Infarto agudo de miocardio : morbimortalidad con antiagregación plaquetaria luego de una hora de evento isquémico, estudio a realizar en el Area de Cardiología del Hospital Luis Vernaza período agosto 2014-agosto 2015
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
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Introducción: El Infarto Agudo de Miocardio es la necrosis de las células miocárdicas como consecuencia del aporte deficiente de oxígeno, producto de una obstrucción total o parcial de una arteria coronaria originada por un trombo generado en una placa ateromatosa. Existen factores de riesgo cardiovascular que predisponen al paciente a padecer una cardiopatía isquémica, entre los más relevantes: Dislipidemias, hipertensión arterial, diabetes mellitus tipo 2, sedentarismo, obesidad, tabaquismo, antecedentes de cardiopatía isquémica, edad mayor a 55 años entre otros. La mortalidad global del infarto de miocardio durante el primer mes del episodio agudo es del 40 -50%, dos terceras partes de estos fallecimientos se deben a trastornos del ritmo y ocurren dentro de las 2 primeras horas. El tratamiento farmacológico se basa en la administración de antiagregantes plaquetarios y anticoagulante para prevenir e impedir la obstrucción completa por trombos de la luz del vaso y de microembolismos distales. La administración de Ácido acetil salicílico reduce la incidencia de infarto y la mortalidad en los meses siguientes, La combinación con Clopidogrel y Ácido acetil salicílico es más eficaz en pacientes de riesgo intermedio alto ya que aumenta el riesgo de hemorragias. La administración de Ácido acetil salicílico constituye el tratamiento más sencillo y eficaz en los síndromes coronarios agudos, tanto en pacientes con angina inestable como en pacientes con infarto; se debe administrar en dosis mayores a las de mantenimiento (160–325mg) con el fin de alcanzar rápidamente sus efectos antiagregantes. Su administración precoz inclusive antes de llegar al hospital, disminuye un 20% la mortalidad por infarto; además potencia los efectos de los fibrinolíticos en el caso en que se requiera utilizarlos.
Materiales y métodos: Éste es estudio observacional, descriptivo, retrospectivo, no experimental y de corte transversal realizado mediante la observación de datos clínicos recolectados, en el período comprendido de 01 de Agosto de 2014 al 01 de Agosto del 2015. Analizaremos de forma retrospectiva a todos los pacientes que ingresaron al servicio de la emergencia del hospital Luis Vernaza con diagnóstico de angina inestable o infarto agudo de miocardio sin antiagregación plaquetaria después de una hora de la sintomatología
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Resultados: se estudiaron de los 103 pacientes del estudio 65 pacientes que representan el 63 % del universo presentaron una morbilidad relacionada con el infarto agudo de miocardio sin antiagregacion plaquetaria en la primera hora desde el evento isquémico. El 37% que en frecuencia representan 38 pacientes no presentaron morbilidad asociada a la cardiopatía isquémica en estudio.
PALABRAS CLAVES: Infarto Agudo de miocardio, Antiagregantes Plaquetarios.
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Introduction; The Acute Myocardial Infarction is the necrosis of myocardial cells as a result of poor oxygen supply, resulting from a total or partial obstruction of a coronary artery caused by a thrombus generated in an atheromatous plaque. There are cardiovascular risk factors that predispose the patient to have ischemic heart disease, among the most relevant: Dyslipidemia, hypertension, type 2 diabetes mellitus, physical inactivity, obesity, smoking, history of ischemic heart disease, more than 55 years old. The overall mortality of myocardial infarction during the first month of the acute episode is 40 -50%, two-thirds of these deaths are due to arrhythmias and occur within the first 2 hours. Drug therapy is based on the administration of antiplatelet and anticoagulant antiplatelet agents to prevent complete obstruction by thrombus of the vessel lumen and distal microembolisms. The administration of acetylsalicylic acid reduces the incidence of stroke and mortality in the following months, the combination with Clopidogrel and acetylsalicylic acid is more effective in patients at high-intermediate risk but also increases the risk of bleeding. The administration of acetylsalicylic acid is the most simple and effective treatment for acute coronary syndromes, in patients with unstable angina and infarction patients; It should be given in higher doses then administering the maintenance dose (160-325mg) in order to quickly achieve their antiplatelet effects. His early administration even before reaching the hospital, 20% decreases mortality from stroke; also potentiates the effects of fibrinolytic in the case where use is required. Materials and methods: This is an observational, descriptive, retrospective, non-experimental and cross-sectional study by observing clinical data collected in the period from 1 August 2014 to 1 August 2015 period retrospectively analyze all patients they were admitted to the hospital emergency Luis Vernaza diagnosed with unstable angina or myocardial infarction without antiplatelet therapy after an hour of symptoms Results: We studied 103 patients of the study 65 patients representing 63% of the universe had a morbidity associated with acute myocardial infarction without xi antiplatelet therapy in the first hour after the ischemic event. 37% that often represent 38 patients had no morbidity associated with ischemic heart disease study.
Introduction; The Acute Myocardial Infarction is the necrosis of myocardial cells as a result of poor oxygen supply, resulting from a total or partial obstruction of a coronary artery caused by a thrombus generated in an atheromatous plaque. There are cardiovascular risk factors that predispose the patient to have ischemic heart disease, among the most relevant: Dyslipidemia, hypertension, type 2 diabetes mellitus, physical inactivity, obesity, smoking, history of ischemic heart disease, more than 55 years old. The overall mortality of myocardial infarction during the first month of the acute episode is 40 -50%, two-thirds of these deaths are due to arrhythmias and occur within the first 2 hours. Drug therapy is based on the administration of antiplatelet and anticoagulant antiplatelet agents to prevent complete obstruction by thrombus of the vessel lumen and distal microembolisms. The administration of acetylsalicylic acid reduces the incidence of stroke and mortality in the following months, the combination with Clopidogrel and acetylsalicylic acid is more effective in patients at high-intermediate risk but also increases the risk of bleeding. The administration of acetylsalicylic acid is the most simple and effective treatment for acute coronary syndromes, in patients with unstable angina and infarction patients; It should be given in higher doses then administering the maintenance dose (160-325mg) in order to quickly achieve their antiplatelet effects. His early administration even before reaching the hospital, 20% decreases mortality from stroke; also potentiates the effects of fibrinolytic in the case where use is required. Materials and methods: This is an observational, descriptive, retrospective, non-experimental and cross-sectional study by observing clinical data collected in the period from 1 August 2014 to 1 August 2015 period retrospectively analyze all patients they were admitted to the hospital emergency Luis Vernaza diagnosed with unstable angina or myocardial infarction without antiplatelet therapy after an hour of symptoms Results: We studied 103 patients of the study 65 patients representing 63% of the universe had a morbidity associated with acute myocardial infarction without xi antiplatelet therapy in the first hour after the ischemic event. 37% that often represent 38 patients had no morbidity associated with ischemic heart disease study.
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INFARTO DE MIOCARDO, ANTIAGREGANTES PLAQUETARIO, INDICADORES DE MORBIMORTLIDAD, FACTORES DE RIESGO, HOSPITAL LUIS VERNAZA, CANTON GUAYAQUIL, ECUADOR