Validación y comparación de los puntajes Timi y Grace en pacientes con síndrome coronario agudo sin elevación del segmento ST
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
La predicción en medicina ha sido un tema central. Un modelo predictivo que estratifique el riesgo de incidencia de un evento, establece grupos que le permiten al clínico no solo conocer la probabilidad de desenlaces, sino escoger las alternativas diagnósticas y terapéuticas óptimas y la intensidad del tratamiento de acuerdo con el balance riesgo/beneficio de cada opción. A nivel mundial, la cardiopatía isquémica representa la principal causa de morbimortalidad. Aunque el Score de Riesgo TIMI sea el más utilizado en síndromes coronarios agudos sin supradesnivel del segmento ST, el Score GRACE tiene potencial superioridad pronóstica. El objetivo general de este estudio es determinar cuál escala, TIMI o GRACE, tiene mayor exactitud pronóstica de eventos adversos, en los pacientes con Infarto agudo de miocardio sin elevación del segmento ST y angina inestable. Se realizó un estudio retrospectivo, transversal mediante recolección de datos de las historias clínicas de pacientes con los diagnóstico mencionados, que ingresaron a la emergencia y consecutivamente al servicio de cardiología del Hospital Dr. Abel Gilbert Pontón entre enero del 2016 a febrero del 2018, y que cumplan con los criterios de inclusión y exclusión. Esta investigación llego a la conclusión que en los eventos que implican gravedad inmediata como muerte y reinfarto GRACE tiene mayor superioridad, mientras que en los eventos que indican fragilidad coronaria como angina refractaria e intervención coronaria de urgencia TIMI tiene mayor valor pronóstico
The prediction in medicine has been a central theme. A predictive model that stratifies patients the risk of occurrence of an event, sets groups that allow the clinician to not only know the probability of outcomes, but choosing the alternatives diagnostic and therapeutic optimal and the intensity of the treatment in accordance with the balance sheet risk/benefit of each option. At the global level, the ischemic heart disease is the leading cause of morbidity and mortality. Although the Risk Score TIMI is the most used in acute coronary syndromes without ST-segment elevation, the Score grace has potential superiority prognostic. The overall objective of this study is to determine what scale, TIMI or grace, has greater prognostic accuracy of adverse events in patients with acute myocardial infarction without ST-segment elevation and unstable angina. A retrospective study was conducted, cross through collection of data from the medical histories of patients with the diagnosis mentioned that were admitted to the emergency and consecutively to the cardiology department of the Hospital Dr. Abel Gilbert Ponton between January 2016 to February 2018, and which comply with the criteria of inclusion and exclusion. This research came to the conclusion that in the events involving gravity immediately as death and reinfarction GRACE has highest superiority, while in the events that indicate fragility coronary as refractory angina and coronary intervention of urgency TIMI has greater prognostic value.
The prediction in medicine has been a central theme. A predictive model that stratifies patients the risk of occurrence of an event, sets groups that allow the clinician to not only know the probability of outcomes, but choosing the alternatives diagnostic and therapeutic optimal and the intensity of the treatment in accordance with the balance sheet risk/benefit of each option. At the global level, the ischemic heart disease is the leading cause of morbidity and mortality. Although the Risk Score TIMI is the most used in acute coronary syndromes without ST-segment elevation, the Score grace has potential superiority prognostic. The overall objective of this study is to determine what scale, TIMI or grace, has greater prognostic accuracy of adverse events in patients with acute myocardial infarction without ST-segment elevation and unstable angina. A retrospective study was conducted, cross through collection of data from the medical histories of patients with the diagnosis mentioned that were admitted to the emergency and consecutively to the cardiology department of the Hospital Dr. Abel Gilbert Ponton between January 2016 to February 2018, and which comply with the criteria of inclusion and exclusion. This research came to the conclusion that in the events involving gravity immediately as death and reinfarction GRACE has highest superiority, while in the events that indicate fragility coronary as refractory angina and coronary intervention of urgency TIMI has greater prognostic value.
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Segmento ST, Síndrome coronario agudo, Pronóstico, Medición de riesgo, Estudios retrospectivos, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Registros médicos