Intervencionismo coronario percutáneo primario en el tratamiento del infarto de miocardio ST elevado en pacientes del Instituto Nacional del Corazón, 2007-2008

OBJETIVOS: Conocer las caracteristicas demograficas y clinicas, asi como la prevalencia de muerte, reinfarto, revascularizacion del vaso culpable y falla cardiaca, tanto intrahospitalario como a los 12 meses de los pacientes a los que se les realizo PCI primaria. MATERIAL Y METODOS: Se evaluaron 45 pacientes, entre el 1 de Enero de 2007 al 30 de Setiembre de 2008 con diagnostico de Infarto de miocardio con elevacion del segmento ST (IMSTE), a los que se le realizo PCI primaria. RESULTADOS: La mediana de edad fue de 68.1, la mayoria fueron varones (82.2%); el 90% pacientes presentaban por lo menos 1 factor de riesgo cardiovascular. El 48.89% de los pacientes fueron transferidos de otro establecimiento de salud, y en el 53% de los pacientes la arteria responsable del evento fue la descendente anterior. Se realizo PCI mas implante de stent en el 95.6% de los casos, siendo exitoso angiograficamente en el 80%. La media del tiempo de isquemia fue de 399 minutos, siendo este tiempo mayor en los pacientes transferidos que en los no transferidos (524 y 279 respectivamente). La mortalidad intrahospitalaria fue del 11%, siendo mayor entre los pacientes con tiempo de isquemia mayor de 180 minutos y en los que la resolucion del segmento ST fue menor del 70% a los 90, estos ultimos presentaron, ademas, mas falla cardiaca. En el presente registro se incluyeron tambien los pacientes con choque cardiogenico. CONCLUSIONES: Nuestra mortalidad, asi como nuestros tiempos de actuacion, fueron mayores que los registrados en diferentes series sudamericanas. La sobrevida se relaciono negativamente con la edad, Clasificacion de Killip y Kimball, Grado de estenosis residual y con un tiempo de isquemia total prolongado. Un mayor tiempo de isquemia conllevo a una mayor mortalidad y falla cardiaca. OBJECTIVES: Conduct a follow-up study, over a 12 months period, to obtain information about the clinical and demographic characteristics, increased prevalence and risk of death, reinfarction, revascularization of the oguiltyo vessel and heart failure of patients who had undergone primary PCI. MATERIAL AND METHODS: 45 patients who had been diagnosed as having ST segment elevation myocardial infarction and had undergone primary PCI were evaluated during the period that started on January 1, 2007, and ended on September 30, 2008. RESULTS: The patients that participated in this study had an average age of 68.1 years, most of them were males (82.2%), 90% of them presented at least one risk factor for cardiovascular disease. 48.89% of the aforementioned patients had been transferred from another health care institution and 53% of them presented with clinical presentation of myocardial infarction due to occlusion of the anterior descending coronary artery. 95.6% of the aforementioned patients had undergone PCI with Stent implantation that was angiographically successful in 80% of the cases. The mean time of ischemia was 399 minutes and this indicator was higher (524 minutes) for those patients that had been referred and transferred in relation to those that had not been transferred (279 minutes). The nosocomial mortality was 11%, this index was higher in those patients with ischemic times longer than 180 minutes and partial ST-segment resolution (lower than 70%), the prevalence of heart failure was higher among patients with partial ST segment resolution. This registry study included patients presenting with cardiogenic shock. CONCLUSIONS: Our mortality rates and response times were higher than those ones recorded in other similar studies conducted in the South America region. Higher mortality rates were associated with a higher Killip-Kimball classification...