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INTRODUÇÃO: Recentemente a intervenção coronária percutânea (ICP) com stents farmacológicos (SFs) tem se mostrado uma opção viável em pacientes selecionados com lesão de tronco de coronária esquerda não-protegido (TCE-NP). Este estudo teve como objetivo avaliar a efetividade e a segurança da ICP com SFs em lesões de TCE-NP da prática diária, analisando a ocorrência combinada de eventos cardíacos adversos maiores (ECAM) a longo prazo. MÉTODOS: Foram tratados 142 pacientes consecutivos, com média de seguimento clínico de 917 ± 743 dias. A decisão de utilizar um ou dois stents e inibidor da glicoproteína IIb/IIIa ficou a critério do operador. Angiografia coronária no seguimento não foi realizada de rotina, mas deixada a critério clínico. RESULTADOS: A média de idade foi de 67,5 ± 16 anos, três quartos dos pacientes eram do sexo masculino, 29% eram portadores de diabetes e 39% apresentavam angina instável. Foram utilizados 2,75 ± 1,25 stents por paciente. Lesões com comprometimento da bifurcação foram identificadas em 90,1% e as técnicas mais frequentemente utilizadas foram o provisional stent em 36% e o small crush em 29% dos pacientes. Ultrassom intracoronário foi realizado em 92,3% dos pacientes, e reintervenção ocorreu em 21,3% dos stents, por apresentarem aposição incompleta de suas hastes após o implante. ECAM na evolução tardia ocorreram em 15,4%, óbito cardíaco ocorreu em 3,6%, revascularização do vaso-alvo em 11,2% e trombose definitiva/ provável do stent em 1,4%. CONCLUSÕES: A ICP com SFs em lesões de TCE-NP neste estudo mostrou ser segura e eficaz na evolução tardia, com baixas taxas de óbito cardíaco e de trombose do stent. BACKGROUND: Recently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has proven to be a feasible option in selected patients with unprotected left main (LM) disease. This study was aimed at assessing the efficacy and safety of PCI with DES in LM lesions in the daily practice, analyzing the long-term occurrence of major adverse cardiac events (MACE). METHODS: A total of 142 consecutive patients were treated with a mean follow-up of 917 ± 743 days. The decision to use one or two stents or glycoprotein IIb/IIIa inhibitors was left to the operator's discretion. Coronary angiography was not performed routinely in the follow-up. RESULTS: Mean age was 67.5 ± 16 years, 75% of the patients were male, 29% had diabetes and 39% had unstable angina. A total of 2.75 ± 1.25 stents were implanted per patient. Bifurcation lesions were identified in 90.1% and the most frequent techniques were the provisional stent in 36% and small crush in 29% of the patients. Intravascular ultrasound was performed in 92.3% of the patients and reinterventions in 21.3% of the stents due to incomplete apposition of the struts after implantation. In the late follow-up, MACE was observed in 15.4% of the patients, cardiac death in 3.6%, target-vessel revascularization in 11.2% and definitive/probably stent thrombosis in 1.4%. CONCLUSIONS: In this study, PCI with DES proved to be safe and effective in the late follow-up of LM lesions, with low cardiac death and stent thrombosis rates.

