Placa de aterosclerose em carótidas como marcador de risco para reestenose de stent em coronárias
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Data
2016-08-26
Autores
Rodrigues, Cássia da Silva Antico [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Fundamento: A reestenose de stent coronariano convencional é a principal limitação da angioplastia coronariana com implante de stent. Existem evidências de que as placas de carótidas são consideradas preditoras de eventos coronarianos. Objetivos: 1- avaliar o aspecto ultrassonográfico das carótidas em pacientes submetidos à cinecoronariografia com história de angioplastia coronária e implante de stent convencional dentro de 12 meses; 2- associar a espessura médio-intimal de carótidas (EMIC) e a ecogenicidade das placas de aterosclerose carotídeas com a ocorrência de reestenose de stents convencionais coronarianos. Métodos: Estudo observacional incluindo 121 pacientes consecutivos submetidos à cinecoronariografia como estratificação de risco de angina estável, que apresentavam história de angioplastia coronária e implante de stent convencional em até 12 meses. Foram efetuadas avaliações clínicas determinando os fatores de risco clássicos para doença cardiovascular e medicações em uso contínuo; avaliações angiográficas de coronárias para avaliar reestenose de stent e avaliações ultrassonográficas de carótidas, considerando a espessura médio-intimal de carótidas, a presença de placas de aterosclerose e a ecogenicidade destas placas. Os dados foram analisados por meio de regressão múltipla de Cox. Nível de significância p<0,05. Resultados: A mediana de idade dos pacientes foi de 60 anos (idade mínima de 36 anos e máxima de 85 anos), sendo 64,5% do sexo masculino. A hipertensão arterial sistêmica foi identificada em 91 pacientes (75,2%), tabagismo em 58 (47,9%), diabetes em 47 (38,8%) e dislipidemia em 119 (98,3%). Houve reestenose de stent coronariano convencional em 57 (47,1%) pacientes. As placas hipoecogênicas de carótidas estavam presentes em 55 (45,5%) pacientes, e 66 (54,5%) pacientes não apresentavam placas ou tinham placas hiperecogênicas. A EMIC estava aumentada em 43 (35,5%) pacientes. Considerando os pacientes que tinham placa hipoecogênica de carótidas, 50 (90,9%) pacientes apresentaram reestenose de stent coronariano, e os pacientes que tinham placa hiperecogênica ou ausência de placas de carótidas, apenas 7 (10,6%) apresentaram reestenose de stent coronariano. A análise univariada mostrou que o risco de reestenose de stent coronariano foi maior no gênero masculino, entre pacientes que apresentavam placas ateroscleróticas hipoecogênicas de carótidas e entre pacientes com valores aumentados de EMIC. Pela análise de regressão múltipla de Cox, ajustada para o risco de reestenose de stent coronariano convencional em função dos potenciais preditores mais fortemente associados (p<0,05) com a reestenose, a presença de placas hipoecogênicas nas carótidas aumentou o risco de reestenose de stent coronariano em 8,21 vezes (RR= 8,21; IC95%: 3,58 – 18,82; p<0,001). Conclusões: A presença de placas ateroscleróticas hipoecogênicas nas carótidas constitui forte preditor de risco para reestenose de stent convencional em coronárias e poderia também ser considerada juntamente com outros preditores de risco na tomada de decisão em relação ao tipo de stent a ser utilizado na angioplastia coronária.
