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2.
Eur. j. anat ; 23(6): 459-463, nov. 2019. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-185089

RESUMO

Situs inversus viscerum (SIV) is a rare congenital anomaly, which is still an intriguing phenomenon to anatomists and physicians alike. A complete SIV is characterized by a left-right transposition and mirror image of all thoraco-abdominal organs and their vasculature. The present report is based on one case with complete SIV, which was observed during the routine educational dissections of cadavers in the authors' Anatomy Department. A transposition of all truncal organs and their vasculature, and several variations of arteries and veins were present. The right branch of the proper hepatic artery was replaced by an artery that emanated from the superior mesenteric artery. The latter also released the inferior mesenteric artery. Additionally, a left accessory renal artery ran anterior to the inferior caval vein and posterior to the ureter to enter the hilum of the left kidney. There was also a variation in the anterior-posterior arrangement of the hilar structures of the left kidney. Additionally, a globally enlarged heart with coronary artery by-passes, a replaced aortic valve and an aortic arch aneurysm was observed. This case report is unique, as it presents a previously unreported co-incidence of SIV and hepatic, intestinal and renal vascular anomalies. It is important for the surgeon to be aware of such variations while planning an abdominal surgery in patients with SIV


No disponible


Assuntos
Humanos , Masculino , Idoso , Situs Inversus , Ductos Biliares Intra-Hepáticos/anormalidades , Trato Gastrointestinal/anormalidades , Rim/anormalidades , Anomalias dos Vasos Coronários , Ductos Biliares Intra-Hepáticos/anatomia & histologia , Trato Gastrointestinal/anatomia & histologia , Rim/anatomia & histologia , Dissecação/métodos , Artérias Mesentéricas/anormalidades , Artérias Mesentéricas/anatomia & histologia , Cadáver , Vasos Coronários/anatomia & histologia
4.
Eur. j. anat ; 23(5): 341-353, sept. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-183864

RESUMO

Coronary artery disease (CAD) is a major cause of death and disability in developed countries, and incidence of CAD is increasing annually in the underdeveloped world. Today, percutaneous coronary intervention plays a major role both in diagnosis and treatment of CAD. As a result, an understanding of the anatomy of the coronary artery system is vital cardiologists. Yet, studies are lacking that focus on Vietnamese hearts. The objective of this study was to examine the morphometric anatomical variation of the right coronary artery (RCA) in Vietnamese cadavers. The hearts from 125 cadavers were used in the study. In all hearts, the RCA originated from the right aortic sinus, had a right marginal branch, and gave rise to one to three right posterior ventricular (RPV) branches. In 96.8% of hearts, the posterior interventricular branch (PIV) originated from the RCA; in 3.2% from the left circumflex artery (LCX), and the mean diameter was 2.09 mm ± 0.62 mm. The RCA had a mean diameter and length of 4.21 mm ± 0.64 mm and 122.5 mm ± 17.8 mm, respectively, and terminated between the crux and left border (72%) and at the crux (14.4%). The origin of the sinoatrial node artery was 81.6% from the RCA, 16.8% from the LCX, and 1.6% from both the RCA and LCX. There were one to four right atrial branches observed across the hearts studied; a maximum of 32% (one branch) and a minimum of 12.8% (four branches). In 68.8% of hearts the conus artery originated from the RCA. In 8.8%, it arose from the right aortic sinus at the same site as the RCA, but in 22.4% away from this site of origin. The RCA gave rise to one to eight right anterior ventricular (RAV) branches (i.e., because they are at the anterior surface of the right ventricular); with the highest incidence of 3 branches in 37.6% of hearts. The RCA gave rise to one to seven left posterior ventricular branches; the majority of cases, 28.8% gave rise to 4 branches. The rare incidence of myocardial bridging in the right coronary system occurred in 7.2% of hearts, and each case involved the posterior interventricular branch. Anatomical variations of the RCA system can cause difficulties in imaging interpretation and interventional procedures. This study is the first to document these variations of the RCA system in Vietnamese hearts, contributing knowledge that is essential for physicians


