Roberto Grinfeld

Argentine Randomized Study: Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple-Vessel Disease (ERACI II): 30-Day and One-Year Follow-up Results

OBJECTIVE The purpose of this study was to compare percutaneous transluminal coronary revascularization (PTCR) employing stent implantation to conventional coronary artery bypass graft surgery (CABG) in symptomatic patients with multivessel coronary artery disease. BACKGROUND Previous randomized studies comparing balloon angioplasty versus CABG have demonstrated equivalent safety results. However, CABG was associated with significantly fewer repeat revascularization procedures. METHODS A total of 2,759 patients with coronary artery disease were screened at seven clinical sites, and 450 patients were randomly assigned to undergo either PTCR (225 patients) or CABG (225 patients). Only patients with multivessel disease and indication for revascularization were enrolled. RESULTS Both groups had similar clinical demographics: unstable angina in 92%; 38% were older than 65 years, and 23% had a history of peripheral vascular disease. During the first 30 days, PTCR patients had lower major adverse events (death, myocardial infarction, repeat revascularization procedures and stroke) compared with CABG patients (3.6% vs. 12.3%, p = 0.002). Death occurred in 0.9% of PTCR patients versus 5.7% in CABG patients, p < 0.013, and Q myocardial infarction (MI) occurred in 0.9% PTCR versus 5.7% of CABG patients, p < 0.013. At follow-up (mean 18.5 +/- 6.4 months), survival was 96.9% in PTCR versus 92.5% in CABG, p < 0.017. Freedom from MI was also better in PTCR compared to CABG patients (97.7% vs. 93.4%, p < 0.017). Requirements for new revascularization procedures were higher in PTCR than in CABG patients (16.8% vs. 4.8%, p < 0.002). CONCLUSIONS In this selected high-risk group of patients with multivessel disease, PTCR with stent implantation showed better survival and freedom from MI than did conventional surgery. Repeat revascularization procedures were higher in the PTCR group.

Congenital Aneurysm of the Left Atrium

Left atrial aneurysm is a rare condition. Only 29 cases have been reported, to our knowledge. We report 1 such case in a 24-year-old man who complained of dyspnea and arrhythmias. Diagnosis was suspected on review of chest roentgenogram and confirmed by echocardiography and cardiac catheterization. Surgical repair was achieved without complications, and preoperative symptoms disappeared completely. According to the literature, these patients are almost always asymptomatic. When present, the most common symptoms are arrhythmias, heart failure, emboli, and chest pain. This lesion is seen mainly in young adults (mean age, 23.5 years). The diagnosis should be confirmed by echocardiography, nuclear imaging, and cardiac catheterization. A review of the literature indicates that surgical repair can be accomplished with low mortality and that arrhythmias usually disappear postoperatively.

Triple Bypass Graft for the Treatment of Severe Triple Coronary Vessel Disease

Abstract In a 3-year period (January, 1970, to January, 1973) three or more bypass grafts were placed in 397 patients who had severe triple coronary vessel disease. Ten patients (2.5%) died in the hospital postoperatively. Fifteen patients (4%) had postoperative myocardial infarctions. Late myocardial infarction occurred in 11 patients (2.8%), and in 6 of these the infarctions were fatal. Late deaths occurred in 11 patients; 7 of the deaths were of cardiac origin. Three patients were lost to follow-up. The remaining 373 patients were followed from 10 to 46 months. Three hundred sixty-one patients (96.7%) improved, 295 (79%) of these becoming asymptomatic. Two hundred twenty-one patients (672 grafts) were restudied from 6 weeks to 31 months after operation. The overall patency rate was 81.5%. There was a direct correlation between relief of angina and completeness of the revascularization. With one functioning graft, 9 patients (42.8%) became asymptomatic; with two functioning grafts, 52 patients (74.2%) became asymptomatic; and with three functioning grafts, 108 patients (87.8%) became asymptomatic. This experience suggests that three or more bypass grafts can be placed with a low operative risk in selected patients. Total or complete revascularization should be attempted in patients with severe triple-vessel disease.