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Órgano de difusión del Servicio de Sanidad Militar y del Colegio Nacional de Médicos Militares

2017, Number 4

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Rev Sanid Milit Mex 2017; 71 (4)

Cardiovascular complications in nonreperfused acute ST segment elevation myocardial infarction

Gutiérrez-Leonar H, Vargas-Aquino H, Rincón-Hernández LE, Galván-Vargas CG, Iñarra-Talboy F

Language: Spanish
References: 40
Page: 349-365
PDF size: 325.85 Kb.


ABSTRACT

Background: Cardiovascular diseases are currently the leading cause of death in industrialized countries. Among them, coronary artery disease is the most prevalent manifestation and is associated with high morbidity and mortality worldwide. In Mexico, ischemic heart disease is the leading cause of death in older than 60s and the second cause in the general population.
Objective: To evaluate cardiovascular complications in patients with acute ST segment elevation myocardial infarction who did not receive acute reperfusion therapy.
Material and method: Descriptive, cross-sectional, retrospective study in which 35 medical files of patients with acute ST segment elevation myocardial infarction without reperfusion treatment who were admitted to the Hospital Central Militar from january 1st to december 31st in 2013. Cardiovascular complications and their association with clinical variables were quantified, as well as the quantification of time in the care system.
Results: The complications were: heart failure 68.2%, arrhythmias 17.1% and death 17.1%. Variables associated with a higher proportion of total cardiovascular complications and heart failure were age ≥ 65 years, location of extensive anterior infarction, and TIMI risk score ≥ 7. Variables such as type 2 diabetes, location of extensive anterior infarct, TIMI risk score ≥ 7, Killip > 2 and arrhythmias were associated with a higher proportion of deaths. Patients who underwent late angioplasty with adequate indication had a lower proportion of deaths. The patient-first medical contact time had a median of 8 hours, the first medical-diagnostic contact time had a median of 11.5 hours and the diagnostic-admission time to the hospital had a median of 3 hours.
Conclusions: All patients admitted for acute myocardial infarction with ST segment elevation without reperfusion therapy had at least one cardiovascular risk factor and a characteristic symptom of acute coronary syndrome at the time of first medical contact.


REFERENCES

  1. Murracy CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2010: Global burden of disease Study. Lancet 1997; 349 (9064); 1498-1504.

  2. Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010; 8; 943-957.

  3. Sistema nacional de información para la salud (SINAIS). Principales causas de mortalidad general nacional 2002.

  4. Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation 2005;111 (25):3481-3488.

  5. Fuster V, Moreno PR, Faya ZA, Corti R, Badunib JJ. Atherotrombosis and high risk plaque. J Am Coll Cardiol. 2005; 46(6); 937-954.

  6. Mehta RH, Eagle KA. Missed diagnoses of acute coronary syndromes in the emergency room. N Engl J Med 2000; 342 (16): 1207-1208.

  7. Thygesen K, Alpert JS, White HD. Universal Definition of myocardial infarction. Eur Heart J. 2007; 28; 2525-2538.

  8. Jennings RB, Ganote CE. Structural changes in myocardium during acute isquemia. Circ Res 1974 ;35 Suppl 3: 156-172

  9. Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, et al. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006; 27(19): 2285-2293.

  10. Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest 2004; 126(12): 461-469.

  11. Lopez-Sendon J, Coma-Canella I, Alcasena S, Seoane J, Gamallo C. Electrocardiographic findings in acute right ventricular infarction: sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, V1, V2 and V3. J Am Coll Cardiol. 1985; 6(6): 1273-1279.

  12. Yan AT, Yan RT, Kennelly BM, Anderson FA Jr, Budaj A, López- Sendón J, et al. Relationship of ST elevation in lead AVR with angiografic findings and outcome in non ST elevacioni acute coronary síndromes. Am Heart J 2007;154 (1):71-78.

  13. Lopes RD, Siha H, Fu Y, Mehta RH, Patel MR, Armstrong PW, et al. Diagnosing acute myocardial infarction in patients with left BundLe branch Block. Am J Cardiol. 2011; 108 (6):782-788.

  14. Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, et al. A comparison of coronary angioplasty with fibrinolitic therapy in acute myocardial infarction. N Engl J Med. 2003; 349(8): 733-742.

  15. Hackett D, Davies G, Chierchia S, Maseri A. Intermitent coronary occlusion in acute myocardial infarction. Value of combined thrombolytic and vasodilatador therapy. N Engl J Med. 1987; 317 (17):1055-1059.

  16. Zijlstra F, Hoorntje JC, de Boer MJ, Reiffers S, Miedema K, Ottervanger JP, et al. Long-Term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1999; 341 (19):1413-1419.

  17. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all ramdomised trials of more than 1000 patients. Fibrinolytic Therapy trialists (FTT) Collaborative Group. Lancet. 1994;343 (8893): 311-322.

  18. Maynard C, Weaver WD, Litwin PE, Martin JS, Kudenchuk PJ, Dewhurst TA, et al. Hospital mortality in acute myocardial in- farction in the era of reperfusion therapy (the Myocardial In- farction Triage and Intervention Project). Am J Cardiol 1993; 72 (12): 877-882.