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vasos Coronários/anatomia & histologia , Cadáver , Músculos Peitorais/anatomia & histologia , Nó Atrioventricular/anatomia & histologia , Nó Sinoatrial/anatomia & histologia , Dissecação/métodos , Doadores de Tecidos
5.
Rev. esp. cardiol. (Ed. impr.) ; 72(6): 456-465, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188406

RESUMO

Introducción y objetivos: Comparar la estrategia de revascularización percutánea de lesiones graves en ramas coronarias secundarias (RS) (diámetro ≥ 2 mm) de arterias epicárdicas mayores frente al tratamiento conservador. Métodos: Estudio de cohortes retrospectivo en el que se compara a pacientes con lesiones graves en RS de arterias epicárdicas principales tratados con revascularización percutánea o con un tratamiento farmacológico a criterio del operador. Se analizó el porcentaje de eventos relacionados con la rama (muerte cardiovascular, infarto de miocardio atribuible a RS o necesidad de revascularización de la RS). Resultados: Se analizaron 679 lesiones en RS (662 pacientes). Tras un seguimiento medio de 22,2+/-10,5 meses, no hubo diferencias significativas entre ambos grupos de tratamiento en mortalidad de causa cardiovascular (el 1,7 frente al 0,4%; p=0,14), infarto agudo de miocardio (IAM) no fatal (el 1,7 frente al 1,7%; p=0,96) o necesidad de revascularización de la RS (el 4,1 frente al 5,4%; p=0,45) ni en el porcentaje total de eventos (el 5,1 frente al 6,3%; p=0,54). Las variables que mostraron asociación con la ocurrencia de eventos en el análisis multivariable fueron la diabetes (sHR=2,87; IC95%, 1,37-5,47; p=0,004), IAM previo (sHR=3,54; IC95%, 1,77-7,30; p < 0,0001), el diámetro de referencia de la RS (sHR=0,16; IC95%, 0,03-0,97; p=0,047) y la longitud de la lesión (sHR=3,77; IC95%, 1,03-1,13; p < 0,0001). Estos resultados se mantuvieron tras realizar análisis por puntuación de propensión. Conclusiones: En el seguimiento, el porcentaje de eventos relacionados con la RS fue bajo respecto al total de pacientes, sin diferencias significativas entre una y otra estrategia de tratamiento. Las variables que se asociaron con la ocurrencia de eventos en el análisis multivariable fueron la diabetes mellitus, el antecedente de IAM y la mayor longitud de la lesión


Introduction and objectives: To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. Methods: This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). Results: We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2+/-10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. Conclusions: The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length


Assuntos
Humanos , Intervenção Coronária Percutânea/métodos , Oclusão Coronária/cirurgia , Síndrome Coronariana Aguda/cirurgia , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Estudos Retrospectivos , Angina Estável/fisiopatologia
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(5): 297-304, mayo 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182804

RESUMO

Introducción: Los pacientes con enfermedad renal crónica (ERC) y diabetes mellitus (DM) tienen un elevado riesgo cardiovascular. Ambas enfermedades se relacionan con el desarrollo de ateroesclerosis sistémica y calcificación vascular. La prevalencia y la severidad de la calcificación arterial coronaria (CaC) es mayor en personas con DM, independientemente de su función renal. Los datos acerca del papel pronóstico a largo plazo de la CaC en pacientes con DM y ERC son escasos. Material y métodos: Se diseñó un estudio prospectivo que incluía a 137 pacientes (85 en hemodiálisis y 52 con ERC avanzada). Se realizó una tomografía computerizada (TC) helicoidal multicorte coronario basal. La CaC se cuantificó mediante el método de Agatston y los pacientes fueron clasificados en CaC leve-moderada (CaC<400UH) y severa (CaC≥400UH). Resultados: El tiempo medio de seguimiento fue de 87,5 meses. El 28% eran pacientes con DM; tenían una CaC más severa, menor nivel de albúmina y una proteína C reactiva más elevada. La albúmina se correlacionó con la CaC severa (r=-0,45; p=0,009). La mortalidad fue del 58%. Los casos con DM mostraban una tendencia lineal de mayor mortalidad en comparación con los sujetos sin DM (Chi cuadrado 3,51, p=0,061). Los pacientes con DM y CaC severa tuvieron, además, una mayor mortalidad en comparación con aquellos con CaC severa sin DM (93% vs.73%; p=0,04). Conclusiones: Los pacientes con ERC avanzada y DM presentan una CaC más severa, datos bioquímicos compatibles con una mayor inflamación-malnutrición y una mayor mortalidad en comparación con aquellos sin DM


