Borrayo SG, Almeida GE, Benítez PC, Madrid MA, Reyes HA, Velasco LG, Sosa JF, López VLT, Guardado MM, Sánchez I, Luviano D, Aparicio HL, Vieyra G, Antezana CJ, Argüero SR

Language: Spanish
References: 10
Page: 17-23
PDF size: 84.12 Kb.

ABSTRACT

Objective: To stratify early patients with acute myocardial infarction with elevation of the ST segment (IAM-CST) in the UCIC. Material and methods: There were included patients serial of any age and gender entered the UCIC with diagnostic of acute myocardial infarction with elevation of the ST at any location, with 2 of the following approaches: a) Chest pain ≥ 20 minutes of duration, b) ST elevation ≥ 2 mm in two anterior contiguous derivations or ≥ 1 mm in two contiguous derivations of the others, c) Elevation to double the creatinphosphokinase normal value. Patients were stratified with the factors of risk, age group, gender, clinical presentation for further complications during their stay in the UCIC. Statistical analysis: The data was presented on the average and standard deviation, percentages. The differences of dichotomy variables were evaluated with χ², the continuous variables with Student t test. The risk was evaluated with relative risk with confidence interval of 95%. The confusion variable was analyzed with logistical regression. It was considered significant a value of p ≤ 0.05, with confidence interval of 95%. Results: From January 2003 to July 2006, 2,865 patients were registered with Acute Coronary Syndrome, from those 1,925 (66.4%) had IAM-CST, the age average was 62 ± 16 years, 1,444 men (75%) and 481 women (25%). The most frequent electric complications were: blockade of right branch (BRDHH) in 11%, complete auriculoventricular blockade (BAVC) in 8.4% and blockade of left branch (BRIHH) in 6.3%. The most frequent clinical complications were: recurrent ischemia (17.5%), heart failure in 16.4%, cardiogenic shock (9.8%) and non fatal infarction (7.8%). The significant factors of risk for recurrent ischemia were: age › 65 years, female, class of Killip ≥ 2, BAVC, BRIHH, previous IAM and fibrinogen › 500 mg/dL. For non fatal infarction: age › 65 years, DM, in female, class of Killip ≥ 2, PAS 8249, 90 mmHg, BAVC, BRIHH, BRDHH, previous IAM and creatinine › 1.5 mg/dL. For flaw ventricular left: age › 65 years, DM, in female, fibrinogen › 500 mg/dL, class of Killip ≥ 2, FC › 100 lpm, PAS ‹ 90 mmHg, BAVC, BRIHH, BRDHH, previous IAM and creatinine › 1.5 mg/dL. For crash cardiogenic: age › 65 years, DMK, feminine gender, class of Killip ≥ 3, FC › 100 lpm, PAS ‹ 90 mmHg, BAVC, BRIHH, BRDHH and creatinine › 1.5 mg/dL. For death: age › 65 years, DMK, there are, tobaccoism, feminine gender, fibrinogen › 500 mg/dL, class of Killip ≥ 2, FC › 100 lpm, PAS ‹ 90 mmHg, BAVC, BRIHH, BRDHH, previous IAM and creatinine › 1.5 mg/dL. Conclusions: The early stratification in patients with IAM-CST should be stratify in the first hours of evolution, taking into account the patient’s basal characteristics as age, gender, factors of risk, followed by the electrocardiography complications like BRDHH, BRIHH, BAVC, as well as the clinical data of hypotension, tachycardia, class of advanced Killip, high level of creatinine and fibrinogen › 500 mg/dL.

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