1996, NIR stent implantation was attempted in 255 patients (341 lesions) enrolled prospectively in a multicenter registry with broad entry criteria. RESULTS: On stepwise logistic regression analysis, the presence of multivessel disease, diabetes, and the total length of the stented segment were predictive of major adverse cardiac events during 6-month follow-up. For every 1 mm increase in stent length, the risk for the combined end point of death or myocardial infarction increased by 3%. Lesion length was not predictive of clinical events on multivariate analysis. CONCLUSIONS: Our data raise the possibility that an attempt to use shorter stents to cover significant stenoses, but not adjacent areas of visible narrowing, may improve outcome.