Dual antiplatelet therapy with aspirin and clopidogrel is an essential treatment to prevent ischemic events in patients undergoing percutaneous coronary intervention (PCI). However, a significant interindividual variability exists in response to clopidogrel treatment, which is responsible for failure in the therapeutic effect and in the development of high residual platelet reactivity (HRPR). Prasugrel could reduce this prothrombotic state. Objectives To evaluate: 1) the antiaggregant response in clopidogrel or prasugrel pretreated patients undergoing successful PCI, and 2) the response to prasugrel loading in patients with low residual platelet reactivity on clopidogrel therapy. Material and Methods Eighty three patients were prospectively included in the study. They underwent successful PCI under dual antiplatelet therapy: aspirin plus clopidogrel (600 mg loading dose or a maintenance dose of 75 mg for more than 7 days; n=42) or prasugrel (60 mg loading dose or a maintenance dose of 10 mg for more than 7 days; n=41). The selection of thienopyridine was left at the discretion of the treating physician. Patients with high hemorrhagic risk were excluded. Platelet function was tested 12-24 hours after PCI with the VerifyNowTM P2Y12 Assay. High residual platelet reactivity (HRPR) was defined as P2Y12-reaction units (PRU) ≥ 230. In case of HRPR, patients received a loading dose of prasugrel 60 mg and platelet function was reassessed 2 hours later. Results Baseline characteristics did not differ in patients who initially received clopidogrel or prasugrel. At 12-24 hours post PCI, patients treated with prasugrel presented significantly less PRU compared with the clopidogrel cohort (median 49 (9-78) vs. 160 (82-224); p < 0.001). HRPR was observed in 24% of patients in the clopidogrel group and in no patients in the prasugrel cohort (p < 0.001). All patients with HRPR on clopidogrel treatment corrected this value after the loading dose of prasugrel. Conclusions After successful PCI, prasugrel administration achieved greater platelet inhibition compared to clopidogrel. Moreover, in patients with high-on treatment platelet reactivity with clopidogrel, optimal platelet inhibition was accomplished by additional prasugrel administration.

Introducción El tratamiento antiagregante dual con aspirina y clopidogrel constituye un tratamiento esencial para la prevención de eventos isquémicos en pacientes sometidos a angioplastia transluminal coronaria (ATC). Sin embargo, existe alta variabilidad interpaciente en la respuesta al clopidogrel, condicionando la falla en su efecto terapéutico, que se manifiesta como hiperreactividad plaquetaria residual (HPR). El prasugrel podría reducir este estado protrombótico. Objetivos 1) Estudiar la respuesta antiagregante en pacientes sometidos a ATC exitosa pretratados con clopidogrel o prasugrel y 2) evaluar la respuesta a una carga de prasugrel en pacientes con HPR bajo tratamiento con clopidogrel. Material y métodos Se incluyeron en forma prospectiva y consecutiva 83 pacientes sin riesgo hemorrágico alto sometidos a ATC exitosa bajo tratamiento antiagregante dual: aspirina más clopidogrel (600 mg de carga o mantenimiento de 75 mg/día por más de 7 días; n = 42) o prasugrel (60 mg de carga o mantenimiento de 10 mg/día por más de 7 días, n = 41). La selección de la tienopiridina quedó a cargo del médico tratante. La función plaquetaria se evaluó a las 12-24 horas pos-ATC con el método VerifyNow®. Se definió HPR a la presencia de ≥ 230 unidades de reactividad plaquetaria (URP). Los pacientes con HPR recibieron una dosis de carga de prasugrel de 60 mg y se repitió la evaluación de la función plaquetaria a las 2 horas. Resultados No hubo diferencias significativas en las características basales de ambos grupos. A las 12-24 horas pos-ATC, los pacientes tratados con prasugrel presentaron menos URP en comparación con el grupo clopidogrel [mediana 49 (9-78) vs. 160 (82-224); p < 0,001]. Se observó HPR en el 24% de los pacientes del grupo clopidogrel y cero en el grupo prasugrel (p < 0,001). Todos los pacientes con HPR bajo tratamiento con clopidogrel lograron corregirla luego de la carga de prasugrel. Conclusiones En pacientes sometidos a ATC exitosa, el tratamiento con prasugrel logró una mayor inhibición de la agregación plaquetaria (IAP) en comparación con la administración de clopidogrel. Por su parte, los pacientes con HPR bajo tratamiento con clopidogrel lograron alcanzar una IAP óptima con la administración adicional de prasugrel.

