RESUMO
BACKGROUND: We investigated the pattern of late luminal loss after sirolimus-eluting or bare stent implantation. METHODS AND RESULTS: The study population comprised 238 patients treated with sirolimus-eluting stents and 526 patients treated with conventional stents. The distribution of late loss of sirolimus stents was largely skewed to the right and differed from the distribution for bare stents. When divided according to the presence of binary restenosis (diameter stenosis >50%), restenotic lesions in the bare stent group (26.0%) had a late loss of 1.40+/-0.64 mm and in the sirolimus group (7.9%) of 1.16+/-0.76 mm. Nonrestenotic lesions in the bare stent group had a late loss of 0.58+/-0.44 mm, whereas the late loss of nonrestenotic lesions in the sirolimus group remained close to zero (-0.05+/-0.33 mm). Differences between poststenting and follow-up measurements in the sirolimus group (late loss) resembled variations observed in repeated angiographic measurements, as assessed from a random sample of 30 segments measured repeatedly. After multivariate adjustment, stent type did not influence the degree of late loss in restenotic lesions. However, nonrestenotic bare stents had a significantly larger estimated luminal loss (0.58 mm; 95% CI, 0.52 to 0.65) than sirolimus-eluting stents, for which the predicted late loss was almost 0 (-0.04 mm; 95% CI, -0.10 to 0.02). CONCLUSIONS: The pattern of late loss after sirolimus-eluting stent implantation follows a peculiar behavior, different from lesions treated with conventional stents. Whether this is explained by an unusual statistical distribution or a biological all-or-none response of restenosis after sirolimus-eluting stenting remains to be investigated.
Assuntos
Reestenose Coronária/prevenção & controle , Sirolimo/uso terapêutico , Stents , Idoso , Angioplastia Coronária com Balão , Estudos de Coortes , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/epidemiologia , Estenose Coronária/tratamento farmacológico , Estenose Coronária/terapia , Implantes de Medicamento , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Sirolimo/administração & dosagemRESUMO
La endocarditis por marcapaso es una complicación infrecuente y grave, debida al implante de marcapaso definitivo transvenoso. El diagnóstico se puede sospechar por la presencia de fibre, escalofríos, compromiso sistémico o lesiones pulmonares posterior a la inserción del electrodo y generadores. Los estafilococos aureus y epidermidis son las bacterias causantes de la mayoría de casos. Se debe realizar precozmente un ecocardiograma tranesofágico multiplanar al ingreso del paciente para visualizar las vegetaciones y posible compromiso anatomofuncional valvular. Actualmente se recomienda retirar lo más pronto posible el electrodo y el generador del marcapaso, asociado a un tratamiento antibiótico de acuerdo a la bacteria causal durante un período de seis semanas.