RESUMO
PURPOSE: To assess the potential role of coronary stent to improved acute success and reduce late restenosis in lesions with reference diameter <2.9 mm using a bare metal stent specifically designed for small coronary vessels. There is controversy on the results among previous studies comparing bare metal stent implantation with conventional balloon percutaneous transluminal coronary angioplasty (PTCA). Differences in baseline characteristics, inclusion and exclusion criteria, and stent design may account for these discrepancies. METHODS: The population of this multicenter, multinational randomized study (LASMAL) consisted of 246 patients undergoing percutaneous coronary intervention of small vessel reference diameter. They were randomized into 2 strategies of percutaneous revascularization: elective primary stent (n = 124) or conventional balloon PTCA with provisional stenting (n = 122) in the presence of acute, threatened closure or flow-limiting dissections. RESULTS: The clinical success rate was significantly better for the stent group (98.3% vs 91.8%; P = 0.038). At 30 days follow-up, requirements of target vessel revascularization (TVR) (6.6% vs 0.8%; P = 0.018) and incidence of major adverse cardiac and cerebrovascular events (MACCE) (9.8% vs 2.4%; P = 0.01) was significantly lower in the stent strategy. Postpercutaneous coronary intervention minimal luminal diameter (MLD) was significantly larger in the stent group (2.3 +/- 0.2 mm vs 2.2 +/- 0.2 mm; P = 0.003). At follow-up, MLD in the stent group was larger than with PTCA (1.7 +/- 0.7 mm vs 1.5 +/- 0.7 mm, respectively; P = 0.035). Net gain was also significantly better with stent strategy (1.1 +/- 0.7 mm vs 0.8 +/- 0.7 mm, respectively; P = 0.002). Stenting resulted in a significant lower angiographic binary restenosis (20% vs 31%; P = 0.02) than PTCA. Furthermore, patients treated with stent were more frequently free from MACCE at 9-month follow-up (death, acute myocardial infarction [AMI], stroke, repeat revascularization procedures) than those treated initially with PTCA (82.2% vs 72% of PTCA, P = 0.046). CONCLUSIONS: The use of a specifically designed bare metal coronary phosphoril choline-coated stent as primary device during percutaneous interventions in small coronary arteries was associated with high procedural success and low in-hospital and 30-day follow-up complications. At long-term follow-up, patients initially treated with stents had lower angiographic restenosis rate and were more frequently free from major adverse cardiac events.
Assuntos
Angioplastia Coronária com Balão , Implante de Prótese Vascular/instrumentação , Doença das Coronárias/terapia , Stents , Idoso , Cineangiografia , Materiais Revestidos Biocompatíveis , Angiografia Coronária , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/epidemiologia , Vasos Coronários/diagnóstico por imagem , Endossonografia , Feminino , Seguimentos , Humanos , Incidência , América Latina/epidemiologia , Masculino , Fosforilcolina , Aço Inoxidável , Fatores de Tempo , Resultado do TratamentoRESUMO
Forty-four consecutive pregnant patients with mitral stenosis were submitted to percutaneous mitral valvuloplasty (PMV) over a period of 12 years. The mean age was 28 +/- 6 years and the mean gestational age was 23 +/- 6 weeks. The mean mitral valve area had a significant increase from 1.17 +/- 0.26 to 2.06 +/- 0.41 cm(2) (P = 0.0000). The mean mitral valve gradient decreased from 16.22 +/- 5.55 to 7.94 +/- 3.75 mm Hg (P = 0.0001). The procedure was performed successfully in 95% of the patients and there were no major complications. Concerning labor and delivery, we evaluated 37 patients. Thirty patients (81%) reached term and delivered normal infants. Seven patients (18.9%) delivered prematurely, resulting in two fetal death; one patient delivered a stillborn. We concluded that PMV is a safe procedure for the treatment of mitral stenosis in pregnant patients, providing significant symptomatic relief and better clinical conditions for labor and delivery.