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ISSN 0188-2198 (Impreso)

2005, Número 4

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Rev Mex Cardiol 2005; 16 (4)


Impacto del flujo TIMI posangioplastia en infarto agudo del miocardio sobre la mortalidad intrahospitalaria y a 6 meses

De la Cruz OR, Palacios RJM, Muñiz GA, Reyes DS, Jáuregui OO, Ogaz GE

Idioma: Español
Referencias bibliográficas: 24
Paginas: 155-161
Archivo PDF: 81.62 Kb.


RESUMEN

Introducción: Actualmente el tratamiento de reperfusión miocárdica mecánica a través de angioplastia coronaria percutánea (ACTP) se considera que tiene mejores resultados en reducción de eventos adversos. El objetivo de obtener y mantener un flujo coronario adecuado es fundamental en esta terapia de reperfusión. Objetivo: Valorar el impacto del flujo TIMI epicárdico posterior a ACTP en pacientes (ptes) con infarto agudo al miocardio (IAM) sobre la mortalidad durante la estancia intrahospitalaria (IH) y a 6 meses de seguimiento. Material y métodos: Se incluyeron 483 ptes sometidos a ACTP primaria desde enero de 1996 hasta enero de 2004. De acuerdo al flujo epicárdico se dividieron en tres grupos, grupo A flujo TIMI 3, grupo B TIMI 2 y grupo C flujo TIMI 0-1. Se analizaron las variables demográficas, hemodinámicas y el seguimiento IH y a 6 meses. Resultados: Grupo A 363 ptes (77.73%), el grupo B 67 ptes (14.34%), grupo C 37 ptes (7.92%). Existió diferencia en la incidencia de choque cardiogénico, el cual se presentó en el 11% del grupo A, 32% en el grupo B y 40% en el grupo C (p = 0.0001). Se mostró diferencia en el tiempo de inicio de síntomas y el momento de la ACTP con promedio de 354 min (A), 404 min (B) y 567 min (C). La incidencia de ACTP de rescate fue de 4.6% (A), 5.9% (B) y 16.21% (C) (p = 0.0002). El uso de stent se utilizó en mayor proporción en el grupo (A) 47.6%, 25.37% (B) y 16.21% (C). La mortalidad en sala de hemodinamia fue 0.55% (A), 4.47% (B) y 13.51% (C), IH fue de 8.8% (A), 28.35% (B) y 51.35% (C), a los 6 meses fue de 12.6% (A), 31.3% (B) y de 54% (C). Conclusión: Se considera que aquellos ptes con flujo TIMI 3 posprocedimiento, tiene menor mortalidad a corto y mediano plazo, concordante con lo reportado en la literatura mundial.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Puma JA, Sketch MH Jr, Thompson TD et al. Support for the open-artery hypothesis in survivors of acute myocardial infarction: analysis of 11,228 patients treated with thrombolytic therapy. Am J Cardiol 1999; 83: 482-487.

  2. White HD, Cross DB, Elliott JM et al. Long-term prognostic importance of patency of the infarct-related coronary artery after thrombolytic therapy for acute myocardial infarction. Circulation 1994; 89: 61-67.

  3. Brodie BR, Stuckey TD, Kisslling G et al. Importance of infarct-related artery patency for recovery of left ventricular function and late survival after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 1996; 28: 319-325.

  4. Braunwald E. The open-artery theory is alive and well: again. N Engl J Med 1993; 329: 1650-1652.

  5. The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673-682.

  6. The GUSTO Angiographic Investigators. The comparative effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function and survival after acute myocardial infarction. N Engl J Med 1993; 329: 1615-1622.

  7. TIMI Study Group. The thrombolysis in myocardial infarction (TIMI) trial: phase I findings. N Engl J Med 1985; 312: 932-936.

  8. Zijlstra F, de Boer MJ, Hoorntje JC et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 1993; 328: 680-4.

  9. Grines CL, Browne KF, Marco J et al. The Primary Angioplasty in Myocardial Infarction Study Group. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1993; 328: 673-9.

  10. De Boer MJ, Suryapranata H, Hoorntje JC et al. Limitation of infarct size and preservation of left ventricular function after primary coronary angioplasty compared with intravenous streptokinase in acute myocardial infarction. Circulation 1994; 90: 753-61.

  11. Zijlstra F, Beukema WP, van’t Hof A et al. Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low-risk patients with acute myocardial infarction. J Am Coll Cardiol 1997; 29: 908-12.

  12. Zijlstra F, Hoorntje JCA, De Boer MJ et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999; 341: 1413-9.

  13. De Boer MJ, Ottervanger JP, van’t Hof AW et al. The Zwolle Myocardial Infarction Study Group. Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol 2002; 39: 1723-8.

  14. Antoniucci D, Valenti R, Migliorini A et al. Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. Am J Cardiol 2002; 89: 1248-52.

  15. Anderson JL, Karagounis LA, Becker LC, Sorensen SG, Menlove RL. TIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction. Ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 study. Circulation 1993; 87: 1829-1839.

  16. Anderson JL, Karagounis LA, Califf RM. Metaanalysis of five reported studies on the relation of early coronary patency grades with mortality and outcomes after acute myocardial infarction. Am J Cardiol 1996; 78: 1-8.

  17. Karagounis L, Sorensen SG, Menlove RL, Moreno F. Does thrombolysis in myocardial infarction perfusion grade 2 represent a mostly patent artery or a mostly occluded artery? Enzymatic and electrocardiographic evidence from the TEAM-2 study. Second multicenter thrombolysis trial of eminase in acute myocardial infarction. J Am Coll Cardiol 1992; 19: 1-10.

  18. Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, Weintraub RA, Kelly TA. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 1998; 32: 1312-1319.

  19. Ito H, Maruyama A, Iwakura K, Takiuchi S, Masuyama T, Hori M, Higashino Y, Fujii K, Minamino T. Clinical implications of the “no reflow” phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 1996; 93: 223-228.

  20. van‘t Hof AWJ, Liem A, Suryapranata H et al. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade: Zwolle Myocardial Infarction Study Group. Circulation 1998; 97: 2302-2306.

  21. Stone GW, Cox D, Garcia E et al. Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001; 104: 636-641.

  22. Marzilli M, Orsini E, Marraccini P et al. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation 2000; 101: 2154-2159.

  23. Michaels AM, Appleby M, Dauterman K et al. Pretreatment with intragraft verapamil prior to percutaneous coronary intervention of saphenous vein graft lesions: results of the randomized, controlled vasodilator prevention of no-reflow (VAPOR) trial. J Invasive Cardiol 2002; 14: 299-302.

  24. Hillegass WB, Dean NA, Liao L et al. Treatment of no-reflow and impaired flow with the nitric oxide donor nitroprusside following percutaneous coronary interventions: initial human clinical experience. J Am Coll Cardiol 2001; 37: 1335-1343.




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