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RESUMEN

Con el objeto de conocer las características de la atención contemporánea (los factores de riesgo, la terapéutica utilizada y la respuesta a ésta) en enfermos con Síndrome Isquémico Coronario Agudo [SICA] con y sin elevación del segmento ST en México se realizó el Registro Nacional de los SICA [RENASICA]. Participaron 18 centros hospitalarios de segundo y tercer nivel, capturándose 4,253 enfermos de enero 1998 a septiembre del 2001; 2,773 con SICA sin elevación del ST (65.2%) y 1,480 con elevación del ST (34.8%). Hallazgos: el dolor precordial fue la causa principal de ingreso (90.5%) y el 50% ya lo había tenido. El mayor número de casos ocurrió en la sexta década de la vida. La prevalencia de la diabetes y de la hipertensión no fue superior a la informada en México para la población general. La edad, el infradesnivel del segmento ST [› 2 mm], los valores de CK-MB [› 2 veces del normal] y la extensión de la enfermedad coronaria [lesiones › 75%] fueron los marcadores de riesgo de muerte y muerte asociada al infarto. La fibrinólisis en los SICA con ESST se utilizó en el 50.4% de los candidatos a este tratamiento. Sólo en el 58% de los propuestos para estudio hemodinámico se pudo concretar el procedimiento y el 55% requirió intervencionismo coronario. La aspirina (ASA) y la heparina se administraron por más de 24 horas en el 70% de los enfermos, egresándose en un porciento similar con ASA. Se registró muy bajo uso de la heparina de bajo peso molecular y de los inhibidores de la glucoproteína IIb/IIIa. RENASICA aporta datos de los SICA a las autoridades de la salud en México que le permitirán ayudar a decidir sobre la aplicabilidad de los recursos médicos y los del intervencionismo coronario en su tratamiento.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Causas de mortalidad en México 2000. Estadísticas de Mortalidad, Secretaría de Salud. http://www.ssa.gob.mx.

2. Braunwald E, Mark DB, Jones RH: Unstable angina: diagnosis and management. Rockville, MD: Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, US Public Health Service, US Department of Health and Human Services; 1994: 1. AHCPR Publication 94-0602.

3. National Center for Health Statistics. Detailed diagnoses and procedures: National Hospital Discharge Survey, 1996. Hyattsville, MD: National Center for Health Statistics; 1998: 13. Data from Vital and Health Statistics.

4. Nourjah P: National Hospital Ambulatory Medical Care Survey:1997 emergency department summary. Hyattsville, MD: National Center for Health Statistics; 1999: 304. Advance data from Vital and Health Statistics.

5. Anderson HV, Cannon CP, Stone PH, Williams DO, McCabe CH , Knatterud GL, et al: One-year results of the Thrombolysis In Myocardial Infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. J Am Coll Cardiol 1995; 26: 1643-1650.

6. Davies MJ, Thomas AC, Knapman PA, Hangartner JR: Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. Circulation 1986; 73: 418–427.

7. Frink RJ, Rooney PA Jr, Trowbridge JO, Rose PJ: Coronary thrombosis and platelet/fibrin microemboli in death associated with acute myocardial infarction. Br Heart J 1988; 59: 196–200.

8. Furman MI, Dauerman HL, Goldberg RJ, Yarzbeski J, Lessard D, Gore JM: Twenty –Two Year (1975 to 1997) Trens in the Incidence , In –Hospital and long-term Case fatality Rates From Initial Q-wave and non-Q-wave Myocardial Infarction: A Multi –Hospital ,Community –Wide Perspective. J Am Coll Cardiol 2001; 37: 1571–1580.

9. Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis DL, Hiratzka LF, et al: ACC/AHA Guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). 1999 update. Localizable en: http://www.acc.org/clinical/guidelines/ami.html

10. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al: ACC/ AHA Guidelines for the managements of patients with unstable angina and non-ST segment elevation MI: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Unstable Angina). J Am Coll Cardiol 2000; 36: 970–1062.

11. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes RJ: National Academy of Clinical Biochemistry Standards of Laboratory Practice recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem 1999; 45: 1104-1121.