Introduction: Patients with chronic kidney disease (CKD) and diabetes mellitus (DM) have high cardiovascular risk. Both conditions are related to systemic atherosclerosis and vascular calcification. The prevalence and severity of coronary artery calcification (CaC) is higher in patients with DM, regardless of their renal function. Data about the long-term prognostic role of CaC in diabetic patients with CKD are scarce. Material and methods: We carried out a prospective longitudinal study enrolling 137 patients with advanced CKD. A non-enhanced multislice coronary computed tomography (CT) was performed at baseline. CaC was assessed using Agatston method. Patients were stratified according to their CaC score: severe calcification group (CaCs≥400HU) and mild-moderate calcification group (CaCs<400HU). Results: The median follow-up time was 87.5 months. DM was found in 28% of subjects. The patients with DM showed more severe CaC, lower albumin and higher C-reactive protein serum levels. Serum albumin was correlated with severe CaC (r=-0.45, P=.009). Overall mortality rate reached 58%. Patients with DM also tended to have higher mortality compared to non-diabetic subjects (X2 3.51, P=.061) especially those with severe CaC showed higher mortality than those with severe CaC without DM (93% vs.73%, P=.04). Conclusions: Patients with advanced CKD and DM have more severe CaC, increased inflammation-malnutrition data and higher mortality compared to those without DM


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Insuficiência Renal Crônica/complicações , Calcificação Vascular/diagnóstico , Diabetes Mellitus/fisiopatologia , Calcinose/diagnóstico , Estudos de Coortes , Vasos Coronários/patologia , Fatores de Risco , Estudos Prospectivos , Diálise Renal/métodos , Calcinose/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Índice de Gravidade de Doença
9.
Eur. j. anat ; 23(3): 159-165, mayo 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-182977

RESUMO

The coronary ostia (CO) lie within the left and right aortic sinuses, respectively; and are bound by the sinotubular junction (STJ) superiorly. The high frequency of cardiac procedures that require catheterization has necessitated the reappraisal of the anatomy of the origin of the coronary arteries. Therefore, this study aimed to describe the CO by recording its diameter, shape, and relation to the sinotubular junction in a select South African population.The present study included the gross dissection of 50 formalin fixed, adult cadaveric hearts. The average diameter of the right coronary ostium (RCO) was 3.29mm and the left coronary ostium (LCO) was 3.87mm. With regard to the shape of the ostia, the RCO was described as circular in 52% (26/50), horizontally ellipsoid in 24% (12/50) and vertically ellipsoid in 24% (12/50) of cases. The LCO was circular in 30% (15/50), horizontally ellipsoid in 60% (30/50) and vertically ellipsoid in 10% (5/50) of cases. The RCO was located below the STJ in 88% (44/50) and at the level of the STJ in 12% (6/50) of cases. The LCO was recorded below the STJ in 64% (32/50), at the level of the STJ in 32% (16/50) and above the STJ in 4% (2/50) of cases. Multiple ostia arising from a single aortic sinus was recorded in 14% (7/50) of cases. In 2% (1/50) of cases, the RCO was located in the non-coronary sinus. In addition, the RCO arose from the left aortic sinus in 2% of cases. The results of the present study correlate with those of previous studies. Anomalous CO, although asymptomatic has been linked to myocardial infarction and sudden cardiac death. It is, therefore, imperative for the clinician to be aware of variant CO anatomy, which may alert them to the predisposition of cardiac risks


No disponible


Assuntos
Humanos , Infarto do Miocárdio/mortalidade , Cadáver , Seio Coronário/anatomia & histologia , Aorta/anatomia & histologia , Coração/anatomia & histologia , Morte Súbita Cardíaca/patologia , África Austral/etnologia , Vasos Coronários/anatomia & histologia
14.
Clín. investig. arterioscler. (Ed. impr.) ; 30(5): 230-239, sept.-oct. 2018. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-175441