Background Aortic valve replacement is the treatment of choice in patients with aortic stenosis. However, a significant number of patients are not candidates for surgery due to high surgical risk and to the presence of comorbidities. Percutaneous aortic valve replacement represents an alternative option to conventional aortic valve surgery for selected high risk patients. Objective To inform about the initial experience with percutaneous aortic valve replacement with a self-expanding CoreValve® aortic valve prosthesis (Medtronic, Minneapolis, MN, USA). Material and Methods We conducted a multicenter registry including 21 patients with severe symptomatic aortic stenosis (aortic valve area < 1 cm²) and high surgical risk undergoing percutaneous aortic valve replacement in four high complexity cardiovascular centers. A multidisciplinary strategy was used involving several specialists: anesthesiologist, surgeon, diagnostic images specialists and interventional cardiologists. Results Mean age was 80.8±7.1 years (range: 63-90); 57% were men. Mean aortic valve area was 0.59±0.25 cm² and mean EuroSCORE was 18.1%±4%. The percentages of patients in functional class III and IV were 73% and 27%, respectively. The procedure was successful in 95.2% (20/21) of patients, with a pronounced reduction in peak transvalvular aortic gradient (from 82±14 mm Hg to 12±3 mm Hg; p <0,001); 14% of patients developed moderate to severe aortic regurgi-tation after the procedure. 85.5% of patients evolved to FC I. Definite pacemaker implantation was required in 38% (8/21). Procedure-related mortality was 4.7% and mortality after 30 days was 9.5%. One patient developed a minor stroke with complete recovery within a week. Four patients died in the long-term follow-up (median 7 months): 2 due to cardiac causes (cardiac mortality 19%) and 2 due to non-cardiac causes. Conclusions Percutaneous aortic valve replacement with CoreValve® aortic valve prosthesis is a feasible option for patients with high surgical risk that is associated with significant clinical improvement. The adequate selection of patients, improvement of the surgical technique and the development of new designs will increase the efficacy and safeness of the procedure.

