Evaluación y manejo actual de la enfermedad del tronco coronario izquierdo
Palabras clave:
Enfermedad de la arteria coronaria principal izquierda, revascularización miocárdica, intervención coronaria percutánea, puente aortocoronario.Resumen
Introducción: En la última década ha aumentado notablemente el manejo de la enfermedad del tronco coronario izquierdo, mediante el intervencionismo coronario percutáneo. Esto se debe a que múltiples metaanálisis y ensayos clínicos aleatorizados han mostrado que esta técnica constituye una alternativa aceptable a la cirugía de revascularización miocárdica.
Objetivo: Describir la evaluación y el manejo actual de la enfermedad del tronco coronario izquierdo.
Resultados: Una lesión en el tronco coronario izquierdo se considera angiográficamente significativa cuando es ≥ 50 %. En las estenosis intermedias o ambiguas (30-69 %), la decisión de revascularización no debe basarse únicamente en la estimación visual angiográfica, sino en una evaluación integral que incluya técnicas de imagen intravascular, estudios fisiológicos y la identificación de marcadores clínicos no invasivos de alto riesgo. Una estenosis igual o superior al 70 % constituye un umbral razonable para indicar revascularización sin requerir otros criterios complementarios. Basados en la evidencia actual, tanto la intervención coronaria percutánea como la cirugía de revascularización miocárdica constituyen modalidades terapéuticas seguras y eficaces, con resultados comparables en términos de supervivencia. No obstante, la intervención percutánea se asocia con más eventos isquémicos y mayor necesidad de revascularización en el seguimiento.
Conclusiones: Dado que, tanto el intervencionismo coronario percutáneo como la cirugía de revascularización miocárdica desempeñan un papel fundamental en el tratamiento de la enfermedad del tronco coronario izquierdo, la toma de decisiones respecto al método de revascularización óptimo en cada paciente debe recaer en un equipo multidisciplinario de expertos en el manejo de esta entidad.
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