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2019, Número S1

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Rev Cubana Cardiol Cir Cardiovasc 2019; 25 (S1)


Mortalidad pre hospitalaria en el Infarto agudo del miocardio. Variables asociadas

Ochoa MLA, González LM, Tamayo VND, Araujo GRE, Santos MM

Idioma: Español
Referencias bibliográficas: 44
Paginas:
Archivo PDF: 824.97 Kb.


RESUMEN

En el infarto agudo de miocardio con elevación del ST (IAMCEST), el tiempo transcurrido entre el inicio de los síntomas hasta la aplicación del tratamiento es inversamente proporcional a la cantidad de miocardio recuperado y en consecuencia al número de vidas salvadas, lo cual hace de la fase pre hospitalaria, la más crítica y a la vez la de mayor oportunidad en el tratamiento de los pacientes.
La mortalidad está determinada por el tiempo total de isquemia en el paciente, en el cual se agrupan variables dependientes del paciente y del sistema de atención.
Reducir al mínimo el tiempo que tarda el paciente en identificar sus síntomas y en consecuencia, solicitar asistencia médica, el arribo precoz de una ambulancia bien equipada, con personal entrenado capaz de realizar el diagnóstico en el sitio del primer contacto, la aplicación del tratamiento farmacológico inicial y el traslado del paciente a un centro de asistencia cardiológico apropiado para recibir terapia de reperfusión, deben ser los pilares de la atención en esta etapa inicial.
La intervención coronaria percutánea primaria (ICPp) es el tratamiento de elección, pero la trombolisis seguida de angiografía coronaria y posiblemente ICP constituye una alternativa válida, en función del riesgo inicial del paciente, el tiempo transcurrido desde el inicio de los síntomas y el retraso asociado a la ICPp.
Disminuir los retrasos dependientes del paciente y del sistema y viabilizar la selección de los casos para estrategias de reperfusión permite mejorar la evolución clínica, el pronóstico y disminuir la mortalidad del IAMCEST.


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