Introducción La cirugía de reemplazo valvular aórtico es el tratamiento de elección en pacientes con estenosis aórtica. Sin embargo, en una proporción considerable de pacientes, el riesgo quirúrgico y la presencia de algunas comorbilidades, que aumentan este riesgo, impiden la cirugía. El reemplazo percutáneo de la válvula aórtica representa una alternativa a la cirugía valvular convencional para pacientes seleccionados de riesgo elevado. Objetivo Comunicar la experiencia inicial de reemplazo percutáneo de la válvula aórtica con prótesis autoexpandible CoreValve® (Medtronic, Minneapolis, MN, USA) en pacientes portadores de estenosis aórtica grave. Material y métodos Registro multicéntrico en el que se incluyeron 21 pacientes con estenosis aórtica grave (área < 1 cm²) sintomática y riesgo quirúrgico elevado sometidos a implante percutáneo en cuatro centros cardiovasculares argentinos de alta complejidad. Para el procedimiento se implementó una estrategia multidisciplinaria que involucró a diversos especialistas: anestesiólogo, cirujano, expertos en imágenes y cardiólogos intervencionistas. Resultados La edad media fue de 80,8 ± 7,1 años (rango: 63-90), el 57% de sexo masculino, área valvular media de 0,59 ± 0,25 cm² y EuroSCORE de 18,1% ± 4%. El 73% y el 27% de los pacientes se encontraban en clase funcional III y IV, respectivamente. El éxito del procedimiento fue del 95,2% (20/21), que se tradujo en una reducción pronunciada del gradiente pico transvalvular aórtico (82 ± 14 mm Hg a 12 ± 3 mm Hg; p < 0,001), mientras que el desarrollo posprocedimiento de regurgitación aórtica de grado moderado-grave fue del 14%. El 85,8% de los pacientes evolucionaron a clase funcional I. El requerimiento de marcapasos definitivo fue del 38% (8/21). La mortalidad del procedimiento y a los 30 días fue del 4,7% y del 9,5%, respectivamente; se observó un caso de accidente cerebrovascular isquémico menor con restitución ad integrum dentro de la semana. Se detectaron 4 óbitos en el seguimiento alejado (mediana 7 meses), dos de origen cardíaco (mortalidad cardíaca 19%) y otros dos de causa no cardíaca. Conclusiones El tratamiento de la estenosis aórtica grave en pacientes de riesgo quirúrgico elevado mediante reemplazo valvular percutáneo con prótesis CoreValve® es una alternativa factible que se asocia con una mejoría funcional notoria. La selección adecuada de pacientes, el perfeccionamiento de la técnica del procedimiento y el desarrollo de nuevos diseños incrementarán su eficacia y seguridad.

Background Inappropriate use of revascularization may be potentially harmful to patients and generate unwarranted costs to the health care system. Recently, the members of an expert panel conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. Objectives To identify the proportion of inappropriate coronary revascularization procedures -percutaneous (PTCA) and surgical (CABG) - in a cardiovascular tertiary referral center according to appropriateness criterion. Material and Methods We consecutively included all patients referred to our center for coronary angiography from January to May 2009 with a significant coronary stenosis (≥ 70%) who underwent percutaneous or surgical revascularization, and evaluated the rate of inappropriate revascularization according to appropriateness criterion recently published. Results From a total of 568 coronary angiographies, 404 (71.2%) had at least a coronary stenosis ≥70%; 81 patients underwent CABGS (20%) and 295 PTCA (73%). In these 376 revascularized patients, the indication was considered inappropriate in 15 (4%), all of them in the PTCA group (15/295; 5%), while only 2 patients with multivessel disease (n=172, 1.2%) underwent inappropriate revascularization. Conclusions In a cardiovascular tertiary referral center, the proportion of inappropriate coronary revascularization procedures (percutaneous or surgical) was low. Appropriateness criterion may be an applicable tool for decision-making in patients with coronary artery disease and for quality control in the departments of cardiology

Introducción Una revascularización coronaria inapropiada conlleva un riesgo muchas veces evitable para el paciente y se traduce en gastos innecesarios para el sistema de salud. Recientemente, los miembros de un panel de expertos en enfermedades cardiovasculares evaluaron el criterio de adecuación de la indicación de revascularización coronaria en varios escenarios clínicos comunes. Objetivos Identificar la proporción de revascularización coronaria inapropiada tanto percutánea (ATC) como quirúrgica (CRM) conforme al criterio de adecuación en un centro de alta complejidad cardiovascular. Material y métodos Desde enero hasta mayo de 2009 se incluyeron en forma consecutiva todos los pacientes derivados a nuestro centro con la indicación clínica de coronariografía que presentaron enfermedad coronaria significativa (estenosis ≥ 70%) y fueron sometidos a revascularización percutánea o quirúrgica. Se evaluó en este grupo la tasa de indicación inapropiada de revascularización coronaria conforme el criterio de adecuación recientemente publicado. Resultados De 568 cateterismos evaluados, 404 (71,2%) presentaron al menos una lesión ≥ 70% de estenosis, 81 pacientes fueron sometidos a CRM (20%) y 295 a ATC (73%). Del total de 376 pacientes revascularizados, la indicación de revascularización coronaria se consideró inapropiada en 15 (4%), todos ellos del grupo ATC (15/295; 5%), mientras que en el grupo de pacientes multiarteriales (n = 172) sólo 2 (1,2%) revascularizaciones resultaron inapropiadas. Conclusiones El criterio de adecuación de revascularización coronaria (percutánea o quirúrgica) en un centro cardiovascular de alta complejidad ha resultado inapropiado en una minoría de los casos. Dicho criterio representa una herramienta potencialmente aplicable tanto en la toma de decisiones en pacientes con enfermedad coronaria como en el control de calidad de los servicios de cardiología.