FUNDAMENTO: A eficácia dos stents farmacológicos em reduzir os índices de eventos cardíacos não é uniforme a todos os subgrupos de lesões ou pacientes. OBJETIVO: Avaliar a evolução clínica tardia dos pacientes submetidos a implante de stents farmacológicos nas lesões ateroscleróticas da artéria descendente anterior e identificar, entre as características clínicas, angiográficas e do ultra-som intravascular, quais as que permitem predizer risco de eventos cardíacos. MÉTODOS: De maio de 2002 a agosto de 2005, foram tratados 205 pacientes com implante de 236 stents farmacológicos guiados pelo ultra-som intravascular. RESULTADOS: Com um acompanhamento médio de 711 dias, a taxa de trombose do stent foi de 0,48%, a mesma observada para infarto agudo do miocárdio ou cirurgia de revascularização. A taxa de revascularização da lesão tratada foi de 7,31% e a taxa global de eventos de 10,24%. Os indicadores de eventos, conforme análise multivariada, foram o implante de mais de um stent na mesma artéria, lesões concêntricas e área mínima intra-stent medida pelo ultra-som intravascular menor que 3,88 mm². CONCLUSÃO: Baseados nos dados obtidos, concluímos que a revascularização da artéria descendente anterior com implante de stents farmacológicos escolhidos e otimizados pelo ultra-som intravascular apresenta baixo índice de eventos tardios. O implante de dois stents farmacológicos para o tratamento das lesões longas foi o principal fator independente para a ocorrência de eventos tardios. A área luminal final maior que 3,88 mm² obtidos nos segmentos de pequenos diâmetros de referência é um indicador independente de evolução livre de eventos. BACKGROUND: The efficacy of pharmacological stents in decreasing the incidence of cardiac events is not homogeneous for all lesions or patient subgroups. OBJECTIVE: 1) To evaluate the late clinical evolution of patients submitted to pharmacological stent implantation in atherosclerotic lesions of the left anterior descending artery; 2) to identify, among the clinical, angiographic and intravascular ultrasonographic characteristics, the ones predictive of cardiac event risk. METHODS: From May 2002 to August 2005, 205 patients were treated with 236 pharmacological stent implants, guided by the intravascular US (IVUS). RESULTS: After a mean follow-up period of 711 days, the rate of stent thrombosis was 0.48%, the same observed for acute myocardial infarction or revascularization surgery. The revascularization rate of the treated lesion was 7.31% and the general event rate was 10.24%. The event indicators, according to the multivariate analysis were the implant of more than one stent in the same artery, concentric lesions and the minimal intra-stent area measured by IVUS < 3.88 mm². CONCLUSION: Based on the data obtained, we conclude that the revascularization of the left anterior descending artery with pharmacological stent implant, chosen and optimized by IVUS, presents a low incidence of late events. The implant of two pharmacological stents for the treatment of long lesions was the main independent factor for the occurrence of late events. The final luminal area > 3.88 mm² obtained in the small reference-diameter segments is an independent indicator of event-free evolution. FUNDAMENTO: La eficacia de los stents farmacológicos para reducir los índices de eventos cardiacos no es la misma para todos los subgrupos de lesiones o pacientes. OBJETIVO: Evaluar la evolución clínica tardía de los pacientes sometidos a implante de stents farmacológicos en las lesiones ateroscleróticas de la arteria descendente anterior e identificar, entre las características clínicas, angiográficas y de ultrasonido intravascular, cuales son las que permiten predecir riesgos de eventos cardiacos MÉTODOS: De mayo de 2002 a agosto de 2005, se trataron a 205 pacientes con implante de 236 stents farmacológicos guiados por ultrasonido intravascular. RESULTADOS: Con un seguimiento promedio de 711 días, la tasa de trombosis del stent fue del 0,48%, la misma que se observó para infarto agudo de miocardio o cirugía de revascularización. La tasa de revascularización de la lesión tratada fue del 7,31% y la tasa global de eventos fue del 10,24%. Los indicadores de eventos, conforme análisis multivariada, fueron el implante de más de un stent en la misma arteria, lesiones concéntricas y área mínima intrastent medida por el ultrasonido intravascular menor que 3,88 mm². CONCLUSIÓN: Tomando como base los datos obtenidos con esta investigación, concluimos que la revascularización de la arteria descendente anterior con implante de stents farmacológicos, elegidos y optimizados por el ultrasonido intravascular, presenta un bajo índice de eventos tardíos. El implante de dos stents farmacológicos para el tratamiento de las lesiones largas fue el principal factor independiente para la ocurrencia de eventos tardíos. El área luminal final mayor que 3,88 mm², obtenida en los segmentos de pequeños diámetros de referencia es un indicador independiente de evolución libre de eventos.

The efficacy of pharmacological stents in decreasing the incidence of cardiac events is not homogeneous for all lesions or patient subgroups.1) To evaluate the late clinical evolution of patients submitted to pharmacological stent implantation in atherosclerotic lesions of the left anterior descending artery; 2) to identify, among the clinical, angiographic and intravascular ultrasonographic characteristics, the ones predictive of cardiac event risk.From May 2002 to August 2005, 205 patients were treated with 236 pharmacological stent implants, guided by the intravascular US (IVUS).After a mean follow-up period of 711 days, the rate of stent thrombosis was 0.48%, the same observed for acute myocardial infarction or revascularization surgery. The revascularization rate of the treated lesion was 7.31% and the general event rate was 10.24%. The event indicators, according to the multivariate analysis were the implant of more than one stent in the same artery, concentric lesions and the minimal intra-stent area measured by IVUS3.88 mm(2).Based on the data obtained, we conclude that the revascularization of the left anterior descending artery with pharmacological stent implant, chosen and optimized by IVUS, presents a low incidence of late events. The implant of two pharmacological stents for the treatment of long lesions was the main independent factor for the occurrence of late events. The final luminal area3.88 mm(2) obtained in the small reference-diameter segments is an independent indicator of event-free evolution.

Brugada syndrome is an inherited cardiac disorder associated with a specific electrocardiographic pattern, involving ST segment elevation in leads V1 to V3. When not spontaneously terminated, it can lead to ventricular fibrillation and sudden death. We present a case report of a young male whose brother suffered a sudden cardiac arrest while playing soccer. A novel mutation c.2678G>A was detected on the gene SCN5A through molecular diagnosis. The mutation was shown to be present in the individual, his daughter and his other brother. For patients with previous ventricular fibrillation and/or syncope, implantable cardiac device (ICD) is recommended. However, how can patients without symptoms but with a clear diagnosis prevent cardiac arrest?