RESUMO

Cardiovascular disease is the primary cause of death in obese and diabetic patients. In these groups of patients, the alterations of epicardial adipose tissue (EAT) contribute to both vascular and myocardial dysfunction. Therefore, it is of clinical interest to determine the mechanisms by which EAT influences cardiovascular disease. Two key factors contribute to the tight intercommunication among EAT, coronary arteries and myocardium. One is the close anatomical proximity between these tissues. The other is the capacity of EAT to secrete cytokines and other molecules with paracrine and vasocrine effects on the cardiovascular system. Epidemiological studies have demonstrated that EAT thickness is associated with not only metabolic syndrome but also atherosclerosis and heart failure. The evaluation of EAT using imaging modalities, although effective, presents several disadvantages including radiation exposure, limited availability and elevated costs. Therefore, there is a clinical interest in EAT as a source of new biomarkers of cardiovascular and endocrine alterations. In this review, we revise the mechanisms involved in the protective and pathological role of EAT and present the molecules released by EAT with greater potential to become biomarkers of cardiometabolic alterations


Las enfermedades cardiovasculares son la primera causa de muerte en pacientes obesos y diabéticos. Las alteraciones del tejido adiposo epicárdico (TAE) contribuyen a la disfunción vascular y del miocardio en estos pacientes. Es por tanto de interés clínico determinar los mecanismos por los cuales el TAE influye en la enfermedad cardiovascular. Aquí resumimos los mecanismos que subyacen a la asociación entre TAE, síndrome metabólico y enfermedades cardiovasculares. Dos factores contribuyen a la estrecha intercomunicación entre el TAE, las arterias coronarias y el miocardio. Uno es la estrecha proximidad anatómica entre estos tejidos. El otro es la capacidad del TAE para secretar citocinas con efectos paracrinos y vasocrinos en el sistema cardiovascular. Estudios epidemiológicos han demostrado que el grosor del TAE está asociado no solo con el síndrome metabólico sino también con la aterosclerosis y la insuficiencia cardíaca. La evaluación del TAE utilizando técnicas de imagen, aunque eficaz presenta desventajas tales como la exposición a la radiación, la disponibilidad limitada y los costes elevados. Por lo tanto, existe un interés clínico en el TAE como fuente de nuevos biomarcadores de alteraciones cardiovasculares y endocrinas. En este artículo, revisamos los mecanismos implicados en el papel protector y patológico del TAE y presentamos las moléculas liberadas por el TAE con mayor potencial para convertirse en biomarcadores de alteraciones cardiometabólicas


Assuntos
Humanos , Doenças Metabólicas/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Tecido Adiposo/fisiologia , Pericárdio/fisiopatologia , Citocinas/fisiologia , Vasos Coronários/fisiopatologia , Coração/fisiopatologia , Biomarcadores
15.
An. pediatr. (2003. Ed. impr.) ; 89(3): 188.e1-188.e22, sept. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177093

RESUMO

La enfermedad de Kawasaki es una vasculitis aguda autolimitada que afecta a vasos de pequeño y mediano calibre y es la causa más común de enfermedad cardiaca adquirida en niños en nuestro medio. Hasta un 25% de pacientes no tratados desarrollan aneurismas coronarios. Se sospecha que un agente infeccioso puede ser el desencadenante de la enfermedad, pero aún se desconoce el agente causal. En base a la evidencia previa, se proponen recomendaciones para el diagnóstico, tratamiento de la enfermedad aguda y manejo a largo plazo de estos pacientes, con el fin de unificar criterios. El diagnóstico debe ser rápido, basado en algoritmos de fácil manejo y con el apoyo de pruebas complementarias. Este documento recoge la indicación de las técnicas de imagen disponibles, así como la planificación de las revisiones cardiológicas en función de la afectación inicial. La inmunoglobulina intravenosa es la base del tratamiento inicial. El papel de los corticoides aún es controvertido, pero cada vez hay más estudios que avalan su uso como tratamiento adyuvante. Un equipo multidisciplinar ha elaborado un esquema con diferentes pautas de tratamiento en función de los factores de riesgo al diagnóstico, situación clínica del paciente y respuesta al tratamiento previo, incluyendo indicaciones sobre tromboprofilaxis en pacientes con afectación coronaria. La estratificación del riesgo para el tratamiento a largo plazo es esencial, así como las recomendaciones acerca del proceder en función de la afectación cardiológica inicial y su evolución. Los pacientes con aneurismas coronarios requieren un seguimiento cardiológico continuo e ininterrumpido de por vida


