Seguimiento a dos años de pacientes con oclusiones totales crónicas de arterias coronarias

Alejandro González Veliz, Leonardo Hipólito López Ferrero, Lidia María Rodríguez Nande, Emilio Alfonso Rodríguez, Susel Ramos Busutil, Lorenzo Daniel Llerena Rojas

Texto completo:

PDF

Resumen

Introducción: El tratamiento percutáneo de las oclusiones totales crónicas de arterias coronarias es uno de los escenarios más complejos para el cardiólogo intervencionista. En casos de baja complejidad, la angioplastia debe ser considerada la terapia de elección, considerando al tratamiento farmacológico como una opción segura. Existen estudios en nuestro país sobre tasas de éxito, así como de predictores clínicos y angiográficos de fracaso del tratamiento percutáneo, sin embargo, no se cuenta con estudios de supervivencia con esta opción de tratamiento y aquellos con tratamiento médico óptimo.

Propósito: Evaluar la supervivencia de los pacientes con oclusiones totales crónicas de arterias coronarias.

Métodos: Para cumplir los objetivos trazados se realizó un estudio observacional, analítico, de cohorte.

Resultados: Se estudiaron 175 pacientes con dos años de seguimiento, edad media de 61,2 años, con predominio del sexo masculino (69,1%). El 58,9 % de los pacientes presentaban otras arterias coronarias con estenosis significativas además de la arteria ocluida totalmente. De los pacientes que se trataron por vía percutánea el 55,9 % resultó exitoso, la presencia de circulación colateral incidió significativamente desde el punto de vista estadístico en cuanto al resultado de proceder. El reingreso por angina fue el evento adverso que más observamos durante el seguimiento. No se observó diferencias estadísticas en cuanto a la aparición de eventos adversos en cuanto a la estrategia de tratamiento optada.

Conclusiones: El intento de apertura de la arteria ocluida no redujo el riesgo de eventos cardiovasculares adversos.


Palabras clave

arterias coronarias; oclusión total crónica; intervencionismo coronario percutáneo

Referencias

Ministerio de Salud Pública. Dirección Nacional de Registros Médicos y Estadísticas de Salud, Anuario Estadístico Cubano [Internet]. 2019. [citado 18 Jun 2019]. Disponible en: http://www.sld.cu/anuncio/2019/04/26/publicado-el-anuario-estadistico-de-salud-2018.

Cosselman KE, Navas-Acien A, Kaufman JD. Environmental factors in Cardiovascular disease[abstract]. Nat Rev Cardiol [Internet]. 2015 oct [cited 2019 Jun 18]; 12: 627–42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Cosselman+KE%2C+Navas-Acien+A%2C+Kaufman+JD.+Environment+al+factors+in+Cardiovascular+disease.+Nat+Rev+Cardiol.

Pipkin M, Ochoa JP, Sol MA, Verón FL, Stampone G, Blanco G, et al. Cirugía de reemplazo valvular aórtico en pacientes octogenarios: resultados peri operatorios y seguimiento a mediano plazo. Rev Arg Cardiol [Internet]. 2014 [citado 18 Jun 2019]; 82: p.13-20. Disponible en: http://dx.doi.org/10.7775/rac.es.v81.i1.1804.

Abud MA, Álvarez_Iorio A, Ballarino M, Cigalini C, Cigalini I, Cohen F, et al. Desarrollo de un Programa de Oclusiones Totales Crónicas en la República Argentina – Colegio Argentino de Cardioangiólogos Intervencionistas. [Internet]. 2018 [citado 18 Jun 2019]; 9(1): 15-38. Disponible en: http://caci.org.ar/assets/uploads/consenso-otc-2018.pdf.

Uribe CE, Zúñiga M, Cabrales J, Medina L, Saaibi F. Tratamiento percutáneo de las oclusiones totales crónicas Parte 2. Rev Colomb Cardiol [Internet]. 2017 [citado 18 Jun 2019];24(S3):71-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S0120563317302401.

Schumacher SP, Stuijfzand WJ, Opolski MP, van Rossum AC, Nap A, Knaapen P. Percutaneous coronary intervention of chronic total occlusions: when and how to treat. Cardiovasc Revasc Med [Internet]. 2019 Jun [cited 2019 Jul 10];20(6):513-22. Available from: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S1553838918303245?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1553838918303245%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F.

Khatri J, Abdallah M, Ellis S. Management of coronary chronic total occlusion [abstract]. Cleve Clin J Med [Internet]. 2017 Dec [cited 2019 Jul 10];84 (Suppl 3):S27-38. Available from: https://www.mdedge.com/ccjm/article/153545/management-coronary-chronic-total-occlusion.

Araya M, Armijo G. Intervencionismo coronario percutáneo en oclusiones coronarias totales: ¿en cuáles pacientes?. Rev Colomb Cardiol [Internet]. 2016 jun [citado 10 Jul 2019];23(4):255-7. Disponible en: https://www.elsevier.es/es-revista-revista-colombiana-cardiologia-203-articulo-intervencionismo-coronario-percutaneo-oclusiones-coronarias-S0120563316300328.

