Amat AA, de la Noval GR, Rodríguez NLM, Llerena RL, Hernández VD, Quirós LJJ

Language: Spanish
References: 27
Page: 1-8
PDF size: 521.60 Kb.

ABSTRACT

Introduction: Acute coronary syndrome includes a heterogeneous group of patients with highly variable prognoses, since those who survive have a high risk of suffering events after discharge.
Objective: To characterize the evolution of patients with acute coronary syndromes after discharge from the Institute of Cardiology and Cardiovascular Surgery years 2018-2019.
Method: Observational, analytical, longitudinal, prospective study that included 310 patients followed up to 2 years. The event-free survival curves were calculate using the Kaplan-Meier, log-rank and Brelow tests. The Cox Proportional Hazards Regression obtained hazard ratios.
Results: The risk factors with the highest prevalence were arterial hypertension 82,9% and smoking 50,3%. The most observed clinical form was STEMI 69,7%. The female sex was less frequent, but they had a lower survival 90,0% vs. 96,8%;(p = 0,013) and an unfavorable prognosis after 12 months with respect to the major death event HR = 3,6 IC 95% 1,2-10,7; (p = 0,021). Conservative treatment was significantly related to the appearance of adverse events (p = 0,003), considering the application of reperfusion methods as a protective element against the occurrence of the death event HR = 0,2 IC 95% 0,07-0,62; (p = 0,005). Cumulative survival in those with NSTEMI decreases during follow-up with a negative impact on death, although not significantly HR = 2,8 IC 95% 0,9-8,4; (p = 0,06).
Conclusions: Patients with acute coronary syndromes may have a longer survival as long as the proper diagnosis is made in the optimal time and reperfusion methods are applied whenever possible, paying special attention after discharge to women and patients with NSTEMI.

REFERENCES

1. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736–88.

2. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1859–922.

3. Organización Panamericana de la Salud. Indicadores básicos 2019: Tendencias de la salud en las Américas. Washington, D.C: OPS; 2019.

4. Anuario Estadístico de Salud MINSAP Cuba 2019. La Habana 2020; e1561-4433 Disponible en http://files.sld.cu/bvscuba/files/2020/05/Anuario-Electronico-Esapñol-2019-ed-2020.pdf. [Consultado el 9 de mayo de 2020].

5. Alnasser SM, Huang W, Gore JM, et al. Late consequences of acute coronary syndromes: Global Registry of Acute Coronary Events (GRACE) follow-up. Am J Med 2015; 128:766–75.

6. Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation 2000; 101:2557–67.

7. De La Noval García R, Hernández Veliz D, Estrategias en prevención secundaria de enfermedades cardiovasculares. El Roadmap de la federación mundial del corazón (WHF). Rev Cuban Cardiol. 2017; 23(2):1561-2937.

8. Goff D.C, Lloyd-Jones D.M, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63 (25):2935–2959

9. Santos Medina M, R. Góngora DC, Parra Siscar J, Rabert Fernández AR. Factores predictivos de mortalidad hospitalaria en el infarto agudo de miocardio con elevación del segmento ST. Cor Salud 2018; 10(3): 202-210.

10. Shang C, Hernández Véliz D, Ferrer Arrocha M, Alonso Martínez y Héctor Pérez Assef H. Factores de riesgo cardiovascular en pacientes con infarto agudo de miocardio con elevación del segmento ST. Cor Salud 2020; 12(1): 31-37.

11. Mate Redondo C, Rodríguez-Pérez MC, Domínguez Coello S y col. Mortalidad hospitalaria de 415.798 pacientes con IAM: 4 años antes en Canarias que en el conjunto de España. Rev Esp Cardiol. 2019; 72(6):466–472.

12. Lanas F, Toro V, Cortés R, Sánchez A. Interheart, un estudio de casos y controles sobre factores de riesgo de infarto del miocardio en el mundo y América Latina. Médicas UIS. 2008; 21(3):176-82.