Kawasaki disease is a self-limiting acute vasculitis that affects small and medium-sized vessels, and is the most common cause of acquired heart disease in children in our environment. Up to 25% of untreated patients develop coronary aneurysms. It is suspected that an infectious agent may be the trigger of the disease, but the causative agent is still unknown. Based on the previous evidence, recommendations are proposed for the diagnosis, treatment of acute disease, and the long-term management of these patients, in order to unify criteria. The diagnosis must be quick, based on easy-to-use algorithms and with the support of complementary tests. This document includes the indication of available imaging techniques, as well as the planning of cardiological examinations based on the initial involvement. Intravenous immunoglobulin is the basis of the initial treatment. The role of corticosteroids is still controversial, but there are studies that support its use as adjuvant treatment. A multidisciplinary working group has developed a scheme with different treatment guidelines depending on the risk factors at diagnosis, the patient's clinical situation, and response to previous treatment, including indications for thromboprophylaxis in patients with coronary involvement. The stratification of risk for long-term treatment is essential, as well as the recommendations on the procedures based on the initial cardiological involvement and its progression. Patients with coronary aneurysms require continuous and uninterrupted cardiological monitoring for life


Assuntos
Humanos , Criança , Consenso , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/terapia , Fatores de Risco , Cardiopatias/diagnóstico , Aneurisma Coronário/complicações , Vasos Coronários/patologia , Vasculite/patologia , Imunoglobulinas/administração & dosagem , Aspirina/administração & dosagem
17.
Rev. esp. cardiol. (Ed. impr.) ; 71(8): 656-667, ago. 2018. ilus, tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-178619

RESUMO

Es bien sabido que ocasionalmente una lesión coronaria angiográficamente aparentemente significativa podría no causar isquemia y viceversa. Por eso las decisiones terapéuticas basadas en un conocimiento de la fisiología coronaria son cada vez más importantes. El uso de la reserva fraccional de flujo (RFF), una herramienta útil para determinar en el laboratorio de hemodinámica las lesiones que se pueden beneficiar de revascularización, ha conseguido una indicación de clase IA en las guías de la Sociedad Europea de Cardiología. Recientemente, el índice diastólico instantáneo sin ondas, de más facilidad de uso que la RFF, se considera equivalente a ella. En esta revisión se repasan y se profundiza en los conceptos de RFF e índice diastólico instantáneo sin ondas y se revisan las evidencias que justifican su uso, así como sus perspectivas futuras


It is well known that the apparent significant coronary stenosis on angiography sometimes does not cause significant ischemia, and vice versa. For this reason, decision-making based on coronary physiology is becoming more and more important. Fractional flow reserve (FFR), which has emerged as a useful tool to determine which lesions need revascularization in the catheterization laboratory, now has a class IA indication in the European Society of Cardiology guidelines. More recently, the instantaneous wave-free ratio, which is considered easier to use than FFR, has been graded as equivalent to FFR. This review discusses the concepts of FFR and instantaneous wave-free ratio, current evidence supporting their use, and future directions in coronary physiology


Assuntos
Humanos , Vasos Coronários/fisiologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Diástole/fisiologia , Fenômenos Fisiológicos Cardiovasculares , Circulação Coronária/fisiologia
18.
Eur. j. anat ; 22(4): 355-365, jul. 2018. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-179099

RESUMO

The division of the left main coronary artery (LMCA) exhibits a range of anatomical variation. It can divide into two, three, four or five branches, and have myocardial bridges. This carries important significance in clinical practice. The objective of this study was to examine the morphometric anatomical variation of the LMCA in Vietnamese cadavers. Hearts from 125 cadavers preserved in formalin solution were used in the study. LMCA was present in 96% of the specimens with the mean diameter of 4.62 ± 0.74 mm and the mean length of 9.05 ± 3.61 mm. The LMCA gave rise to two branches (bifurcation) in 51.2%, three branches (trifurcation) in 43.2% and four branches (quadrifurcation) in 5.6%. The mean outer diameter of the anterior interventricular artery, circumflex artery and the intermediate branch were 3.78 ± 0.54 mm, 3.33 ± 0.67 mm, and 1.80 ± 0.62 mm, respectively. The anterior interventricular artery ended at the anterior interventricular sulcus in 1.6% of the specimens, ended at the apex in 21.6%, and crossed over the apex to reach the posterior interventricular sulcus and terminate there in 76.8%. The circumflex artery ended before the left border in 4.13%, at the left border in 46.28%, between the left border and the crux in 46.62% and at the crux in 4.13%. The myocardial bridge was present only at anterior interventricular artery in 41.6%; in both anterior interventricular artery and posterior interventricular branch in 5.6%. LMCA varies in length and it can divide into two, three or four branches. End position of the anterior interventricular artery and the circumflex artery are variable. These variations may prove challenging during percutaneous coronary intervention (PCI) or coronary artery diagnostic imaging


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Coração/anatomia & histologia , Vasos Coronários/anatomia & histologia , Ventrículos do Coração/anatomia & histologia , Variação Anatômica , Ponte Miocárdica , Vietnã , Cadáver , Antropometria/métodos , Intervenção Coronária Percutânea
19.
Rev. esp. cardiol. (Ed. impr.) ; 71(6): 432-439, jun. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178555

RESUMO

Introducción y objetivos: Hay escasa evidencia sobre el tratamiento de lesiones en bifurcación en relación con una oclusión coronaria crónica total (OCT). Este estudio analiza los resultados inmediatos y a medio plazo de pacientes con lesiones en bifurcación en OCT tratados con 1 stent provisional frente a 2 stents en un registro multicéntrico. Métodos: Entre enero de 2012 y junio de 2016, se recanalizaron 922 OCT en los 4 centros participantes. De ellas, 238 (25,8%) con lesión en bifurcación se trataron mediante estrategia simple (n = 201) o compleja (n = 37). Se calculó la puntuación de propensión emparejada para detectar sesgos entre ambos grupos. Los eventos adversos cardiovasculares mayores (MACE) se definieron como muerte cardiaca, infarto y revascularización de la lesión diana. Resultados: Los éxitos angiográfico y del procedimiento fueron similares con la técnica simple (el 94,5 frente al 97,3%; p = 0,48) y con la compleja (el 85,6 frente al 81,1%; p = 0,49), aunque la cantidad de contraste, la dosis de radiación y el tiempo de fluoroscopia fueron menores con la técnica simple. Al seguimiento (25 meses), la tasa de MACE fue del 8% de los pacientes con la técnica simple y el 10,8% de los tratados con 2 stents (p = 0,58). En este grupo hubo tendencia a una menor supervivencia libre de MACE (el 80,1 frente al 69,8%; p = 0,08). Después del análisis de propensión, no se observaron diferencias entre los grupos en los resultados inmediatos ni al seguimiento. Conclusiones: Las LB en OCT pueden tratarse de modo similar que las demás bifurcaciones, para las que el stent provisional es la técnica de elección. Después de la puntuación de propensión emparejada, no hubo diferencias en los resultados inmediatos y a medio plazo entre ambos grupos


Introduction and objectives: There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. Methods: Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2 mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n = 201) or complex strategy (n = 37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. Results: Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P = .48 and 85.6% vs 81.1%; P = .49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P = .58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P = .08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. Conclusions: Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies


Assuntos
Humanos , Oclusão Coronária/cirurgia , Stents , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/epidemiologia , Vasos Coronários/lesões , Inibidores da Agregação de Plaquetas/uso terapêutico , Comorbidade , Resultado do Tratamento
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