12. Braunwald E: Unstable angina: an etiologic approach to management (Editorial). Circulation 1998; 98: 2219-2222.

13. Braunwald E: Unstable angina classification. Circulation 1989; 80: 410-414.

14. Campeau L: Grading of angina pectoris (Letter). Circulation 1976; 54: 522-533.

15. PURSUIT Trial Investigators: Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med 1998; 339: 436-443.

16. Selker HP, Beshansky JR, Griffith JL: Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia: a multicenter, controlled clinical trial. Ann Intern Med 1998; 129: 845-855.

17. Ghali JK, Cooper RS, Kowatly I, Liao Y: Delay between onset of chest pain and arrival to the coronary care unit among minority and disadvantaged patients. J Natl Med Assoc 1993; 85: 180-184.

18. Altman DG: Practical statistics for medical research. London: Chapman and Hall; 1991.

19. Hargarten K, Chapman PD, Stueven HA: Prehospital prophylactic lidocaine does not favorably affect outcome in patients with chest pain. Ann Emerg Med 1990; 19: 1274-1279.

20. Eagle KA, Goodman SG, Avezum A for the GRACE investigators: Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet 2002; 359: 373-377.

21. Newby LK, Califf RM, Guerci A, Weaver DW, Col J, Horgan JH, et al: Early discharge in the thrombolytic era: an analysis of criteria for uncomplicated infarction from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) trial. J Am Coll Cardiol 1996; 27: 625-632.

22. Maynard C, Weaver WD, Lambrew C, Bowlby LJ, Rogers WJ, Rubison RM, for participants in the National Registry of Myocardial Infarction: Factors influencing the time to administration of thrombolytic therapy with recombinant tissue plasminogen activator (data from the National Registry of Myocardial Infarction). Am J Cardiol 1995; 76: 548-552.

23. Weaver WD, Cerqueira M, Hallstrom AP: Prehospital-initiated vs hospital-initiated thrombolytic therapy: the Myocardial Infarction Triage and Intervention Trial. JAMA 1993; 270: 1211-1216.

24. Pope JH, Ruthazer R, Beshansky JR, Griffith JL, Selker HP: Clinical features of emergency department patients presenting with symptoms suggestive of acute cardiac ischemia a multicenter study. J Thromb Thrombolysis 1998; 6: 63-74.

25. Theroux P, Fuster V: Acute coronary syndromes: unstable angina and non–Q-wave myocardial infarction. Circulation 1998; 97: 1195-1206.

26. Savonitto S, Ardissino D, Granger C, Morando G, Prando MD, Mafrici A, et al: Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA 1999; 281: 707–713.

27. Cannon CP, Thompson B, McCabe C, Mueller HS, Kirshenbaum JM, Herson S, et al: Predictors of non-Q-wave acute myocardial infarction in patients with acute ischemic syndromes: an analysis from the thrombolysis in myocardial ischemia (TIMI ) III trials. Am J Cardiol 1995; 75: 977-981.

28. Antman EM: Troponin Measurements in Ischemic Heart Disease: More Than Just a Black and White Picture. J Am Coll Cardiol 2001; 38: 987-990.

29. Antman EM, Cohen M, Bernink PJLM, McCabe CH, Horacek T, Papuchis G, et al: The TIMI risk score for unstable angina – non ST-elevation MI: a method for prognostication and therapeutic decision-making. JAMA 2000; 284: 835- 842.

30. SHEP Cooperative Research Group: Prevention of stroke by anti-hypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255-3264.

31. Cohen M, Stinnett S, Weatherley B, Gurfinkel EP, Fromell G, Goodman SG, et al: Predictors of recurrent ischemic events and death in unstable coronary artery disease after treatment with combination antithrombotic therapy. Am Heart J 2000; 139: 962-970.

32. Chaitman BR, Bourassa MG, Davis K, Rogers WJ, Tyras DH, Berger R, et al: Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation 1981; 64: 360-367.

33. Pryor DB, Harrell FEJ, Lee KL, Califf RM, Rosati RA: Estimating the likelihood of significant coronary artery disease. Am J Med 1983; 75: 771-780.

34. Pryor DB, Shaw L, McCants CB, Lee KL, Mark DB, Harrell FE, et al: Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med 1993; 118: 81-90.

35. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al: ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol 1999; 33: 2092-2197.

36. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L: Acute chest pain in the emergency room: identification and examination of low-risk patients. Arch Intern Med 1985; 145: 65-69.

37. Pozen MW, D’Agostino RB, Selker HP, Sytkowski PA, Hood WBJ: A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial. N Engl J Med 1984; 310: 1273-1278.

