medigraphic.com
ISSN 0188-2198 (Impreso)

2011, Número 1

<< Anterior Siguiente >>

Rev Mex Cardiol 2011; 22 (1)


Resultados en el paciente mayor de 75 años con infarto agudo del miocardio tratado con angioplastia primaria. Estudio comparativo y seguimiento hospitalario

Palacios RJM, Galván GE, Ficker LGB, Jiménez TO, Díaz LGE, Baena SE, Acuña MVH, Fong PM, De la Cruz OR, Cantú RS, Medellín MB

Idioma: Español
Referencias bibliográficas: 33
Paginas: 17-23
Archivo PDF: 250.71 Kb.


RESUMEN

El presente reporte es un estudio observacional, descriptivo, retrospectivo y muestra los resultados comparativos en pacientes (Pts) › de 75 años vs ≤ de 75 años sometidos a una angioplastia primaria (AP) por infarto agudo con elevación del segmento ST (IMEST). Material y métodos: Mostramos los resultados en 800 Pts sometidos a AP por IMEST; 82 Pts (10.5%) fueron › de 75 años (gpo I) vs 718 Pts ≤ de 75 años (Gpo II), el criterio de inclusión fue ser portadores de IMEST ≤ 12 h de evolución, los puntos primarios a analizar fueron la incidencia en hospital de eventos cardiovasculares mayores (ECM) (reinfarto, reintervención, muerte o nuevo inicio de falla cardiaca). Resultados: El gpo I presentó mayor edad: 78.68 ± 3.98 años vs 58.46 ± 9.9 años; incidencia de sexo femenino 34.1% vs 20.6% y mayor estado de comorbilidad; hipertensión arterial (HTA) infarto previo, mayor deterioro en la función ventricular (FE%), y enfermedad multivaso (EMV) (Todos p ‹ 0.05). El tiempo de abordaje síntoma-balón (Sx-B) fue muy similar para ambos grupos (p ‹ NS), previo a la AP el flujo TIMI 0-1 y el uso de stents coronarios fue similar en ambos grupos (p = NS). El manejo IIb/IIIa fue mayor en el gpo I vs gpo II 36.6 vs 30.4% p ‹ 0.042. Posterior al procedimiento el flujo TIMI III fue similar en ambos grupos, así también la estenosis residual por angiografía (P = NS ambos). Los ECM se presentaron más en gpo I vs GII; hemorragia intracraneal (HIC) se presentó en 2 Pts 2.46% vs 0% p = 0.43, choque cardiogénico (ChC) en el 16% vs 8, 7% p ‹ 0.031, la muerte en hospital fue 20.7 vs 11.4% p ‹ 0.001 (Con ChC) y de 16.9% vs 4.9% (sin ChC) p ‹ 0.0001. En el análisis bivariado los predictores de riesgo de mortalidad fueron a) Enf multivascular, b) Predominancia enfermedad de la descendente anterior (DA), c) Mayor presencia de ChC. d) FE% baja. Conclusión: Nuestros resultados sugieren a la AP como 1era elección en Pts › 75 años con IAMEST. La reperfusión exitosa puede ser alcanzada en una proporción similar ‹ 75 años. Así también la mortalidad es menor que lo reportado en registros de no intervención coronaria percutánea (ICP), aun así la presencia de mayor EMV, FE baja, mayor incidencia de ChC predisponen a mayor mortalidad a corto plazo.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Berger AK, Radford MJ, Krumholz HM. Factors associated with delay in reperfusion therapy in elderly patients with acute myocardial infarction: analysis of the Cooperative Cardiovascular Project. Am Heart J 2000; 139: 985-992.

  2. Bueno H, Vidán T, Almazán A, López-Sendón J, Delcán JL. Influence of sex on the short-term outcome of elderly patients with a first acute myocardial infarction. Circulation 1995; 92: 1133-1140.

  3. Bueno H. Ischemic heart disease in the elderly: a need to understand the causes of high mortality after acute myocardial infarction. Am J Geriatr Cardiol 2000; 9: 271-272.

  4. Krumholz HM. Cardiopatía isquémica en el anciano. Rev Esp Cardiol 2001; 54: 819-826.

  5. White HD. Thrombolitic therapy in the elderly. Lancet 2000; 356: 2028-2030.

  6. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet 1994; 343: 211-222.

  7. Thiemannn DR, Coresh J, Schulman SP, Gerstenblith G, Oetgen WJ, Powe NR. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 2000; 101: 2239-2246.

  8. Ayanian JZ, Braunwald E. Thrombolytic therapy for patients with myocardial infarction who are older than 75 years. Do the risk outweigh the benefits? Circulation 2000; 101: 2224-2226.

  9. Simoons ML, Maggioni AP, Knatterud G, Leimberger JD, De Jaegere P, van Domburg R, Boersma E, Franzosi MG, Callif R, Schroder R, Braunwald E. Individual risk assessment for intracranial hemorrhage during thrombolytic therapy. Lancet 1993, 342: 1523-1528.

