Hiperglicemia como factor pronóstico de mortalidad precoz en pacientes con infarto agudo del miocardio Unidad de Cuidados Coronarios. Hospital Regional 2 Dr. Teodoro Maldonado Carbo 2009-2010
Fecha
2013
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El infarto agudo de miocardio (IAM) en el músculo cardiaco es una patología
que se presenta en aproximadamente el 35% de los problemas coronarios
agudos con gran frecuencia y mortalidad en el Ecuador, inclusive en sujetos
que quedan internados en las unidades de cuidados intensivos. Muchas de
estas muertes se deben a la imposibilidad de dar asistencia preventiva o
temprana. Es fundamental para el médico intensivista poder pronosticar
mortalidad precoz en individuos con IAM. Se ha propuesto que la
hiperglucemia aguda que acompaña a esta enfermedad podría anticipar un
mayor riesgo de muerte pero los resultados son controversiales. El hospital
“Dr. Teodoro Maldonado Carbo” posee un área de UCI cardiológico, donde
cada año, muchos pacientes con IAM son atendidos y se necesitaba establecer
el valor de este parámetro. Objetivo: Evaluar el valor de la determinación de
glucemia al ingreso como factor pronóstico de muerte precoz en pacientes
con IAM. Metodología: Se desarrolló un estudio transversal, en el que se
incorporarán 50 individuos con IAM que murieron y 50 que no presentaron
este desenlace que fueron atendidos en la UCI del hospital entre 2009 y 2010.
Análisis estadístico: Se emplearon ARA, RR; OR y la prueba de Chi2 y el
Test exacto de Fisher. Resultados: Existió una mayor prevalencia de
hiperglucemia en pacientes con IAM que presentaron muerte precoz en
relación a los que no lo hicieron pero no fue estadísticamente significativa (P:
0.4). Los cálculos de riesgo relativo (RR: 2,7857 IC 95%: 0,4883 – 15-89-34)
y Odds Ratio (OR: 2.9531 IC 95%: 0,4694-18,581) no mostraron un
incremento estable del riesgo de esta asociación. Conclusiones: La
hiperglucemia al ingreso no demuestra ser un buen predictor de muerte
precoz en pacientes con IAM.
Palabras Claves: INFARTO AGUDO DEL MIOCARDIO. FACTORES
PRONÓSTICOS. MUERTE
VI
ABSTRACT
Acute myocardial infarction (AMI) in cardiac muscle is a condition that occurs in approximately 35% of acute coronary problems with high frequency and mortality in Ecuador, even in subjects who are placed in care units intensive. Many of these deaths are due to the impossibility of providing preventive care or early. Fundamental to the intensive care physician to predict early mortality in individuals with AMI. It has been proposed that acute hyperglycemia that accompanies this disease could anticipate a greater risk of death but the results are controversial. The Teodoro Maldonado hospital has an area of cardiology intensive care, where every year, many patients whit AIM are cared for and are needed to establish the value of this parameter. Objective: To evaluate the value of admission plasma glucose determination as a predictor of early death in patients with AMI. Methodology: A cross sectional study was developed, which incorporated 50 individuals with AMI who died and 50 who did not have the outcome that were treated in the ICU of the hospital between 2009 and 2010. Statistical analysis: We used ARA, RR, OR and Chi 2 test and Fisher exact test. Results: There was a higher prevalence of hyperglycemia in patients with AMI who presented early death in relation to those who did not but it was not statistically significant (P = 0.4). Estimates of relative risk (RR: 2.7857 95% CI 0.4883 - 15-89-34) and Odds Ratio (OR: 2.9531 95% CI 0.4694 to 18.581) showed a steady increase in the risk of this association. Conclusions: Hyperglycemia at admission proves to be a good predictor of early death in patients with AMI.
Acute myocardial infarction (AMI) in cardiac muscle is a condition that occurs in approximately 35% of acute coronary problems with high frequency and mortality in Ecuador, even in subjects who are placed in care units intensive. Many of these deaths are due to the impossibility of providing preventive care or early. Fundamental to the intensive care physician to predict early mortality in individuals with AMI. It has been proposed that acute hyperglycemia that accompanies this disease could anticipate a greater risk of death but the results are controversial. The Teodoro Maldonado hospital has an area of cardiology intensive care, where every year, many patients whit AIM are cared for and are needed to establish the value of this parameter. Objective: To evaluate the value of admission plasma glucose determination as a predictor of early death in patients with AMI. Methodology: A cross sectional study was developed, which incorporated 50 individuals with AMI who died and 50 who did not have the outcome that were treated in the ICU of the hospital between 2009 and 2010. Statistical analysis: We used ARA, RR, OR and Chi 2 test and Fisher exact test. Results: There was a higher prevalence of hyperglycemia in patients with AMI who presented early death in relation to those who did not but it was not statistically significant (P = 0.4). Estimates of relative risk (RR: 2.7857 95% CI 0.4883 - 15-89-34) and Odds Ratio (OR: 2.9531 95% CI 0.4694 to 18.581) showed a steady increase in the risk of this association. Conclusions: Hyperglycemia at admission proves to be a good predictor of early death in patients with AMI.
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Infarto del miocardio, Hiperglucemia, Pronóstico, Mortalidad, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Unidades de Cuidados Coronarios