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2004, Número 2

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Rev Mex Cardiol 2004; 15 (2)


Resultados de la implantación de stent coronario en angioplastia primaria en el infarto agudo del miocardio

Palomo VJA, Padilla PF, Reyes CF, Silvestre MA, Astudillo SR, Flores FJ, Estrada GJ, Abundes VA, Pimentel MG, Farell CJ

Idioma: Español
Referencias bibliográficas: 57
Paginas: 66-74
Archivo PDF: 104.27 Kb.


RESUMEN

El objetivo es describir nuestra experiencia y evaluar los resultados clínicos y angiográficos inmediatos durante la fase aguda del infarto del miocardio que fueron sometidos a angioplastia coronaria transluminal percutánea (ACTP)primaria con colocación de “Stents.” Material y métodos: de enero de 1999 a diciembre de 2002 se realizaron 2,380 ACTP con colocación de stents, se seleccionó a un grupo de 98 enfermos a los que se implantaron 98 stents por paciente “arteria culpable”. Representan el 4.1% del total del grupo. Con edades de 30 a 91 años promedio 60.7 ± 7.44 con 72 hombres y 26 mujeres. Con hipertensión arterial sistémica 50, diabetes mellitus 32, de tabaquismo intenso 49, hipercolesterolemia 17. IAM Inferior 42, anterior extenso 31 y anterolateral 25. CPK-MB pico (U) promedio 348 ± 240. Con Killip Kimball 1 (48), II (31), III (1) y IV (18). El tiempo promedio de presentación menor de seis horas en el 96%. Enfermedad de un vaso 57, dos vasos 20 y múltiples vasos 21. Fracción de expulsión sólo se midió en 45. Con infarto previo siete, fueron incluidos con choque cardiogénico 18, mismos en los que se usó balón intraaórtico de contrapulsación cardiaca. Mortalidad intrahospitalaria en nueve. Fueron excluidos: enfermedad del tronco coronario izquierdo,trombolizados, con trombo > 20 mm, y cuando no se encontrara la información del expediente clínico o de la base de datos del servicio. Se definió éxito angiográfico en presencia de una estenosis residual < 10% y flujo TIMI 2-3 al final del procedimiento. Resultados: se obtuvo éxito angiográfico en 90 enfermos,existió flujo TIMI 0-1 preintervención en 100% y postintervención TIMI 3 en 80 y TIMI 0, 1, 2 en 18. Las complicaciones: se desarrolló choque cardiogénico y acidosis metabólica ya en el procedimiento en ocho pacientes, mismos que fallecieron, otro murió 12 horas después por edema agudo pulmonar. Fueron predictores independientes de mortalidad intrahospitalaria, edad superior a 65 años, Killip Kimbal IV, enfermedad multivaso y flujo TIMI 0-2. Conclusiones: estos resultados sugieren que la aplicación de stents coronarios en la ACTP primaria es un procedimiento exitoso, clínico y angiográfico, en nuestro medio a pesar de su mayor perfilde riesgo.


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