RESUMEN
BACKGROUND: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease. METHODS: This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization. RESULTS: During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG. CONCLUSIONS: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifiers: NCT05125367 and NCT00997828.
Asunto(s)
Enfermedad de la Arteria Coronaria , Stents Liberadores de Fármacos , Infarto del Miocardio , Intervención Coronaria Percutánea , Humanos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Everolimus/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Stents Liberadores de Fármacos/efectos adversos , Estudios de Seguimiento , Estudios Prospectivos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Resultado del TratamientoRESUMEN
In-stent restenosis after implantation of sirolimus-eluting stents (SES) still occur in some cases and stent fracture was recently suggested as a new potential mechanism of restenosis. We report a case of delayed stent strut fracture after percutaneous coronary intervention with SES. Until now, three cases regarding Cypher stent fracture have been reported in the literature. Further investigation should be performed to elucidate the clinical significance of stent fractures of SES.
Asunto(s)
Implantación de Prótesis Vascular/efectos adversos , Reestenosis Coronaria/etiología , Falla de Prótesis , Stents , Angioplastia de Balón Asistida por Láser , Implantación de Prótesis Vascular/instrumentación , Estenosis Coronaria/terapia , Femenino , Humanos , Inmunosupresores/uso terapéutico , Persona de Mediana Edad , Sirolimus/uso terapéuticoRESUMEN
Behçet disease is a multisystem disease, which can cause cardiovascular manifestations such as arterial occlusion or aneurysm. This report describes multidetector-row computed tomography findings of an unruptured aneurysm of the left Valsalva sinus which was associated with Behçet disease. A 45-year-old woman with Behçet disease had an aneurysm of the left Valsalva sinus which constricted the left anterior descending artery. The multidetector-row computed tomography was useful in detecting the aneurysm and complications, and was beneficial in the evaluation of patency in the coronary arteries after surgery.