  10. Mark DB, Hlatky MA, Califf RM, Naylor CD, Lee KL, Armstrong PW, Barbash G, White H, Simoons ML, Nelson CL, Clapp-Channing N, Knight JD, Harrell FE, Simes J, Topol EJ. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med 1995, 332: 1418-1424.

  11. De Jaegere PP, Arnold AA, Balk AH, Simoons ML. Intracranial hemorrhage in association with thrombolytic therapy: Incidence and clinical predictive factors. J Am Coll Cardiol 1992; 19: 289-294.

  12. Ryan TJ, Anderson JL, Antman EM, Braniff BA, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel BJ, Russell RO, Smith EE, Weaver WD. ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1996; 28: 1328-1428.

  13. DeGeare VS, Stone GW, Grines L, Brodie BR, Cox DA, Garcia E, Wharton TP, Boura JA, O’Neill WW, Grines CL. Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials). Am J Cardiol 2000; 86: 30-34.

  14. Goldberg RJ, McCormick D, Gurwitz JH, Yarzebski J, Lessard D, Gore JM. Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975-1995). Am J Cardiol 1998; 82: 1311-1317.

  15. Yang XS, Willems JL, Pardaens J, De Geest H. Acute myocardial infarction in the very elderly. A comparison with younger age groups. Acta Cardiol 1987; 42: 59-68.

  16. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Ludbrook P, Markis JE, Mueller H, Passamani ER, Powers ER, Rao AK, Robertson T, Ross A, Ryan TJ, Sobel BE, Willerson J, Williams DO, Zaret BL, Braunwald E. Thrombolysis in Myocardial Infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Circulation 1987; 76: 142-154.

  17. Cannon CP, McCabe CH, Diver DJ, Herson S, Greene RM, Shah PK, Sequeira RF, Leya F, Kirshenbaum JM, Magorien RD, Palmeri ST, Davis V, Gibson MC, Poole WK, Braunwald E for the TIMI 4 investigators: Comparison of front-loaded recombinant tissue-type plasminogen activator, anistreplase and combination thrombolytic therapy in acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) 4 trial. J Am Coll Cardiol 1994; 24: 1602-1610.

  18. The GUSTO Investigators: An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673-682.

  19. Thiemann DR, Coresh J, Schulman SP, Gerstenblith G, Oetgen WJ, Powe NR. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 2000; 101: 2239-2246.

  20. Bueno H, Martínez-Selles M, Pérez-David E, López-Palop R. Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction. Eur Heart J 2005; 26: 1705-1711.

  21. Martinez-Selles M, Datino T, Bueno H. Coronary care unit admission of very old patients with acute myocardial infarction. Heart 2006; 92: 549-550.

  22. Martínez-Selles M, Datino T, Bueno H. Influence of reperfusion therapy on prognosis in patients aged > 85 years with acute myocardial infarction. Am J Cardiol 2005; 95: 1232-1234.

  23. O’Neill WW, Menko J, Gibbons RJ, Holmes DR, Timmis GC, Sachs D, Grines CL, Zijlistra F. Lessons from the pooled outcome of the PAMI, ZWOLLE and Mayo Clinic randomized trials of primary angioplasty versus thrombolytic therapy of acute myocardial infarction. J Invest Cardiol 1998; 10: 4A-10A.

  24. Matetzky S, Sharir T, Noc M, Domingo M, Kuang-Yuh Chyu, Kar S. Primary angioplasty for acute myocardial infarction in octogenarians. Am J Cardiol 2001; 88: 680-683.

  25. Grines C. Senior PAMI: a prospective randomized trial of primary angioplasty and thrombolytic therapy in elderly patients with acute myocardial infarction. Presented at Transcatheter Cardiovascular Therapeutics; Washington, D.C. October 2005: 16-21.

  26. Sakai K, Nakagawa Y, Kimura T, Doi T, Yokoi H, Iwabuchi M. Comparison of results of coronary angioplasty for acute myocardial infarction in patients ³ 75 years of age versus patients < 75 years of age. Am J Cardiol 2002; 89: 797-800.

  27. de Boer MJ, Ottervanger JP, van’t Hof AWJ, Hoorntje JCA, Suryapranata H, Zijlstra F, for the Zwolle Myocardial Infarction Study Group. Reperfusion therapy in elderly patients with acute myocardial infarction. A randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol 2002; 39: 1723-1728.

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

  29. Topol EJ, Califf RM. Thrombolytic therapy for elderly patients. N Engl J Med 1992; 327: 45-47.

  30. Gurwitz JH, Goldberg RJ, Gore GM. Coronary thrombolysis for the elderly? JAMA 1991; 265: 1720-1723.

  31. Grines C, Patel A, Zijlstra F, Weaver WD, Granger C, Simes RJ. PCAT Collaborators; percutaneous transluminal coronary angioplasty. Primary coronary angioplasty compared with intravenous thrombolytic therapy for acute myocardial infarction: six-month follow up and analysis of individual patient data from randomized trials. Am Heart J 2003; 145: 47-57.

  32. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Sub study Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 1997; 336: 1621-1628.

  33. Leone A. Causes of death from myocardial infarction before and after thrombolysis era: a pathologic study. Singapore Med J 1996; 37: 270-272.




2020     |     www.medigraphic.com