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2011, Número 2

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Rev Mex Cardiol 2011; 22 (2)


Mortalidad intrahospitalaria en choque cardiogénico: Pacientes con infarto agudo de miocardio tratados con angioplastia coronaria

Galván-García JE, Palacios-Rodríguez JM, Cantú-Ramírez S, Vargas-Ramírez JF, Medellín-Moreno BJ, Baena-Santillán E, Sánchez-Rodríguez IA, Ficker-Lacayo GB, Méndez-Chávez JA, Cetina-Domínguez G, Morán-Benavente EA, Melano-Carranza E, Leos A, Tolosa-Dzul G, Ontiveros R, López G

Idioma: Español
Referencias bibliográficas: 29
Paginas: 74-82
Archivo PDF: 334.40 Kb.


RESUMEN

Introducción: La angioplastia primaria en infarto agudo de miocardio complicado con choque cardiogénico, ha mostrado ser una estrategia con buenos resultados a corto y largo plazo, extendiendo su beneficio hasta 6 años posterior al evento. La frecuencia de la terapia de reperfusión con angioplastia se ha incrementado en los últimos años, de forma opuesta al tratamiento quirúrgico de esta complicación. Material y métodos: Se estudiaron pacientes con choque cardiogénico secundario a infarto agudo de miocardio, de febrero de 1996 a noviembre 2009, analizándose variables clínicas, demográficas y angiográficos así como la mortalidad intrahospitalaria. Se realizó análisis bivariado y multivariado para definir factores de riesgo independientes asociados a mortalidad. Resultados: Se incluyeron 142 pacientes, 71.1% hombres, la mortalidad global fue del 46.6%. Los predictores independientes de muerte fueron: angioplastia fallida, RM (razón de Momios) de 4.34 (IC 1.77 – 10.64) p = 0.001, enfermedad de la arteria circunfleja, RM de 2.69 (IC 1.29-5.62) p = 0.008 y desarrollo de edema agudo pulmonar intrahospitalario, RM 4.35 (IC 1.23-15.3) p = 0.022. Conclusiones: La frecuencia de choque cardiogénico y la mortalidad asociada en pacientes tratados con angioplastia coronaria en nuestra población, es similar a la reportada en la literatura con resultados reproducibles en centros de alto volumen, el éxito clínico y angiográfico representa las variables predictoras más importantes de mortalidad. El uso oportuno de terapia farmacológica con nuevos antiagregantes plaquetarios, el uso de nuevos dispositivos invasivos, así como el incremento en implantes de stents constituyen las áreas de oportunidad para mejorar la tasa de éxito en intervencionismo, y por tanto aumentar la sobrevida en este grupo de pacientes.


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