INTRODUÇÃO: O uso de tromboaspiração manual demonstrou melhorar a reperfusão miocárdica durante a intervenção percutânea primária. Entretanto, a população adequada para esse tratamento ainda não foi bem estabelecida. Este estudo teve como objetivo determinar a taxa de utilização e a seleção de pacientes para tromboaspiração manual durante intervenção percutânea primária. MÉTODO: No período de julho de 2008 a fevereiro de 2009, incluímos 183 pacientes com intervenção percutânea primária de oito centros argentinos em um registro prospectivo de infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). As características clínicas, angiográficas e do procedimento e os desfechos clínicos foram comparados entre os pacientes tratados com e sem tromboaspiração manual. RESULTADOS: A tromboaspiração manual foi utilizada em 20,8% dos pacientes. As características clínicas basais foram, em geral, semelhantes entre os pacientes tratados com e sem tromboaspiração manual. Entretanto, os pacientes tratados com tromboaspiração manual tinham pior função renal pré-procedimento e maior somatória de supradesnivelamento do segmento ST basal (12,2 ± 7,7 mm vs. 10,2 ± 8,6 mm; P = 0,06). O grupo com tromboaspiração manual apresentou maior proporção de pacientes com trombo graus 4-5 (86,8% vs. 49%; P < 0,01), maior fluxo TIMI 0 basal (tromboaspiração manual: 63,2% vs. 40,7%; P = 0,03), maior diâmetro do vaso (3,46 ± 0,5 mm vs. 3,12 ± 0,5 mm; P = 0,01), e maior utilização de filtro distal (13,1% vs. 0,7%; P = 0,04) e de balão intra-aórtico (10,5% vs. 3,4%; P = 0,05), assim como de inibidores da glicoproteína IIb/IIIa (39,5% vs. 14,5%; P = 0,04). A taxa de resgate de material aterotrombótico macroscópico foi de 76,3%. Embora o grupo com tromboaspiração manual apresentasse pico mais elevado de creatina fosfoquinase (tromboaspiração manual: 3.195,9 ± 2.598 UI/ml vs. 1.757,6 ± 1.806,6 UI/ml; P = 0,02), a porcentagem de resolução do segmento ST e o fluxo TIMI 3 final não foram diferentes entre os grupos. A taxa de eventos cardiovasculares adversos maiores no acompanhamento foi semelhante (21,1% vs. 15,2%; P = 0,36). CONCLUSÃO: O emprego da tromboaspiração manual na prática diária em paciente com IAMCSST destina-se a pacientes de maior complexidade tanto clínica como angiográfica, acarretando, no final, resultados clínicos semelhantes aos de pacientes não tratados com tromboaspiração manual.

