Evolução clínica de pacientes com lesões de tronco de coronária esquerda não-protegido submetidos a angioplastia coronária com implante de stents farmacológicos

Abstract

Background: Recently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has proven to be a feasible option in selected patients with unprotected left main (LM) disease. This study was aimed at assessing the efficacy and safety of PCI with DES in LM lesions in the daily practice, analyzing the long-term occurrence of major adverse cardiac events (MACE). Methods: A total of 142 consecutive patients were treated with a mean follow-up of 917 ± 743 days. The decision to use one or two stents or glycoprotein IIb/IIIa inhibitors was left to the operator's discretion. Coronary angiography was not performed routinely in the follow-up. Results: Mean age was 67.5 ± 16 years, 75% of the patients were male, 29% had diabetes and 39% had unstable angina. A total of 2.75 ± 1.25 stents were implanted per patient. Bifurcation lesions were identified in 90.1% and the most frequent techniques were the provisional stent in 36% and small crush in 29% of the patients. Intravascular ultrasound was performed in 92.3% of the patients and reinterventions in 21.3% of the stents due to incomplete apposition of the struts after implantation. In the late follow-up, MACE was observed in 15.4% of the patients, cardiac death in 3.6%, target-vessel revascularization in 11.2% and definitive/ probably stent thrombosis in 1.4%. Conclusions: In this study, PCI with DES proved to be safe and effective in the late follow-up of LM lesions, with low cardiac death and stent thrombosis rates. © 2011 Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista.