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| Format: | Artículo científico |
| Language: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2014
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| Online Access: | https://www.redalyc.org/articulo.oa?id=398941893011 |
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Table of Contents:
- Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up José Guilherme Rodrigues de Paula Moacir Fernandes de Godoy Márcio Antônio dos Santos Flávio Corrêa Pivatelli Alan Vinicius Gamero Osti Luciano Folchine Trindade Diego Novelli Marcelo Arruda Nakazone Medicina Angio plasty Mortality Scintigraphy Coronary disease Objective: In the clinical scenario of ST-segment elevation acute myocardial infarction, several patients with multivessel coronary atherosclerotic disease are discharged without a de - fined strategy to monitor the residual atherosclerotic lesions. The clinical endpoints evaluated were cardiovascular death, symptoms of angina pectoris, rehospitalization for a new acute coronary syndrome, and the necessity of reintervention during the two-year follow-up. Methods: This observational, prospective, and historical study included multivessel coronary atherosclerotic disease patients who were admitted to a tertiary care university hospital with ST-segment elevation acute myocardial infarction and underwent primary percutaneous coronary intervention with stent implan - tation only at the culprit lesion site; these patients were monitored in the outpatient clinic according to two treatments: the Clinical Group - CG (optimized pharmacological therapy associated with counseling for a healthy diet and cardiac rehabilitation) or the Intervention Group - IG (new staged percutaneous coronary intervention or surgical coronary artery bypass graft surgery combined with the previously prescribed treatment). Results: Of 143 patients consecutively admitted with ST-seg - ment elevation acute myocardial infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the clinical endpoints, the cardiovascular death rate did not differ between the CG and IG. The symptom of angina pectoris and the rehospitalization rate for a new episode of acute coronary syndrome were accen - tuated in the CG ( P =0.020 and P =0.049, respectively) mainly in individuals with evidence of ischemia evidenced by myocardial scintigraphy ( P <0.001 and P =0.001, respectively) which culmi - nated in an even greater need for reintervention ( P =0.001) in this subgroup of patients. Conclusion: The staged intervention was demonstrated to be safe and able to reduce angina pectoris and rehospitalization for a new episode of acute coronary syndrome. In addition, it decreases the likelihood of unplanned reinterventions of patients without ischemia evidenced by myocardial scintigraphy. 2014 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941893011 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.2 Vol.29