38. Selker HP, Griffith JL, D’Agostino RB: A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use: a time-insensitive predictive instrument (TIPI) for acute cardiac ischemia a multicenter study [erratum appears in Med Care 1992; 30: 188]. Med Care 1991; 29: 610-627.

39. Brieger DB, Mak KH, White HD, Kleiman NS, Miller DP, Vahanian A, et al: Benefit of early sustained reperfusion in patients with prior myocardial infarction (the GUSTO-I trial). Global Utilization of Streptokinase and TPA for Occluded Arteries. Am J Cardiol 1998; 81: 282-287.

40. Hochman JS, Tamis JE, Thompson TD, Weaver D, White HD, Van de Werf F, et al: for the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med 1999; 341: 226-232.

41. Hochman JS, McCabe CH, Stone PH, Becker RC, Cannon CP, DeFeo-Fraulini T, et al. for the TIMI Investigators: Thrombolysis In Myocardial Infarction. Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB. J Am Coll Cardiol 1997; 30: 141-148.

42. Juárez UH, Lasses LA, Martín RP, Luna JG, López MCR, Chuquiure EV, et al: Utilidad de la determinación cualitativa rápida de troponina T, fracción MB de creatina fosfocinasa y mioglobina en los síndromes isquémicos coronarios agudos. Arch Inst Cardiol Méx 1998; 68: 473–481.

43. Ross AM, MolhoeK P, Lundergan C: Randomized comparison of enoxaparin, a low-molecular –weight heparin, with unfarctionated heparin adjuntive to recombinant tissue plasminogen activator thrombolysis and aspirin: second trial of heparin and aspirin reperfusion therapy (HEART II). Circulation 2001; 22: 13-22.

44. Antman EM, Louwerenburg HW, Baars HF, Wesdorp JCL, Hamer B, Bassand J-P, et al. for the ENTIRE – TIMI 23 Investigators: Enoxaparin as adjunctive antithrombin therapy for ST-Elevation myocardial infarction: Results of the ENTIRE – Thrombolysis in Myocardial Infarction (TIMI ) 23 trial. Circulation 2002; 105: 1642–1649.

45. Holmes DRJ, White HD, Pieper F, Ellis SG, Califf RM, Topol EJ: Effect of age on outcome with primary angioplasty versus thrombolysis. J Am Coll Cardiol 1999; 33: 412-419.

46. White HD, Barbash GI, Califf RM, Simes JR, Granger CB, Weaver D, et al: Age and outcome with contemporary thrombolytic therapy: results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation 1996; 94: 1826-1833.

47. Mak KH, Moliterno DJ, Granger CB, Miller DP, White HD, Wilcox RG, et al. for the GUSTO-I Investigators: Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. J Am Coll Cardiol 1997; 30: 171-179.

48. Jerjes–Sánchez C, Arriaga–Nava R, Martínez–Enriquez: Accelerated versus standard streptokinase infusion in acute myocardial infarction. Chest 1996; 110: 107S.

49. Martínez–Sánchez C, Domínguez JL, Aguirre SJ, Carrillo J, Chuquiure EV, Franco J, et al: Tratamiento del infarto agudo al miocardio con rt-PA en 60 minutos . Estudio Cooperativo. Arch Inst Cardiol Méx1997; 67: 126-131.

50. Jerjes–Sánchez C, Garza-Ruíz A, Gutierrez-Fajardo P: Trombólisis farmacológica en el infarto agudo del miocardio: lecciones aprendidas después del ISSIS –2 y GUSTO I. (Parte I). Arch Inst Cardiol Méx1999; 69: 478-487.

51. Jerjes –Sánchez C, Garza Ruíz A, Gutierrez-Fajardo P: Trombólisis farmacológica en el infarto agudo del miocardio: lecciones aprendidas después del ISSIS –2 y GUSTO I. (Parte II). Arch Inst Cardiol Méx 1999; 69: 570-579.

52. Juárez –Herrera U, Lasses LA, López MC, Chuquiure E, Gónzalez PH, Carrillo CJ, et al: Resultados del enfermo con infarto agudo del miocardio con terapia trombolítica. Experiencia en 473 enfermos de la unidad coronaria del Instituto Nacional de Cardiología “Ignacio Chávez”. Arch Inst Cardiol Méx1998; 68: 411-420.

