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2017, Number 1

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Rev Sanid Milit Mex 2017; 71 (1)

Treatment of acute anteroapical ST elevation myocardial infarction not reperfused Killip and Kimbal class III by splinting of anterior descending artery with stent

Gutiérrez-Leonard H, Fuentes-Córdova BA, Galván-Vargas CG, Cabrera-Arroyo CG, Meneses-Bonilla A, Hernández-Casas AS

Language: Spanish
References: 31
Page: 31-41
PDF size: 350.43 Kb.


ABSTRACT

Background: Acute heart failure as a complication of acute anteroapical ST elevation myocardial infarction is the most frequent complication and Is the first cause of death in the acute and chronic phase. At present, medical pharmacological treatment has been improved and guidelines have been proposed for the management of these patients who have a good evolution, but a non negligible percentage of patients have refractory heart failure, hemodynamic instability, pulmonary congestion, which implies a longer hospital stay and nosocomial infections.
Objective: To reduce mortality of acute anteroapical ST elevation myocardial infarction not reperfused Killip and Kimbal class III.
Materials and methods: We included patients attended at the Hospital Central Militar interventional cardiology department, with the diagnosis of acute anteroapical ST elevation myocardial infarction not reperfused. The infarct was classified as Killip and Kimbal class III with decreased ejection fraction and after 72 hours of optimal medical treatment for heart failure, persisted in the Killip and Kimbal class III. Coronary angiography and ventriculography were performed, finding total obstruction of the anterior descending artery and akinesia, dyskinesia or anteroapical left ventricular aneurysm. The technique of splinting of anterior descending artery with stents was performed in the hemodynamic laboratory. Their management was continued in the coronary care unit. Transthoracic echocardiography was performed 8 days after the intervention.
Results: A total of 21 patients who met the selection criteria were included. The ejection fraction of the left ventricle prior to the procedure was on average 29%. Five subjects developed cardiogenic shock in the first twelve hours of hospitalization, but only one died. Of the remaining subjects, two additional deaths were observed, none at an early age (first 30 days). The 30-day survival was 95.2%, with a median survival of 29.76 days (95% CI 29.3, 30.2).
Conclusion: In patients with acute anteroapical ST elevation myocardial infarction not reperfused Killip and Kimbal class III with reduced left ventricular ejection fraction (less than 35%) and akinesia dyskinesia-apical aneurysm, the technique of splinting of anterior descending artery with stents was associated with a better prognosis with a 30-day survival rate was 95.2%, with a median survival of 29.76 days (95% CI 29.3, 30.2), with a significant improvement in left ventricular ejection fraction (previous 30.5 + 6.4% , posterior 33.3 + 6.5%, p = 0.016).


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