Predictive factors of intra-hospital complications in Non-ST-segment elevation Acute Coronary Syndrome
Keywords:
Myocardial ischemia, acute coronary syndrome, unstable angina, Non-ST-Elevated Myocardial Infarction, risk factors, complications.Abstract
Introduction: The clinical spectrum of Non-ST-segment elevation Acute Coronary Syndromes includes both asymptomatic patients and those with active ischemia, electrical instability, hemodynamic or cardiac arrest.
Objective: To evaluate probable predictive factors of non-lethal intra-hospital complications in patients diagnosed with Non-ST-segment elevation Acute Coronary Syndrome.
Material and Methods: An observational, analytical, cross-sectional study was conducted with a universe of 218 individuals admitted into the Intensive Coronary Care Unit of "Manuel Fajardo" Clinical and Surgical Hospital between 2016 and 2017.
Results: Male sex predominated (51.4%) and the mean age was 68 years. Arterial Hypertension prevailed as a coronary risk factor. The age showed significant statistical association with the appearance of any complication (p = 0.015) and with hemodynamic complications (p =0,014). The intermediate-high risk, according to the TIMI score, had a statistically significant association with hemodynamic complications (p <0.01).
Conclusions: Age was statistically associated with the appearance of non-lethal intra-hospital complications. Sex was not associated with complications, nor did the background studied either. Patients with an intermediate-high risk at admission were associated with hemodynamic complications.
Downloads
References
1. Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald: Tratado de Cardiología. Texto de Medicina Cardiovascular. 10ma ed. Barcelona: Elsevier; 2016.
2. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. Guía ESC 2015 sobre el tratamiento de los síndromes coronarios agudos en pacientes sin elevación persistente del segmento ST. Rev Esp Cardiol [Internet]. 2015;68(12):1125.e1-e64. [Citado 22/01/2019]. Disponible en: http://dx.doi.org/10.1016/j.recesp.2015.10.012
3. Centro Nacional de Información de Ciencias Médicas. Biblioteca Médica Nacional. Cardiopatía isquémica. Estadísticas Mundiales. Factográfico salud [Internet]. 201;5(2):1-11. [Citado 22/01/2019]. Disponible en: http://files.sld.cu/bmn/files/2019/02/factografico-de-salud-febrero-2019.pdf
4. Dirección de Registros médicos y estadísticas de salud. Anuario Estadístico de Salud 2017. Cuba: bvscuba; 2018. [Citado 22/01/2019]. Disponible en: http://bvscuba.sld.cu/anuario-estadistico-de-cuba/
5. Antman EM, Cohen M, Bernink PJ. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA [Internet]. 2000; 284:835-42. [Citado 27/01/2019]. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/10938172
6. Parra PF, Buitrago N, Carvajal R, Wagner K, Viáfara J, Calle A, et al. Diferencias angiográficas y epidemiológicas entre hombres y mujeres que desarrollan síndrome coronario agudo. Rev Colomb Cardiol [Internet]. 2017;24(5):436-441. [Citado 22/1/2019]. Disponible en: http://dx.doi.org/10.1016/j.rccar.2017.04.010
7. Bellea L, Caylab G, Cottinc Y, Costed P, Khalifee K, Labèquef JN, et al. French Registry on Acute ST-elevation and non−ST-elevation Myocardial Infarction 2015 (FAST-MI 2015). Design and baseline data. Archives of Cardiovascular Disease [Internet]. 2017; 110:366-378. [Citado 22/01/2019]. Disponible en: http://dx.doi.org/10.1016/j.acvd.2017.05.001
8. Kozan O, Ergene O, Oto A, Kapland AK. A real life registry to evaluate patient profile, diagnostic and practice patterns in Acute Coronary Syndrome in Turkey: TURK-AKS study. International Journal of the Cardiovascular Academy [Internet]. 2017;3: 85-93. [Citado 4/02/2019]. Disponible en : https://doi.org/10.1016/j.ijcac.2017.08.003
9. Santos M, Barreiro A, García RC, Barreiro AE. Factores de riesgo de mortalidad hospitalaria post infarto agudo de miocardio. Rev Cubana Cardiol Cir Cardiovasc [Internet]. 2017; 23(3). [Citado 4/02/2019]. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/710/pdf_91
10. De Abreu M, Cosarinsky L, Silberstein A, Mariani JA, Doval HC, Gagliardi JA, et al. Características clínicas, angiográficas, estrategias terapéuticas y pronóstico de pacientes jóvenes con síndrome coronario agudo. Rev Argent Cardiol [Internet]. 2013; 81:22-30. [Citado 4/02/2019]. Disponible en: http://dx.doi.org/10.7775/rac.es.v81.i1.1101
11. Fernández HE, Bilbao JA, Cohen H, Ayerdi ML, Telayna JM, Duronto EA, et al. Calidad de atención del infarto agudo de miocardio en la Argentina. Observaciones del Registro SCAR (Síndromes Coronarios Agudos en Argentina). Rev Argent Cardiol [Internet]. 2014; 82(5): 373-80. [Citado 4/02/2019]. Disponible en: http://dx.doi.org/10.7775/rac.es.v82.i5.3358