53. Carrillo CJ, Chuquiure E, Martínez –Sánchez C, Gónzalez PH, Jáuregui L, Juárez –Herrera U, et al: Análisis de la permeabilidad de la arteria responsable del infarto miocárdico agudo. Arch Inst Cardiol Méx 1997; 67: 186-194 .

54. Hochman JS, Sleeper LA, Godfrey E, McKinlay SM, Sanborn T, Col J, et al. for the SHOCK Trial Study Group.: Should we emergently revascularize Occluded Coronaries for Cardiogenic ShocK: an international randomized trial of emergency PTCA/CABG-trial design. Am Heart J 1999; 137: 313–321.

55. Holmes DR Jr, Berger BP, Hochman JS, Granger CB, Thompson TD, Califf RM, et al: Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation 1999; 100: 2067–2073.

56. Rouan GW, Lee TH, Cook EF, Brand DA, Weisberg MC, Goldman L: Clinical characteristics and outcome of acute myocardial infarction in patients with initially normal or nonspecific electrocardiograms (a report from the Multicenter Chest Pain Study). Am J Cardiol 1989; 64: 1087-1092.

57. Zaacks SM, Liebson PR, Calvin JE, Parrillo JE, Klein LW: Unstable angina and non–Q wave myocardial infarction: does the clinical diagnosis have therapeutic implications? J Am Coll Cardiol 1999; 33: 107-118.

58. Lee TH, Cook EF, Weisberg MC, Rouan GW, Brand DA, Goldman L: Impact of the availability of a prior electrocardiogram on the triage of the patient with acute chest pain. J Gen Intern Med 1990; 5: 381-388.

59. Fesmire FM, Percy RF, Wears RL: Diagnostic and prognostic importance of comparing the initial to the previous electrocardiogram in patients admitted for suspected acute myocardial infarction. South Med J 1991; 84: 841-6.

60. Adams JE, Abendschein DR, Jaffe AS: Biochemical markers of myocardial injury: is MB creatine kinase the choice for the 1990s? Circulation 1993; 88: 750-763.

61. Gomez-Villalobos M, Vargas-Barrón J, Romero-Cárdenas A, Rijlaarsdam M, Keirns C, Lupi-Herrera E, et al: Right Atrial and Ventricular Infarction: Evaluation with Transesophageal Echocardiography. Echocardiography 1995; 12: 129-137.

62. Battler A, Slutsky R, Karliner J, Froelicher V, Ashburn W, Ross J Jr: Left ventricular ejection fraction and first third ejection fraction early after myocardial infarction: value for predicting mortality and morbidity. Am J Cardiol 1980; 45: 197–202.

63. Zornoff LAM, Skali H, Pfeffer MA, St. John SM, Rouleau JL, Lamas GA, et al. for the SAVE Investigators: Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol 2002; 39: 1450–1455.

64. Lupi –Herrera E, Lasses LA, Cosio-Aranda J, Chuquiure-Valenzuela E, Martínez –Sánchez C, Ortíz P, et al: Acute right ventricular infarction: clinical spectrum, results of reperfusion therapy and short-term prognosis. Coron Artery Dis 2002; 13: 57-64.

65. Boerma E, Harrington RA, Moliterno DJ, White H, Teroux P, Van de Werf F, et al: Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-anlysis of all major randomized trials. Lancet 2002; 359: 189–198.

66. Bertrand ME, Simmons ML, Fox KAA: Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation: recommendation of the Task Force of the European Society of Cardiology. Eur Heart J 2000; 21: 1406–1432.

67. Falk E: Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: characteristics of coronary atherosclerotic plaquesunderlying fatal occlusive thrombi. Br Heart J 1983; 50: 127–134.

68. Davies MJ, Thomas A: Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984; 310: 1137–1140.

69. Falk E, Shah PK, Fuster V: Coronary plaque disruption. Circulation 1995; 92: 657–671.

70. Libby P: Molecular basis of the acute coronary syndromes. Circulation 1995; 91: 2844–2850.

71. Davies MJ: A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation 1990; 82 (Suppl II): II-38–II-46.

72. Goldstein JA, Demetriou D, Grines CL, Pica M, Shoukfeh M, O´Neill WW: Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med 2000; 343: 915–922.

73. Asakura M, Ueda Y, Yamaguchi O, Adachi T, Hirayama A, Hori M, et al: Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol 2001; 37: 1284–1288.