Bardají A, Rodriguez-López J, Torres-Sánchez M. Chronic total occlusion: To treat or not to treat. World J Cardiol [Internet]. 2014 Jul [cited 2019 Jul 10];6(7):621-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Bardaj%C3%AD+A%2C+Rodriguez-L%C3%B3pez+J%2C+Torres-S%C3%A1nchez+M.+Chronic+total+occlusion%3A+To+treat+or+not+to+treat.+World+J+Cardiol++6(7)%3A621-9.

Lee PH, Lee SW, Park HS, Kang SH, Bae BJ, Chang M, et al. Successful recanalization of native coronary chronic total occlusion is not associated with improved long-term survival. JACC Cardiovasc Interv [Internet]. 2016 Mar [cited 2019 Jul 10];9(6):530-8. Available from: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S1936879815017525?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1936879815017525%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F.

Sanguineti F, Garot P, O'Connor S, Watanabe Y, Spaziano M, Lefèvre T, et al. Chronic total coronary occlusion treated by percutaneous coronary intervention: long-term outcome in patients with and without diabetes. EuroIntervention [Internet]. 2017 Feb [cited 2019 Jul 10];12(15):1889-97. Available from: https://eurointervention.pcronline.com/article/chronic-total-coronary-occlusion-treated-by-percutaneous-coronary-intervention-long-term-outcome-in-patients-with-and-without-diabetes.

Christopoulos G, Menon RV, Karmpaliotis D, Alaswad K, Lombardi W, Grantham JA, et al. Application of the "hybrid approach" to chronic total occlusions in patients with previous coronary artery bypass graft surgery (from a Contemporary Multicenter US registry)[abstract]. Am J Cardiol [Internet]. 2014 Jun [cited 2019 Jul 10];113(12):1990-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Christopoulos+G%2C+Menon+RV%2C+Karmpaliotis+D%2C+Alaswad+K%2C+Lombardi+W%2C+Grantham+JA+et+al.+Application+of+the+%E2%80%9Chybrid+approach%E2%80%9D+to+chronic+total+occlusions+in+patients+with+previous+coronary+artery+bypass+graft+surgery.

Agrawal H, Lange R, Montanez R, Wali S, Mohammad KO, Kar S, et al. The role of percutaneous coronary intervention in the treatment of chronic total occlusions: Rationale and review of the literature. Curr Vasc Pharmacol [Internet]. 2018 [cited 2019 Jul 10];17(3):278-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Agrawal+H%2C+Lange+R%2C+Montanez+R%2C+Wali+S%2C+Mohammad+KO%2C+Kar+S%2C+et+al.+The+Role+of+percutaneous+Coronary+Intervention+in+the+Treatment+of+Chronic+Total+Occlusions%3A+Rationale+and+Review+of+the+Literature.

González_Veliz A, López_Ferrero LH, Rodríguez_Nande LM, LLerena_Rojas LD, Alfonso_Rodríguez E, Martínez_Benítez P. Intervencionismo coronario percutáneo en oclusiones totales crónicas. Rev Cuban Cardiol Cirug [Internet]. 2019 [citado 10 Jul 2019]; 25 (2): [aprox. 41p.]. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/815.

Galassi AR, Boukhris M, Azzarelli S, Castaing M, Marzà F, Tomasello SD. Percutaneous coronary revascularization for chronic total occlusions. J Am Coll Cardiol Intv [Internet].2016 [cited 2019 Nov 12];9:911–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Galassi+AR%2C+Boukhris+M%2C+Azzarelli+S%2C+Castaing+M%2C+Marz%C3%A0+F%2C+Tomasello+SD.+Percutaneous+Coronary+Revascularization+for+Chronic+Total+Occlusions.

Tomasello SD, Boukhris M, Giubilato S, Marzà F, Garbo R, Contegiacomo G, et al. Management strategies in patients affected by chronic total occlusions: results from the Italian registry of chronic total oclusions. Eur Heart J [Internet]. 2015 [cited 2019 Nov 12];36(45):3189-98. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Tomasello+SD%2C+Boukhris+M%2C+Giubilato+S%2C+Marz%C3%A0+F%2C+Garbo+R%2C+Contegiacomo+G%2C+et+al.+Management+strategies+in+patients+affected+by+chronic+total+occlusions%3A+results+from+the+Italian+Registry+of+Chronic+Total+Occlusions.

Ellis SG, Burke MN, Murad MB, Graham JJ, Badawi R, Toma C, et al. Predictors of successful hybrid-approach chronic total coronary artery occlusion stenting. J Am Coll Cardiol Intv [Internet]. 2017 [cited 2019 Nov 12];10:1089–98. Available from: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S1936879817305460?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1936879817305460%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F.