Background: Restenosis of a conventional coronary stent is a principal limitation of coronary angioplasty with stent implant. There is evidence that carotid plaques are considered predictors of coronary events. Objectives: 1- to evaluate the ultrasonographic aspect of carotids in patients submitted to coronary angiography with a history of coronary angioplasty and implantation of a conventional stent within 12 months; 2- to associate the carotid intima-media thickness (IMT) and the echogenicity of carotid atherosclerotic plaques with the occurrence of restenosis of conventional coronary stents. Methods: Observational study including 121 consecutive patients submitted to coronary angiography as risk stratification of stable angina, that presented a history of coronary angioplasty and implantation of conventional stent within 12 months. Clinical evaluations were performed to determine the classical risk factors for cardiovascular disease and medications in continuous use; angiographic evaluations of coronary to assess stent restenosis and ultrasonographic evaluations of carotids, considering the intima-media thickness of carotids, the presence of atherosclerotic plaques and their echogenicity. The data were analyzed by Cox multiple regression. The significance level p<0.05. Results: The median age of patients was 60 years (from minimum 36 years to maximum 85 years), with 64.5% being male. Systemic arterial hypertension was identified in 91 patients (75.2%), tobacco smoking in 58 (47.9%), diabetes in 47 (38.8%) and dyslipidemia in 119 (98.3%). There was restenosis of a conventional coronary stent in 57 (47.1%) patients. The hypoechogenic carotid plaques were present in 55 (45.5%) patients, and 66 (54.5%) patients did not present plaques or had hyperechogenic plaques. IMT was elevated in 43 (35.5%) patients. Considering the patients that had hypoechogenic plaque of carotids, 50 (90.9%) patients presented coronary-stent restenosis, while of the patients that had hyperechogenic plaque or absence of carotid plaques, only 7 (10.6%) presented coronary-stent restenosis. Univariate analysis showed that the risk of coronary- stent restenosis was greater among males, among patients that presented hypoechogenic plaques atherosclerotic of carotids and among patients with augmented IMT values. In Cox multiple regression analysis, adjusted for risk of restenosis of a conventional coronary stent as a function of potential predictors more strongly associated (p<0.05) with restenosis, the presence of hypoechogenic plaques in carotids increased the risk of coronary-stent restenosis by 8.21 fold (RR= 8.21; CI95%: 3.58 – 18.82; p<0.001). Conclusions: The presence of hypoechogenic atherosclerotic plaques in carotids was a strong predictor of risk for conventional-stent restenosis in coronary and may also be considered together with other risk predictors in deciding which stent type to utilize in coronary angioplasty.
Background: Restenosis of a conventional coronary stent is a principal limitation of coronary angioplasty with stent implant. There is evidence that carotid plaques are considered predictors of coronary events. Objectives: 1- to evaluate the ultrasonographic aspect of carotids in patients submitted to coronary angiography with a history of coronary angioplasty and implantation of a conventional stent within 12 months; 2- to associate the carotid intima-media thickness (IMT) and the echogenicity of carotid atherosclerotic plaques with the occurrence of restenosis of conventional coronary stents. Methods: Observational study including 121 consecutive patients submitted to coronary angiography as risk stratification of stable angina, that presented a history of coronary angioplasty and implantation of conventional stent within 12 months. Clinical evaluations were performed to determine the classical risk factors for cardiovascular disease and medications in continuous use; angiographic evaluations of coronary to assess stent restenosis and ultrasonographic evaluations of carotids, considering the intima-media thickness of carotids, the presence of atherosclerotic plaques and their echogenicity. The data were analyzed by Cox multiple regression. The significance level p<0.05. Results: The median age of patients was 60 years (from minimum 36 years to maximum 85 years), with 64.5% being male. Systemic arterial hypertension was identified in 91 patients (75.2%), tobacco smoking in 58 (47.9%), diabetes in 47 (38.8%) and dyslipidemia in 119 (98.3%). There was restenosis of a conventional coronary stent in 57 (47.1%) patients. The hypoechogenic carotid plaques were present in 55 (45.5%) patients, and 66 (54.5%) patients did not present plaques or had hyperechogenic plaques. IMT was elevated in 43 (35.5%) patients. Considering the patients that had hypoechogenic plaque of carotids, 50 (90.9%) patients presented coronary-stent restenosis, while of the patients that had hyperechogenic plaque or absence of carotid plaques, only 7 (10.6%) presented coronary-stent restenosis. Univariate analysis showed that the risk of coronary- stent restenosis was greater among males, among patients that presented hypoechogenic plaques atherosclerotic of carotids and among patients with augmented IMT values. In Cox multiple regression analysis, adjusted for risk of restenosis of a conventional coronary stent as a function of potential predictors more strongly associated (p<0.05) with restenosis, the presence of hypoechogenic plaques in carotids increased the risk of coronary-stent restenosis by 8.21 fold (RR= 8.21; CI95%: 3.58 – 18.82; p<0.001). Conclusions: The presence of hypoechogenic atherosclerotic plaques in carotids was a strong predictor of risk for conventional-stent restenosis in coronary and may also be considered together with other risk predictors in deciding which stent type to utilize in coronary angioplasty.
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Palavras-chave
Ultrassonografia de carótida, Stent, Placas carótidas, Doença arterial coronária, Reestenose, Ultrasonography of the carotid, Carotid plaques, Coronary arterial disease, Restenosis