Intervencionismo coronario percutáneo con implantación de stent liberador de sirolimus con recubrimiento abluminal: Primeros casos realizados en Cuba

Leonardo H. López Ferrero, Emilio Alfonso Rodríguez, Lorenzo D. Llerena Rojas, Alejandro González Véliz, Raúl Señor Dross, Lidia Rodríguez Nande, Aresky Zabala García, Eduardo Roldos Cuza, Ana M. Barreda Pérez

Resumen

Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en el mundo y en nuestro país. El intervencionismo coronario percutáneo con stents liberadores de fármacos ha mejorado el tratamiento y evolución de estos pacientes.

Objetivos: Describir las características clínicas y angiográficas de los pacientes tratados con stents ihtDEStiny e identificar los eventos cardíacos mayores en el seguimiento clínico.

Método: Se realizó un estudio observacional, analítico y prospectivo en el Instituto de Cardiología y Cirugía Cardiovascular, de junio de 2019 a diciembre 2020 donde se incluyeron los primeros 50 pacientes consecutivos tratados en Cuba con stents liberadores de sirolimus con recubrimiento abluminal.

Resultados: La edad media fue de 61,5 años, con un predominio del género masculino (88%). El factor de riesgo cardiovascular (FRC) predominante fue la HTA 37 (74%), seguido de la DM 13 (26%). Se trataron 79 estenosis a razón de 1,58 stents por pacientes. La descendente anterior fue la arteria coronaria más afectada, predominaron las estenosis tipo B2. Se implantó stent directo en el 60% de los casos. El éxito inmediato fue del 98,7%. Se realizó un seguimiento clínico a los 6 y 12 meses con escasos eventos cardíacos mayores.

Conclusiones: Los stents liberadores de fármacos de sirolimus utilizados en este estudio son seguros y garantizan un periodo libre de eventos cardíacos mayores.

Referencias

Ministerio de Salud Pública. Dirección Nacional de Registros Médicos y Estadísticas de Salud, Anuario Estadístico Cubano. [Internet]. 2015. [citado 19 Ene 2021]. 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 2021 Jan 19]; 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.

Ministerio de Salud Pública. Dirección Nacional de Registros Médicos y Estadísticas de Salud, Anuario Estadístico Cubano. [Internet]. 2012. [citado 19 Ene 2021]. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=68424.

Pipkin M, Ochoa JP, Sol MA, Verón FL, Stampone G, Blanco G, et al, et al. Cirugía de reemplazo valvular aórtico en pacientes octogenarios: resultados peri operatorios y seguimiento a mediano plazo. Rev Arg Cardiol [Internet]. 2014 [citado 19 Ene 2021];82(1):13-20. Disponible en: http://dx.doi.org/10.7775/rac.es.v81.i1.1804.

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 May [citado 19 Ene 2021];25(2):[aprox. 41p.]. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/815.

Gruntzig A. Transluminal dilatation of coronary-artery stenosis. Lancet [Internet]. 1978 Feb [cited 2021 Jan 19];1(8058):263. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673678905007.

Sigwart U, Puel J, Mirkovitch V, Jofre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med [Internet]. 1987 Mar [cited 2021 Feb 12];316(12):701-6. Available from: https://doi.org/10.1056/nejm198703193161201.

Torrado J, Buckley L, Durán A, Trujillo P, Toldo S, Valle Raleigh J, et al, et al. Restenosis, Stent Thrombosis, and Bleeding Complications. Navigating Between Scylla and Charybdis. J Am Coll Cardiol [Internet]. 2018 Apr [cited 2021 Feb 12];71(15):1676-95. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109718332558.

Thipparaboina R, Khan W, Domb AJ. Eluting combination drugs from stents. Int J Pharm [Internet]. 2013 Sep [cited 2021 Feb 12];454(1):4-10. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0378517313006091.

Foerst J, Vorpahl M, Engelhardt M, Koehler T, Tiroch K, Wessely R. Evolution of Coronary Stents: From Bare-Metal Stents to Fully Biodegradable, Drug-Elu-ting Stents. Comb Prod Ther [Internet]. 2013 Dec [cited 2021 Feb 12];3(12):9-24. Available from: https://link.springer.com/article/10.1007/s13556-013-0005-7.

Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J [Internet]. 2018 Jan [cited 2021 Feb 12];39(3):213-60. Available from: https://academic.oup.com/eurheartj/article/39/3/213/4095043.

Iqbal J, Gunn J, Serruys PW. Coronary stents: Historical development, current status and future directions. Br Med Bull [Internet]. 2013 [cited 2021 Feb 26];106:193-211. Available from: https://academic.oup.com/bmb/article/106/1/193/321394.