12. Morgado G, Pereira H, Caldeira D. Adopting an early invasive strategy for non-ST-elevation myocardial infarction: Analysis of the Portuguese Registry on Acute Coronary Syndromes. Rev Port Cardiol [Internet]. 2018; 37(1):53-61. [Citado 12/2/2019]. Disponible en: https://doi.org/10.1016/j.repce.2017.06.013
13. Silva LE, Sosa OE, Mahecha JA, Polanco JP, Guechá AC, Horta KL, et al. Caracterización de los pacientes con diagnóstico presuntivo de síndrome coronario agudo sin elevación del segmento ST que asisten a un servicio de urgencias. Rev Colomb Cardiol [Internet]. 2018; 25(4):243-8. [Citado 12/02/2019]. Disponible en: https://doi.org/10.1016/j.rccar.2017.09.006
14. Martínez-Sánchez C, Jerjes-Sánchez C, Nicolau JC, Bazzino O, Antepara N, Mármol R. Acute coronary syndromes in Latin America: lessons from the ACCESS registry. Rev Med Inst Mex Seguro Soc [Internet]. 2016; 54(6): 726-37.[Citado 12/02/2019]. Disponible en: http://www.medigraphic.com/pdfs/imss/im-2016/im166g.pdf
15. Valdés-Martín A, Rivas-Estany E, Martínez-Benítez P, Chipi-Rodríguez Y, Reyes- Navia G, Echevarría-Sifontes LA. Caracterización del síndrome coronario agudo en adultos menores de 45 años de una institución especializada en La Habana, Cuba, entre 2013 y 2014. MéD.UIS [Internet]. 2015; 28(3): 281-90. [Citado 12/02/2019]. Disponible en: http://dx.doi.org/10.18273/revmed.v28n3-2015002
16. Mirza AJ, Taha AY, Khdhir BR. Risk factors for acute coronary syndrome in patients below the age of 40 years. The Egyptian Heart Journal [Internet]. 2018;70:233-235.[Citado 12/02/2019]. Disponible en: https://doi.org/10.1016/j.ehj.2018.05.005
17. Harada-Shiba M, Ako J, Arai H, Hirayama A, Murakami Y, Nohara A, et al. Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome in Japan: Results of the EXPLORE-J study. Atherosclerosis [Internet]. 2018; 277: 362-8. [Citado 16/02/2019]. Disponible en: https://doi.org/10.1016/j.atherosclerosis.2018.06.856
18. Dégano IR, Subirana I, Fusco D, Tavazzi L, Kirchberger I, Farmakis D, et al. Percutaneous coronary intervention reduces mortality in myocardial infarction patients with comorbidities: Implications for elderly patients with diabetes or kidney disease. Int. J. Cardiol [Internet]. 2017; 249:83-9. [Citado 16/02/2019]. Disponible en: http://dx.doi.org/10.1016/j.ijcard.2017.07.054
19. Bhatia S, Arora S, Mallam S, Agnihotri K, Patel P, Patel N. Percutaneous Coronary Intervention is associated with decreased mortality in NSTEMI patients with advanced CKD J. Am. Coll. Cardiol [Internet]. 2017; 69(11 supplement):1283. [Citado 19/02/2019]. Disponible en: http://www.onlinejacc.org/content/69/11_Supplement/1283.abstract
20. Foraker RE, Guha A, Chang H, O’Brien EC, Bower JK, Crouser ED, et al. Survival After MI in a Community Cohort Study. Contribution of Comorbidities in NSTEMI. GLOBAL HEART [Internet]. 2018; 13(1):13-8. [Citado 19/2/2019]. Disponible en: https://doi.org/10.1016/j.gheart.2018.01.002
21. García A, Pérez B, González AM, Muñoz J, Cano J, Arboleda JA, et al. Síndrome coronario agudo en pacientes jóvenes. CARDIOCORE [Internet]. 2015; 50(Espec Congr): 135. [Citado 19/02/2019]. Disponible en: http://www.elsevier.es/controladores/congresosherramientas.php?idCongreso=17&idSesion=1401&idComunicacion=16046&r=298
22. Ávalos-Cabrera JM, Carranza-Quispe F. Características clínico epidemiológicas de pacientes con Síndrome Coronario Agudo de la Unidad de Cuidados Intensivos del Hospital Félix Torrealva Gutiérrez. ICA. Perú. Rev. méd. Panacea [Internet]. 2012; 2(3):81-6. [Citado 19/02/2019]. Disponible en: http://www.imbiomed.com.mx/1/1/articulos.php?method=showDetail&id_articulo=93179&id_seccion=5320&id_ejemplar=9133&id_revista=343
23. Schmidt FP, Schmitt C, Hochadel M, Giannitsis E, Darius H, Maier LS, et al. Invasive treatment of NSTEMI patients in German Chest Pain Units-Evidence for a treatment paradox Int. J. Cardiol [Internet]. 2018; 255:15-9. [Citado 19/02/2019]. Disponible en: https://doi.org/10.1016/j.ijcard.2017.11.018
24. Hammami R, Jdidi J, Mroua F, Kallel R, Hentati M, Abid L, et al. Accuracy of the TIMI and GRACE scores in predicting coronary disease in patients with non-ST-elevation acute coronary syndrome. Rev Port Cardiol [Internet]. 2018;37(1):41-9.[Citado 19/02/2019]. Disponible en: https://doi.org/10.1016/j.repc.2017.05.012
25. Roy SS, Azam A, Ullah KM, Rahman MA. GRACE and TIMI risk scores in predicting the angiographic severity of non-ST elevation acute coronary síndrome. Indian Heart Journal [Internet]. 2018; 70: S250-S253. [Citado 19/02/2019]. Disponible en: https://doi.org/10.1016/j.ihj.2018.01.026
26. Sénior JM, Fernández A, Rodríguez A, Muñoz E, Díaz J, Gándara J, et al. Validación y comparación de los puntajes TIMI y GRACE en pacientes con síndrome coronario agudo sin elevación del segmento ST. Rev Colomb Cardiol. [Internet]. 2016;23(6):479-86. [Citado 19/02/2019]. Disponible en: https://doi.org/10.1016/j.rccar.2016.04.016