  19. Frans Van de Werf, the investigators of European cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator. Lessons from the European Cooperative Recombinant Tissue-Type Plasminogen Activator (rt-PA) versus placebo trial. JACC 1988; 12 (6): A14-A19.

  20. Juillière Y, Cambou JP, Bataille V, Mulak G, Galinier M, Gibelin P, et al. Insuficiencia cardiaca en el infarto agudo de miocardio: comparación de pacientes con o sin criterios de insuficiencia cardiaca del registro FAST-MI. Rev Esp Cardiol. 2012; 65(4): 326-333.

  21. Garcia CA, Jerjes SC, Martinez BP, Azpiri LJ, Autrey CA, Martínez SC. RENASICA II, Registro Mexicano de Sindromes Coronarios Agudos. Archivos de cardiologia de Mexico 2005, Vol. 75 (1): S6-S19

  22. Balnavera A, Martinez G, Gaspar J. Angioplastia primaria en el tratamiento del infarto agudo del miocardio. An Med Asoc Med Hosp ABC, 1997; 42(3): 105-110.

  23. Shapira I, Isakov A, Burke M, Almog C. Cardiac rupture in patients with acute myocardial infarction. Chest 1987; 92 (2): 219-223.

  24. Maynard C, Weaver WD, Litwin PE, Martin JS, Kudenchuk PJ, Dewhurst TA, et al. Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the Myocardial Infarction Triage and Intervention Project). Am J Cardiol 1993; 72 (12): 877-882.

  25. Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967; 20(4): 457-464.

  26. Pfeffer MA, Pfeffer JM, Fishbein MC, Fletcher PJ, Spadaro J, Kloner RA, et al. Myocardial infarct size and ventricular function in rats. Circ Res 1979; 44 (4): 503-512.

  27. Askari AT, Shishehbor MH, Kaminski MA, Riley MJ, Hsu A, Lincoff AM, et al. The association between early ventricular arrhytmias, rening-angiotensin-aldosterone system antagonism, and mortality in patients with ST-segmenT elevation myocardial infarction: insights from Global Use of Strategies to Open coronary arteries (GUSTO) V. Am Heart J. 2009; 158 (2): 238-243.

  28. Fu Y, Goodman S, Chang WC, Van De Werf F, Granger CB, Armstrong PW. Time to treatment influences the impact of ST-segment resolution on one year prognosis: insights from the assessment of the safety and efficacy of a new thrombolytic (ASSENT-2) trial. Circulation 2001; 104 (22): 2653-2659.

  29. Chevalier P, Burri H, Fahrat F, Cucherat M, Jegaden O, Obadia JF, et al. Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation. Eur J Cardiothorac Surg. 2004; 26(2): 330-335.

  30. Topaz O, Taylor AL. Interventricular septal rupture complicating acute myocardial infarction: from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management. Am J Med. 1992; 93 (6): 683-688.

  31. Imazio M, Negro A, Belli R, Beqaraj F, Forno D, Giammaria M, et al. Frequency and prognostic significance of pericarditis following acute myocardial infarction treated by primary percutaneous coronary intervention. Am J Cardiol. 2009; 103 (11): 1525-1529.

  32. Osherov AB, Borovik-Raz M, Aronson D, Agmon Y, Kapeliovich M, Kerner A, et al. Incidence of early left ventricular thrombus after acute anterior wall myocardial infarction in the primary coronary intervention era. Am Heart J. 2009; 157 (6): 1074-1080.

  33. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio thoracic Surgery (EACTS). Eur Heart J.2010; 31(20): 2501-2555.

  34. Luepker RV, Raczynski JM, Osganian S, Goldberg RJ, Finnegan JR Jr, Hedges JR. Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) trial. JAMA. 2000; 284(1): 60-67.

  35. Diercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV Jr, Kirk JD, et al. Frecuency and consequences of recording an electrocardiogram >10 minutes after arrival in an emergency room in non-ST segment elevation acute coronary syndromes (from the CRUSADE initiative). Am J Cardiol. 2006; 97 (4):437-442.

  36. Terkelsen CJ, Sorensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA 2010; 304 (7): 763-771.

  37. Pinto DS, Kirtane AJ, Nallamothu BK, Murphy SA, Cohen DJ, Laham RJ, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 2006; 114 (19): 2019-2025.

  38. Welsh RC, Chang W, Goldstein P, Adgey J, Granger CB, Verheugt FW, et al. Time to treatment and the impact of a physician on pre-hospital managemen of acute ST elevation myocardial infarction: insgihts form the ASSENT-3 PLUS tiral. Heart. 2005; 91 (11): 1400-1406.

  39. Ferreira-González I, Permanyer-Miralda G, Marrugat J, Heras M, Cuñat J, Civeira E, et al. Estudio MASCARA (Manejo del Síndrome Coronario Agudo. Registro Actualizado). Resultados globales. Rev Esp Cardiol. 2008; 61(8): 803-816.

  40. Steg G, James S, Atar D, Badano L, Lundqvist C, Borger M, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012, 33 (20): 2569-2619.




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