13. Franco Terrero MR, Sainz González de la Peña B, Ramos Gutiérrez y col. Caracterización de pacientes con infarto agudo de Miocardio con elevación del Segmento ST. Rev Cuban Cardiol. 2015; 21(1):16-23.

14. Santos Medina M, Rodríguez Ramos M, Prohias Martínez J y col. Registro Cubano de Infarto de Miocardio Agudo (RECUIMA), los primeros 1000 casos. Rev Cuban Cardiol. 2019; 25 (Supl 1):419-435.

15. Prokhorov MD, Dovgalevsky PY, et al. Impact of patient-related and treatment-related factors on in hospital mortality of patients with ST- elevation myocardial infarction: Data of Russian Acute Coronary Syndrome Registry. COR ET VASA. 2015; 56 (3):e2127-e227.

16. Lin CC, Lee PY, Chen KC, Liao PC, Hsu JC, Li AH. Clinical, Demographic, and Biochemical Characteristics of Patients with Acute ST-Segment Elevation Myocardial Infarction: An Analysis of Acute Coronary Syndrome Registry Data of a Single Medical Center from 2005 to 2016. Acta Cardiol Sin 2020; 36: 1-7.

17. Andrés E, Cordero A, Magán P, Alegría E, León M, Luengo E, y col. Mortalidad a largo plazo y reingreso hospitalario tras infarto agudo de miocardio: un estudio de seguimiento de ocho años. Rev. Esp Cardiol. 2012; 65:414-20.

18. Santos Medina M, Parra Siscar JL, Rabert Fernández AR, Duliesky Góngora Cortés D. Factores predictivos de eventos cardiacos adversos mayores en pacientes con infarto agudo de miocardio. Rev Cub Cardiol. 2018; 24(3):1561-2937.

19. García-García C, Molina L, Subirana I, Sala J, Bruguera J, Arós F, y col. Diferencias en función del sexo en las características clínicas, tratamiento y mortalidad a 28 días y 7 años de un primer infarto agudo de miocardio. Estudio RESCATE II. Rev Esp Cardiol. 2014; 67(1):28–35.

20. Barreda Pérez AM, López Ferrero L, Rodríguez Nande L, González Espinosa AB, Antuña Aguilar T, Borges Machado L. Caracterización de las mujeres con intervencionismo coronario percutáneo. Rev Cub Cardiol. 2018; 24(2):1561-2937

21. Leyva Quert A, Arguedas Alcázar M, Valdés Recarey M, Almeida Gómez J, Mendoza Ortiz J, Brooks Tamayo J y col. Resultados al año del intervencionismo coronario percutáneo multiarterial. Cor Salud 2014; 6(3):211-216.

22. Álvarez Álvarez B, Abou Jokh CCh, Cordero A, Martínez GA, Cid AAB, Agra BR y col. Coronariografía precoz y mortalidad a largo plazo en infarto agudo de miocardio de alto riesgo. Registro CARDIOCHUS-HUSJ. Rev Esp Cardiol. 2020;73(1):35–42

23. Kotseva K, Wood D, De Bacquer D, De BackerG, Rydén, et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 european countries. Eur J Prev Cardiol. 2016; 23(6):636-48.

24. Ridker PM, Lonn E, Paynter NP, Glynn R, Yusuf S. Primary prevention with statin therapy in the elderly: new meta-analyses from the contemporary JUPITER and HOPE-3 randomized trials. Circulation 2017; 135:1979–81.

25. Rivas-Estany E, et al. Programa cubano de rehabilitación cardíaca. Resultados. Rehabilitación (Madr). 2013. http://dx.doi.org/10.1016/j.rh.2013.07.003 [Consultado 16 de junio de 2020]

26. Mauri L y Bhatt DL. Intervención coronaria percutánea. En: Braunwald E, editor. Braunwald Tratado de Cardiologia. Texto de Medicina Cardiovascular. 10ª ed. España: Elsevier; 2016. p.1245-62.

27. Widimsky P, Holmes DR. How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease? Eur Heart J. 2011; 32:396–403.