Kang SH, Chae IH, Park JJ, Seung Lee H, Kang DY, Hwang SS, et al. Stent thrombosis with drug-eluting stents and bioresorbable scafolds: evidence from a network meta-analysis of 147 trials. J Am Coll Cardiol Intv [Internet]. 2016 Jun [cited 2021 Feb 26];9(12):1203-12. Available from: https://www.sciencedirect.com/science/article/pii/S1936879816303223?via%3Dihub.

Ali ZA, Gao RF, Kimura T, Onuma Y, Kereiakes DJ, Ellis SG, et al. Three-year outcomes with the Absorb bioresorbable scafold: individual-patient-data meta-analysis from the ABSORB randomized trials. Circulation [Internet]. 2018 Jan [cited 2021 Feb 26];137(5):464-79. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.031843.

Hu T, Yang J, Cui K, Rao Q, Yin T, Tan L, et al. Controlled Slow-Release Drug-Eluting Stents for the Prevention of Coronary Restenosis: Recent Progress and Future Prospects. ACS Appl Mater Interfaces [Internet]. 2015 Jun [cited 2021 Feb 26];7(22): 11695-712. Available from: https://pubs.acs.org/doi/10.1021/acsami.5b01993.

Chen W, Habraken T, Hennink WE, Kok RJ. Polymer-free drug-eluting stents: an overview of coating strategies and comparison with polymer-coated drug-elu-ting stents Polymer-free drug-eluting stents: an overview of coating strategies and comparison with polymer-coated drug-eluting stents. Bioconjug Chem [Internet]. 2015 Jul [cited 2021 Feb 26];26(7):1277-88. Available from: https://pubs.acs.org/doi/10.1021/acs.bioconjchem.5b00192.

Muramatsu T, Onuma Y, Zhang YJ, Bourantas CV, Kharlamov A, Diletti R, et al. Progress in treatment by percutaneous coronary intervention: the stent of the future. Rev Esp Cardiol (Engl Ed) [Internet]. 2013 Jun [cited 2021 Mar 15];66(6):483-96. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1885585713000364?via%3Dihub.

Pilgrim T, Piccolo R, Heg D, Roffi M, Tüller D, Muller O, et al. Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial. Lancet [Internet]. 2018 Sep [cited 2021 Mar 15];392(10149):737-46. Available from: https://www.sciencedirect.com/science/article/abs/pii/S014067361831715X?via%3Dihub

Iglesias JF, Muller O, Heg D, Moarof I, Roffi M, Kurz DJ, et al. Biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in patients with ST-segment elevation myocardial infarction (BIOSTEMI): a single-blind, prospective, randomised superiority trial. Lancet [Internet]. 2019 Oct [cited 2021 Mar 15];394(10205):1243–53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S014067361931877X.

López Pérez JE, Filgueiras Frías E, Aroche Aportelá R, Llerena Rojas L, López Ferrero L, Obregón Santos AG, et al. Seguimiento a cuatro años de pacientes con stent Firebird liberador de Sirolimus en Cuba. Rev Fed Arg Cardiol [Internet]. 2010 [citado 15 Mar 2021];39(2):105-9. Disponible en: http://articulos.sld.cu/cimeq/?m=20100822.

Park KW Rhee TM, Kang HJ, Koo BK, Gwon HC, Yoon JH, et al. Randomized Prospective Comparison of Everolimus-Eluting vs. Sirolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention. Circ J [Internet]. 2018 May [cited 2021 Sep 15];82 (6):1566-74. Available from: https://www.jstage.jst.go.jp/article/circj/82/6/82_CJ-17-0677/_article.

Mc Sweeney JC, Rosenfeld AG, Abel WM. Preventing and Experiencing Ischemic Heart Disease as a Woman: state of the science: a scientific statement from the American Heart Association. Circulation [Internet]. 2016 [cited 2021 Mar 15];133(13):1302-31. Available from: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000381.

Kakizaki R, Minami Y, Katamine M, Katsura A, Muramatsu Y, Hashimoto T, et al. Clinical outcome of biodegradable polymer sirolimus-eluting stent and durable polymer everolimus-eluting stent in patients with diabetes. Cardiovasc Diabetol [Internet]. 2020 Oct [cited 2021 Mar 15];19(162):1-9. Available from: https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01145-x.

Gasior P, Gierlotka M, Szczurek-Katanski K, Osuch M, Rolede M, Hawranek M, et al. Biodegradable polymer-coated thin strut sirolimus--eluting stent versus durable polymer-coated everolimus-eluting stent in the diabetic population. Cardiol J [Internet]. 2021 [cited 2021 Mar 15];28(2):235-43. Available from: https://journals.viamedica.pl/cardiology_journal/article/view/64675.