BACKGROUND: Manual thrombus-aspiration has proven to improve myocardial reperfusion during primary percutaneous coronary intervention. However, the adequate population for this approach has not been well established. The aim of this study was to determine the frequency and patient selection for thrombus-aspiration during primary percutaneous coronary intervention. METHOD: From July 2008 to February 2009, we included 183 patients submitted to primary percutaneous coronary intervention from eight Argentinean centers in a prospective ST-segment elevation myocardial infarction (STEMI) registry. Baseline characteristics as well as clinical and angiographic outcomes were compared among patients treated with and without thrombus-aspiration. RESULTS: Manual thrombus-aspiration was used in 20.8% of the patients. Baseline clinical characteristics were similar among patients treated with and without thrombus-aspiration. However, thrombus-aspiration treatment was associated with worse baseline renal function and greater baseline ST-segment elevation (thrombus-aspiration: 12.2 ± 7.7 mm vs. 10.2 ± 8.6 mm; P = 0.06). The thrombus-aspiration group had a higher rate of patients with grade 4-5 thrombus (86.8% vs. 49%; P < 0.01) and baseline TIMI flow 0 (thrombus-aspiration 63.2% vs. 40.7%; P = 0.03), greater vessel diameter (3.46 ± 0.5 mm vs. 3.12 ± 0.5 mm; P = 0.01), use of distal filter (13.1% vs. 0.7%; P = 0.04) and use of intra-aortic balloon (10.5% vs 3.4%; P = 0.05), as well as glycoprotein IIb/IIIa inhibitor administration (39.5% vs. 14.5%; P = 0.04). Debris was retrieved from 76.3% of the patients. Although the thrombus-aspiration group had higher CK levels (thrombus-aspiration: 3195.9 ± 2598 UI/ml vs. 1757.6 ± 1806.6 UI/ml; P = 0.02), the percentage of ST-segment resolution and final TIMI 3 flow did not differ between groups. The follow-up rate of major cardiovascular events was similar for both groups (thrombusaspiration: 21.1% vs. 15.2%; P = 0.36). CONCLUSION: Routine thrombus-aspiration in patients with STEMI is used in patients with higher clinical and angiographic complexity, leading to similar overall clinical results as those not treated with thrombus-aspiration.

FUNDAMENTO: A superioridade da angioplastia primária em relação aos fibrinolíticos já foi amplamente demonstrada em diversos estudos, mas, muitas vezes, por questões logísticas, observamos retardo na incorporação das recomendações nos diversos cenários de vida real. Comparamos o desempenho da angioplastia primária no Registro SOLACI em três períodos a partir de 1995. MÉTODO: O Registro SOLACI incluiu dados de 43.725 angioplastias primárias realizadas nos períodos de 1995-1997 (n = 6.793), 2000-2003 (n = 23.007) e 2007-2008 (n = 13.925). RESULTADOS: Observamos complexidade crescente dos pacientes tratados, com incremento do porcentual de mulheres, diabéticos, e pacientes com infarto agudo do miocárdio prévio e com disfunção ventricular moderada a grave. O sucesso do procedimento manteve-se elevado (> 91%) em todos os períodos, independentemente do instrumental utilizado. Adicionalmente, notamos diminuição expressiva do tempo porta-balão, uso crescente dos stents e redução de 45% na utilização dos inibidores da glicoproteína IIb/IIIa. No que tange à evolução hospitalar, em comparação ao período de 1995-1997, observamos, nos períodos de 20002003 e 2007-2008, decréscimo da mortalidade (9,1% vs. 5,3% e 4,5%) e redução do reinfarto (4,1% vs. 2,6% e 2,7%) e da necessidade urgente de nova revascularização (3,5% vs. 0,7% e 0,7%). CONCLUSÃO: Apesar do perfil de risco mais complexo, a incorporação dos avanços tecnológicos e a redução do tempo porta-balão resultaram em melhora dos desfechos cardíacos hospitalares pós-angioplastia primária na América Latina.

