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2006, Número 4

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Arch Cardiol Mex 2006; 76 (4)


Alteraciones de la perfusión miocárdica y marcadores de inflamación en pacientes con infarto agudo al miocardio tratados con angioplastía primaria

Exaire JE, Fathi RB, Brener SJ, Karha J, Ellis SG, Bhatt DL

Idioma: Ingles.
Referencias bibliográficas: 47
Paginas: 376-382
Archivo PDF: 103.32 Kb.


RESUMEN

Objetivos: La disfunción de la microcirculación coronaria durante el infarto agudo al miocardio es mediada por varios mecanismos incluyendo inflamación y embolización de placa y/o trombo. La hipótesis del presente estudio es que los pacientes con infarto agudo al miocardio que se presentan con niveles bajos de perfusión microcirculatoria (definidos como grado de perfusión Thrombolysis in Myocardial Infarction (TIMI) (TMP) ‹ 2) tienen un aumento en los marcadores inflamatorios, tales como proteína C-reactiva de alta sensibilidad (hs-CRP) y glóbulos blancos, y la correlación de estos niveles con la mortalidad de esta cohorte. Métodos: De enero de 2002 a diciembre de 2003, 166 pacientes (178 lesiones) fueron referidos para intervención percutánea. Los pacientes fueron estratificados para este análisis en TMP ‹ 2 o TMP 3 2. Los factores asociados a mortalidad intrahospitalaria fueron determinados con análisis de regresión logística. Resultados: Un TMP ‹ 2 preintervención fue encontrado en 66% vs 34% de los pacientes (P ‹ .001). Los niveles de hs-CRP se encontraron elevados en ambos grupos pero no significativamente diferentes (37.9 ± 6 vs 33.7 ± 6 mg/L, P = 0.63). Los pacientes con TMP ‹ 2 tuvieron cuentas de glóbulos blancos mayores (12.83 ± 4.55 · 10-3 vs 10.83 ± 3.00 · 10-3, P = .04), menor fracción de expulsión (40 ± 11% vs 46 ± 12%, P ‹ .001), y mayores niveles de CK-MB a la admisión (116 ± 13 ng/mL vs 55 ± 13 ng/mL, P = .006). La muerte ocurrió en 12% del grupo TMP ‹2 vs 1.8% en el grupo con TMP › 2 (P = .03). La edad avanzada, el uso de balón de contrapulsación y los niveles elevados de glóbulos blancos al momento de la admisión se relacionaron independientemente con la muerte intrahospitalaria y a 30 días. Conclusiones: Los niveles elevados de hs-CRP no se asociaron con disfunción de la microcirculación. La disfunción microcirculatoria puede estar relacionada a un proceso inflamatorio, independiente de los niveles elevados de hs-CRP.


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