Comparación de una estrategia de revascularización coronaria completa vs revascularización coronaria guiada por ecocardiograma de esfuerzo en pacientes con infarto agudo de miocardio y enfermedad coronaria multivaso

Abstract

This doctoral thesis is a clinical trial that compares two non-culprit vessel revascularization strategies in patients with ST segment elevation acute myocardial infarction and multivesel disease who have a successful percutaneous revascularization procedure in the infarct related artery. Patients were randomized to percutaneous revascularization of all non-infarct related coronary lesions in a second elective procedure (154 patients) or to a stress echocardiography and percutaneous revascularization of those coronary stenoses showing extensive myocardial isquemia (152 patients). The primary endpoint (the composite of cardiovascular death, myocardial infarction, coronary revascularization or readmission due to heart failure at 12 months follow-up) did not show any significant difference between study groups even when follow-up was extended up to three years. Myocardial isquemia was detected in 64 patients randomized to stress echocardiography and in 44 patients of this study group a revascularization procedure in a non-infarct related coronary lesion was performed. Medical expenses at hospital discharge and after one year follow-up were significantly lower in the stress echocardiography-guided revascularization strategy.