Ecocardiografia de estresse com dobutamina e atropina para avaliação de estenose intra-stent em pacientes submetidos à angioplastia com implante de prótese intracoronária na vigência do infarto agudo do miacárdio

Abstract

Coronary angioplasty with stenting has been performed as elective procedure during acute myocardial infarction. Intra-stent stenosis is important complication related to this treatment and diagnostic accuracy for such event is still unreached. Objective. To assess value of dobutamine- atropine stress echocardiography as an intra-stent stenosis diagnostic method in patients who underwent primary stenting. Material and methods. This is an observable, retrospective and sequential study. Trial includes 23 stenting primary angioplasty patients who underwent subsequent EED-A and coronary arteriography follow-up at Prontocardio Hospital, between 1998 and 2002. Patients with cardiogenic shock and some who underwent cardiopulmonary resuscitation were eligible for this study. Analyses of variables were performed in accordance with the Fisher-Freeman-Haltin method at a 0.05 levei, and coronary arteriography was applied as the gold standard to assess diagnostic accuracy of EED-A. Results. Of 23 stenting primary angioplasty patients, 11 showed negative EED-A and underwent subsequent coronary arteriography because of angina, 1 had intra-stent stenosis (faulty negative result), and 12 showed positive EED-A. In this positive group, coronary arteriography demonstrated intra-stent stenosis in 5 patients, lack of lesions in the stenting artery in 2 patients (fautly positive result), and stenosis in the stenting artery, but distant from stent, in 5 patients. Latter 5 patient group was excluded from this trial, meaning to procure EED-A accuracy levei. Foliowing values were assessed: sensitivity was 83.3%, specificity was 83.3%, negative predictive value was 90.9% and positive predictive value was 71.4%. Conclusion. By considering coronary arteriography the gold standard, EED-A has proved to be a safe diagnostic method for the diagnosis of intra-stent stenosis, in patients who underwent primary stenting.