Estrategia invasiva, inmediata, mediata y tardía en el síndrome coronario agudo sin elevación del segmento ST

Liliete Caraballoso García; Victor J. Caraballoso García; Idanis Orea Cordero; Dayma Solís de la Paz

Authors

Liliete Caraballoso García
Victor J. Caraballoso García
Idanis Orea Cordero
Dayma Solís de la Paz

Abstract

Introduction: Non-ST segment elevation acute coronary syndrome (NSTE-ACS) is responsible for 2 to 2.5 million deaths worldwide. The percutaneous coronary intervention is related to better evolution in patients of moderate and high risk; however, there are still doubts about the optimal time to carry out the procedure.

Objectives: To identify the optimal time for the coronary angiography and percutaneous coronary intervention in patients with NSTE-ACS of moderate-high risk.

Method: An observational, longitudinal and prospective study was conducted with 74 patients who were admitted with a diagnosis of NSTE-ACS at the «Instituto de Cardiología y Cirugía Cardiovascular», from January 1, 2011 to December 31, 2013.

Results: A total of 74 patients were analyzed, with a mean age of 69.7±9.56 and a predominance of males (55.4%). There were no discrepancies between the risk factors in each group (p>0.05). The TIMI average was 4.8. Most of patients presented two-vessel disease. The infarct-related artery was mostly the left anterior descending artery. Major events occurred in 8 patients (10.8%), the largest number was observed in the late intervention group. The most frequent minor event was angina, (7 patients), most frequently in the late intervention group. The group with the lowest probability of survival was that of late treatment.

Conclusions: The patients in the intermediate intervention group (between 12 and 24 hours, group B) showed the greatest benefits of the coronary angiography and reperfusion strategy.

Downloads

Download data is not yet available.

References

1. Gaziano TA, Gaziano JM. Repercusión global de las enfermedades cardiovasculares. En: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald Tratado de Cardiología: Texto de Medicina Cardiovascular. 9na ed. Barcelona: Elsevier España, SL; 2012. p. 1-20.

2. Doval HC, Tajer CD. Evidencias en Cardiología. 5ª ed. Buenos Aires: Editorial GEDIC; 2008.

3. Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics – 2007 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115(5):e69-171.

4. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50(7):e1-e157.

5. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123(18):e426-e579.

6. Ministerio de Salud Pública. Anuario Estadístico de Salud 2012. La Habana: Dirección Nacional de Registros Médicos y Estadísticas de Salud; 2013.

7. Braunwald E. Unstable angina: An etiologic approach to management. Circulation. 1998;98(21):2219-22.

8. Williams DO, Abbott JD, Kip KE; DEScover Investigators. Outcomes of 6906 patients undergoing percutaneous coronary intervention in the era of drug-eluting stents: report of the DEScover Registry. Circulation. 2011;114(20):2154-62.

9. Fox KA, Poole-Wilson P, Clayton TC, Henderson RA, Shaw TR, Wheatley DJ, et al. 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005;366(9489):914-20.

10. Aragam KG, Tamhane UU, Kline-Rogers E, Li J, Fox KA, Goodman SG, et al. Does simplicity compromise accuracy in ACS risk prediction? A retrospective analysis of the TIMI and GRACE risk scores. PLoS One [Internet]. 2009 [citado 18 Abr 2017];4(11):e7947. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776353/pdf/pone.0007947.pdf

11. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-42.

12. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494-502.

13. Fox KA, Poole-Wilson PA, Henderson RA, Clayton TC, Chamberlain DA, Shaw TR. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. Lancet. 2002;360(9335):743-51.

14. Michalis LK, Stroumbis CS, Pappas K, Sourla E, Niokou D, Goudevenos JA, et al. Treatment of refractory unstable angina in geographically isolated areas without cardiac surgery. Invasive versus conservative strategy (TRUCS study). Eur Heart J. 2000;21(23):1954-9.

15. Neumann FJ, Kastrati A, Pogatsa-Murray G, Mehilli J, Bollwein H, Bestehorn HP, et al. Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA. 2003;290(12):1593-9.

16. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics – 2012 update: A report from the American Heart Association. Circulation. 2012;125(1):e2-220.

17. Heras M. Cardiopatía isquémica en la mujer: Presentación clínica, pruebas diagnósticas y tratamiento de los síndromes coronarios agudos. Rev Esp Cardiol. 2006;59(4):371-81.

18. Alfredsson J, Stenestrand U, Wallentin L, Swahn E. Gender differences in management and outcome in non-ST-elevation acute coronary syndrome. Heart. 2012;93(11):1357-62.

19. Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: What a difference a decade makes. Circulation. 2011;124(19):2145-54.

20. Filgueiras Frías CE, Laria Menchaca S, Cruz Pantoja M, López Pérez JE, Torres Pérez JA, López Ferrero L, et al. La coronariografía diagnostica desde la perspectiva del sexo. Rev Cuban Cardiol [Internet]. 2011 [citado 15 Oct 2017];17(1):18-26. Disponible en: http://www.bvs.sld.cu/revistas/car/vol17_1_11/car04111.pdf

21. Bendersky M. Asociaciones de drogas en hipertensión arterial. Rev Fed Arg Cardiol. 2010;39(1):16-21.

22. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. Part 1 - Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335(8692):765-74.

23. Samet JM. Los riesgos del tabaquismo activo y pasivo. Salud Pública Méx. 2002;44(Supl. 1):144-60.

24. Badimón L, Vilahur G, Padró T. Lipoproteínas, plaquetas y aterotrombosis. Rev Esp Cardiol. 2009;62(10):1161-78.

25. Testamariam B, Cohen RA. Free radicals mediate endothelial cell dysfunction caused by elevated glucose. Am J Physiol. 1992;263(2 Pt 2):H321-6.

26. Inzucchi SE. Diagnosis of diabetes. N Engl J Med. 2012;367(6):542-50.

27. Imperatore G, Riccardi G, Iovine C, Rivellese AA, Vaccaro O. Plasma fibrinogen: A new factor of the metabolic syndrome. A population-based study. Diabetes Care. 1998;21(4):649-54.

28. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities - The role of insulin resistance and the sympathoadrenal system. N Engl J Med. 1996;334(6):374-81.

29. Centers for Disease Control and Prevention. National Diabetes Fact Sheet [Internet], 2011 [citado 10 Oct 2017]. Disponible en: https://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

30. Dotevall A, Hasdai D, Wallentin L, Battler A, Rosengren A. Diabetes mellitus: clinical presentation and outcome in men and women with acute coronary syndromes. Data from the Euro Heart Survey ACS. Diabet Med. 2005;22(11):1542-50.

31. Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344(25):1879-87.

32. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425.