INTRODUCTION: The superiority of primary angioplasty compared to fibrinolytic agents has been broadly demonstrated in different studies, but due to logistic issues we have observed a delay in the implementation of the recommendations in real world scenarios. We compared primary angioplasty results at three different timepoints in the SOLACI Registry. METHOD: The SOLACI Registry included data of 43,725 primary angioplasties carried out from 1995-97 (n = 6,793), 2000-03 (n = 23,007) and 2007-08 (n = 13,925). RESULTS: An increasing complexity of treated patients was observed, with an increment in the percentage of women, diabetics, patients with prior myocardial infarction and patients with moderate to severe ventricular dysfunction. Procedural success remained high (> 91%) at all timepoints, regardless of the device used. In addition, we observed a significant decrease of door-to-balloon time, increased use of stents and a 45% decrease in the use of glycoprotein IIb/IIIa inhibitors. Regarding in-hospital outcomes, a decreased mortality (9.1% vs. 5.3% vs. 4.5%), reinfarction (4.1% vs. 2.6% vs. 2.7%) and target vessel revascularization procedures (3.5% vs. 0.7% vs. 0.7%) was observed. CONCLUSION: Despite the more complex risk profile, the incorporation of technological advances and the reduction of door-to-balloon time led to improved inhospital cardiac outcomes after primary angioplasty in Latin America.

Introduction Age is an independent risk predictor in patients with coronary disease. This could be explained by the lack of adaptation to acute myocardial ischemia. Preconditioning is a mechanism whereby repeated ischemia episodes induce in the myocardium an increased tolerance to further episodes. Objective To assess the development of ischemic preconditioning in elderly patients. Material and methods Sixty five patients who underwent elective coronary angioplasty were enrolled (<70 years [n=47] and ³70 years [n=18]). Preconditioning development was assessed during three periods of coronary occlusion. ST elevation at the end of each dilation was measured by intra coronary EKG, and ST resolution percentage after the third dilation was recorded and compared to the maximum recorded value. Data are presented as mean and inter-quartile interval 25/75%. Results There were no significant differences in the clinical baseline characteristics. The maximum ST recorded, ST after the third dilation and ST resolution percentage were 14 (9/24) mm, 8 (4/14) mm y 23.8% (0/55.5) for the young patients and 9.5 (5/ 18) mm (p = ns), 6.5 (4/16) mm (p=ns) and 5.5% (0/20) (p=0.04) for the elderly. Upon stratification per age group, the ration of patients that reached an ST resolution ≥ 50% showed a linear distribution by chi square for trend (p=0.025). Conclusions Our study suggests that ischemic preconditioning would be decreased in elderly patients. The functionality of this mechanism would progressively decrease with aging.

Introducción La edad es un predictor independiente de riesgo en pacientes con enfermedad coronaria. Esto podría explicarse por la falta de adaptación a la isquemia miocárdica aguda. El precondicionamiento es un mecanismo por el cual episodios repetitivos de isquemia inducen en el miocardio una tolerancia mayor a episodios subsiguientes. Objetivo Evaluar el desarrollo de precondicionamiento isquémico en pacientes añosos. Material y métodos Se incluyeron 65 pacientes sometidos a angioplastia coronaria electiva (< 70 años [n = 47] y ≥ 70 años [n = 18]). Se evaluó el desarrollo de precondicionamiento durante tres períodos de oclusión coronaria. Por ECG intracoronario se midió la elevación del ST al final de cada dilatación y se registró el porcentaje de resolución del ST a la tercera dilatación respecto del máximo valor registrado. Los datos se presentan como mediana e intervalo intercuartil 25/75%. Resultados No hubo diferencias significativas en las características clínicas basales. El máximo ST registrado, el ST a la tercera dilatación y el porcentaje de resolución del ST fueron 14 (9/24) mm, 8 (4/14) mm y 23,8% (0/55,5) para los pacientes jóvenes y 9,5 (5/18) mm (p = ns), 6,5 (4/ 16) mm (p = ns) y 5,5% (0/20) (p = 0,04) para los añosos. Al estratificar por grupos etarios, la proporción de pacientes que alcanzaron una resolución del ST ≥ 50% mostró una distribución lineal por chi cuadrado de tendencia (p = 0,025). Conclusiones Nuestro estudio sugiere que el precondicionamiento isquémico se encontraría disminuido en pacientes añosos. La funcionalidad de este mecanismo menguaría en forma progresiva con el envejecimiento.

