Impacto clínico da isquemia e viabilidade miocárdicas após tratamento de oclusão coronária crônica no segmento proximal da artéria descendente anterior

• Autor(a) principal: Nunes, Cássio Dos Santos
• Data de Publicação: 2013
• Outros Autores: Pimentel Filho, Wilson Albino, Custódio, Wellington Borges, Olivotti, Gustavo Vinicius Lambert, Sada, Carlos Alberto, Osterne, Thomas Edison Cintra, Curado, Fernando Augusto Molinori Di Castro, Pupin Filho, Waigner Bento, Soares Neto, Milton Macedo [UNIFESP], Büchler, Jorge Roberto, Assis, Stoessel Figueredo De
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S2179-83972013000200010; http://repositorio.unifesp.br/handle/11600/7804
• topic: Angioplasty; Drug-eluting stents; Coronary occlusion; Coronary angiography; Angioplastia; Stents farmacológicos; Oclusão coronária; Angiografia coronária

BACKGROUND: Evaluation of myocardial ischemia and viability is recommended prior to percutaneous coronary intervention (PCI) for chronic total occlusions. We evaluated late adverse cardiovascular events of patients with PCI for proximal left anterior descending artery occlusions, comparing patients with or without myocardial ischemia or viability. METHODS: Patients were allocated to groups with myocardial ischemia/viability (G1, n = 91) and without myocardial ischemia/viability (G2, n = 65) and adverse cardiovascular events (death, myocardial infarction, target-vessel revascularization and congestive heart failure) were compared. RESULTS: Most patients were male (68.1% vs 69.2%; P = 0.56), with a mean age of 65.4 ± 10 years vs 63.5 ± 8.7 years (P = 0.61) and almost one third were diabetics (33% vs 29.2%; P = 0.76). No differences regarding the clinical and angiographic profile were observed, except for the left ventricular ejection fraction (48.6 ± 13.7% vs 39.5 ± 11.8%; P = 0.04) and the degree of angiographic collateral flow grade to the left anterior descending artery, which was more evident in G1 (P = 0.03). The 3-year follow-up incidence of composite adverse cardiovascular events was lower in patients with myocardial ischemia/viability (12.5% vs 31.1%; P < 0.01). The factors that contributed the most for this difference were the incidence of congestive heart failure (3.3% vs 15.3%; P = 0.02) and death (2.2% vs 7.7%; P = 0.13). CONCLUSIONS: Treatment of proximal left anterior descending artery chronic total occlusions in patients with evidence of myocardial ischemia or viability reduces the incidence of adverse cardiovascular events in the long term.