Crea F. Dyslipidaemias in stroke, chronic kidney disease, and aortic stenosis: the new frontiers for cholesterol lowering. Eur Heart J [Internet]. 2021 Jun [cited 2021 Jun 30];42(22):2137–40. Available from: https://academic.oup.com/eurheartj/article/42/22/2137/6294591.

Guan C, Yang W, Song L, Chen J, Qian J, Wu F, et al. Association of Acute Procedural Results with Long-term Outcomes After CTO-PCI. J Am Coll Cardiol Intv [Internet]. 2021 Feb [cited 2021 Jun 30];14(3):289-91. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1936879820320240.

Park TK, Hun Lee S, Hong Choi K, Myung Lee J, Hoon Yang J, Bin Song Y, et al. Late Survival Benefit of Percutaneous Coronary Intervention Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion: A 10- Year Follow- Up Study. J Am Heart Assoc [Internet]. 2021 Mar [cited 2021 Jul 14];(10):1-10. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.120.019022.

Jah Yeon C, Seung-Woon R, Byoung Geol C, Se Yeon C, Jae Kyeong B, Won Young J, et al. Percutaneous Coronary Intervention for Chronic Total Occlusion in Single Coronary Arteries. Heart Inst J [Internet]. 2021 [cited 2021 Jul 14];48(2):1-11. Available from: https://meridian.allenpress.com/thij/article/48/2/e197023/466220/Percutaneous-Coronary-Intervention-for-Chronic.

Sianos G, Konstantinidis NV, Di Mario C, Karvounis H. Theory and practical based approach to chronic total occlusions. BMC Cardiovasc Disord [Internet]. 2016 Feb [cited 2021 Jul 28];16(33):1-11. Available from: https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-016-0209-3#citeas.

Su YM, Pan M, Geng HH, Zhang R, Qu YY, Ma GS, et al. Outcomes after percutaneous coronary intervention and comparison among scoring systems in predicting procedural success in elderly patients (≥75 years) with chronic total occlusion. Coron Artery Dis [Internet]. 2019 [cited 2021 Jul 28];30(7):481-7. Available from: https://journals.lww.com/coronary-artery/Fulltext/2019/11000/Outcomes_after_percutaneous_coronary_intervention.2.aspx.

van Veelen A, Claessen BE, Houterman S, Hoebers LP, Elias J, Henriques JP, et al. Incidence and outcomes of chronic total occlusion percutaneous coronary intervention in the Netherlands: data from a nationwide registry. Neth Heart J [Internet]. 2021 Jan [cited 2021 Jul 28]; (29):4-13. Available from: https://link.springer.com/article/10.1007/s12471-020-01521-y.

Bryniarski L, Opolski MO, Wójcik J, Lesiak M, Pawłowski T, Drozd J, et al. Chronic total occlusion percutaneous coronary intervention in everyday clinical practice – an expert opinion of the Association of Cardiovascular Interventions of the Polish Cardiac Society. Adv Interv Cardiol [Internet]. 2021 [cited 2021 Aug 6];1(63):6-20. Available from: https://www.termedia.pl/Chronic-total-occlusion-percutaneous-coronary-intervention-in-everyday-clinical-practice-an-expert-opinion-of-the-Association-of-Cardiovascular-Interventions-of-the-Polish-Cardiac-Society,35,43633,1,1.html.

Seung-Woon R, Byoung Geol C, Man Jong B, Yang gi R, Hu L, Se Yeon C, et al. Five-Year Outcomes of Successful Percutaneous Coronary Intervention with Drug-Eluting Stents versus Medical Therapy for Chronic Total Occlusions. Yonsei Med J [Internet]. 2018 Jul [cited 2021 Aug 14];59(5):602-10. Available from: https://eymj.org/DOIx.php?id=10.3349/ymj.2018.59.5.602.

Lei G, Lei Z, Kun C, Jian W, Rong-Chong H. Long-term clinical outcomes of optimal medical therapy vs. successful percutaneous coronary intervention for patients with coronary chronic total occlusions. Hell J Cardiol [Internet]. 2018 Oct [cited 2021 Aug 14];59(5):281-7. Available from: https://www.sciencedirect.com/science/article/pii/S1109966617306115.

Choi SY, Choi BG, Rha SW, Baek MJ, Ryu YG, Park Y, et al. Percutaneous coronary intervention versus optimal medical therapy for chronic total coronary occlusion with well-developed collaterals. J Am Heart Assoc [Internet]. 2017 Sep [cited 2019 Jul 10];6(9):[about 40 p.] Available from: https://www.ahajournals.org/doi/10.1161/JAHA.117.006357.

Hwang JW, Yang JH, Choi SH, Hwang JK, Jang WJ, Hahn JY, et al. Optimal medical therapy may be a better initial strategy in patients with chronic total occlusion of a single coronary artery[abstract]. Int J Cardiol [Internet]. 2016 May [cited 2019 Nov 12];210:56-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Optimal+medical+therapy+may+be+a+better+initial+strategy+in+patients+with+chronic+total+occlusion+of+a+single+coronary+artery



Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.