Background Randomized studies have shown the superiority of drug eluting stents (DES) compared to conventional stents (CS). In our country, the information available regarding implantation of DES is scarce. Objective To compare the clinical results obtained in patients implanted with a DES versus a CS in a tertiary center of Argentina. Material and methods All patients undergoing elective angioplasty from April 2003 until June 2005 were included, and divided in two groups: patients subjected to implant of one or more DES (group DES, n = 373) and patients subjected to the implant of a CS (group CS, n = 857). Results Basal characteristics were similar in both groups. The group with DES had a higher percentage of anterior descending artery lesions (50.6 versus 40.6%; p < 0.001) and intrastent restenosis lesions (16.6 versus 8.7%; p < 0.001), as well as a smaller vessel size (3.01 ± 0.57 versus 3.11 ± 0.57; p = 0.068) and a greater lesion length (20.6 ± 9.0 versus15.9± 7.8, p < 0.001) than the group with CS. As to implanted stents, their total length was greater (36.7 ± 18.1 versus 28.2 ± 17.7; p = 0.002) and their mean diameter was smaller in the DES group than in the CS group (3.09 ± 0.47 versus 3.17 ± 0.44; p = 0.007). At 30 days follow up, the rate of death, infarction and emergency revascularization was similar. At one year, in the DES group, the incidence of new revascularizations decreased (7.2% versus 11.7%; > 0.001), secondary to a reduction in the rate of coronary surgery (1.4% versus 5.8%; p = 0.045). Conclusion The assessment of DES implantation in a tertiary center of Argentina showed that it is safe and, compared to implantation of CS, led to a lower reintervention rate, mainly by reducing the rate of revascularization surgery.

Antecedentes Estudios aleatorizados demostraron la superioridad del uso de stents liberadores de droga (SL) sobre el stent convencional (SC). La información en nuestro medio sobre el implante de SL es escasa. Objetivo Comparar los resultados clínicos obtenidos en pacientes sometidos a implante de SL versus SC en un centro terciario de la Argentina. Material y métodos Se incluyeron todos los pacientes sometidos a angioplastia electiva desde abril de 2003 hasta junio de 2005 y se dividieron en dos grupos: los pacientes sometidos a implante de uno o más SL (grupo SL, n = 373) y los sometidos solamente a implante de SC (grupo SC, n = 857). Resultados Las características basales fueron similares entre los dos grupos. En el grupo SL se observó un porcentaje mayor de lesiones en la arteria descendente anterior (50,6 versus 40,6%; p< 0,001) y de lesiones tipo reestenosis intrastent (16,6 versus 8,7%; p < 0,001) junto con un tamaño menor del vaso (3,01 ± 0,57 versus 3,11 ± 0,57; p = 0,068) y una longitud mayor de la lesión (20,6 ± 9,0 versus 15,9 ± 7,8; p < 0,001) que en el grupo SC. En cuanto a los stents implantados, su longitud total fue mayor (36,7 ± 18,1 versus 28,2 ± 17,7; p = 0,002) y su diámetro promedio fue menor en el grupo SL que en el SC (3,09 ± 0,47 versus 3,17 ± 0,44; p = 0,007). Se observó una tasa similar de muerte, infarto y revascularización de urgencia a los 30 días de seguimiento. Al año, en el grupo SL se redujo la incidencia de nuevas revascularizaciones (7,2% versus 11,7%; p > 0,001), gracias a una reducción de la tasa de cirugía coronaria (1,4% versus 5,8%; p = 0,045). Conclusión El uso de SL en un centro terciario de la Argentina demostró que es seguro y, en comparación con el implante de sólo SC, dio por resultado una tasa menor de reintervención, primariamente por haber reducido la tasa de cirugía de revascularización miocárdica.