Abhyankar A, Abizaid A, Chamié D, Rathod M. Comparison of neointimal coverage between ultrathin biodegradable polymer-coated sirolimus-eluting stents and durable polymer-coated everolimus-eluting stents: 6 months optical coherence tomography follow-up from the TAXCO study. Catheter Cardiovasc Interv [Internet]. 2021 Feb [cited 2021 Mar 28];97(3):423-30. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccd.28833.

Iñiguez A, Chevalier B, Richardt G, Neylon A, Jiménez VA, Kornowski R, et al. Comparison of long-term clinical outcomes in multivessel coronary artery disease patients treated either with bioresoarbable polymer sirolimus-eluting stent or permanent polymer everolimus-eluting stent: 5-year results of the CENTURY II randomized clinical trial. Catheter Cardiovasc Interv [Internet]. 2020 Apr [cited 2021 Mar 28];95(2):175-84. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/ccd.28224.

Fortich F, Uribe CE, Tenorio CA, Eusse CA, Ortiz JC. Arteria coronaria descendente anterior doble: reporte de un caso y revisión de la literatura. Rev Colomb Cardiol [Internet]. 2012 Abr [citado 28 Mar 2021];19(2):96-9. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332012000200008.

Saito S, Valdes-Chavarri M, Richardt G, Moreno R, Iñiguez Romo A, Barbato E, et al. A randomized, prospective, intercontinental evaluation of a bioresorbable polymer sirolimus-eluting coronary stent system: the CENTURY II (Clinical Evaluation of New Terumo Drug-Eluting Coronary Stent System in the Treatment of Patients with Coronary Artery Disease) trial. Eur Heart J [Internet]. 2014 Aug [cited 2021 Mar 28];35(30):2021-31. Available from: https://academic.oup.com/eurheartj/article/35/30/2021/2293093.

King SB, Smith SC, Hirshfeld JW, Jacobs AK, Morrison DA, Williams DO, et al. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Ciculation [Internet]. 2008 [cited 2021 Mar 28];117(2):261-95. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.188208?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.

Li S, Wei Y, Jia Sheng Y, Xue Bo L, Yi Zhe W, Ai Jun S, et al. Nine month Angiographic and Two Year Clinical Follow up of Novel Biodegradable Polymer Arsenic Trioxide eluting Stent Versus Durable polymer Sirolimus eluting Stent For Coronary Artery Disease. Chin Med J [Internet]. 2015 Mar [cited 2021 Mar 28];128(6):768-73. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833980/.

Kuramitsu S, Kazuno Y, Sonoda S, Domei T, Jinnouchi H, Yamaji K, et al. Vascular response to bioresorbable polymer sirolimus-eluting stent vs. permanent polymer everolimus-eluting stent at 9-month follow-up: an optical coherence tomography sub-study from the CENTURY II trial. Eur Heart J Cardiovasc Imaging [Internet]. 2016 Jan [cited 2021 Mar 28];17(1):34-40. Available from: https://academic.oup.com/ehjcimaging/article/17/1/34/2464816.

Kandzari DE, Mauri L, Koolen JJ, Massaro JM, Doros G, Garcia-Garcia HM, et al. Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin, durable polymer everolimus-eluting stents in patients undergoing coronary revascularisation (BIOFLOW V): a randomised trial. Lancet [Internet]. 2017 Aug [cited 2021 Apr 20];390:1843-52. Available from: https://pubmed.ncbi.nlm.nih.gov/28851504/.

Obregón Oblitas J, Ribamar Costa J, Siqueira DA, Maldonado A, Barreira G, Slhessarenko J, et al. Implante de Stents Con o Sin Predilatación en Pacientes con Síndrome Coronaria Aguda Sin Supradesnivel del Segmento ST. Rev Bras Cardiol Invasiva [Internet]. 2013 [citado 20 Abr 2021];21(4):338-43. Disponible en: https://solaci.org/es/2015/09/09/n-11939/.

Barbosa MH, Moreira TM, Tavares JL, Andrade EV, Bitencourt MN, Bitencourt KB, et al. Complicaciones en pacientes sometidos a Angioplastia Coronaria Transluminal Percutánea. Enferm. glob. [Internet]. 2013 Jul [citado 20 Abr 2021];12(31):14-23. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1695-61412013000300002.

Zbinden R, Piccolo R, Heg D, Roffi M, Kurz DJ, Muller O, et al. Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable-Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularization: 2-Year Results of the BIOSCIENCE Trial. J Am Heart Assoc [Internet]. 2016 Mar [cited 2021 Apr 20];5(3):1-10. Available from: https://www.ahajournals.org/doi/epub/10.1161/JAHA.116.003255

Enlaces refback

  • No hay ningún enlace refback.


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