RESUMEN
Antecedentes. La insuficiencia cardiaca (Killip>I) en pacientes con síndrome coronario agudo (SCA) es un reconocido factor de riesgo para mortalidad; sin embargo, su relación con la aparición de nuevos episodios isquémicos agudos no ha sido bien establecida. Objetivo. El objetivo del presente trabajo fue evaluar la asociación entre Killip>I al ingreso y la aparición de infarto agudo de miocardio (IAM) tras el alta hospitalaria por SCA. Pacientes y métodos. Se estudió de forma prospectiva y consecutiva 972 y 426 supervivientes a un SCA sin elevación del segmento ST (SCASEST) e IAM con elevación del segmento ST (IAMCEST) respectivamente. Se determinó la presencia de Killip>I en el momento del ingreso junto con variables pronósticas clásicas. La asociación entre Killip>I e IAM se determinó mediante regresión de Cox adaptada para episodios competitivos. Resultados. Durante una mediana de seguimiento de 3 años, 135 (13,9%) y 53 (12,4%) pacientes con SCASEST y IAMCEST presentaron un IAM. Los pacientes con SCASEST y IAMCEST con Killip>I (15,6 y 21,3% respectivamente) presentaron más frecuentemente IAM (28,3 vs 6,3 y 10,6 vs 3,3 por 100 pacientes-año seguimiento, p<0 001 respectivamente el análisis multivariante ajustado por factores de riesgo y controlado episodios competitivos muerte revascularización confirmó que scasest iamcest killip I mostraron un incremento en el riesgo de IAM (HR=1,76; IC 95%: 1,15-2,68; p<0 009 y hr="1,90;" ic 95 : 1 07-3 36 p="0,029" respectivamente. Conclusiones. En pacientes con SCASEST y IAMCEST, la presencia de Killip>I al ingreso se asocia de manera independiente con mayor riego de IAM en el seguimiento(AU)
Background. Heart failure (Killip>I) in patients with acute coronary syndrome (ACS) is a recognized risk factor for death. However, its relationship with the risk of new acute ischemic events has not been well established. Objective. The aim of this study has been to evaluate the association between Killip>I on admission and the risk of a new acute myocardial infarction (AMI) during follow-up due to ACS. Patients and methods. A total of 972 and 426 survivors of an ACS with non-ST segment evaluation (Non-STE-ACS) and AMI with ST segment elevation (STEMI) were studied prospectively and consecutively. The presence of Killip>I was determined on admission together with the classical prognostic variables. The relationship between Killip>I and subsequent post-discharge AMI was established with the Cox regression adapted for competitive events. Results. During a median follow-up of 3 years, 135 (13.9%) and 53 (12.4%) patients with Non-STE-ACS and STEMI presented a new AMI. Patients with Non-STE-ACS and STEMI with Killip>I (15.6% and 21.3% respectively) showed a higher incidence of AMI (28.3 vs 6.3 and 10.6 vs 3.3 per 100 patients-years of follow-up, p<0 001 respectively in the multivariate analysis adjusted for traditional risk factors and controlled competitive events death revascularization confirmed that killip I subjects with Non-STE-ACS and STEMI showed a significantly higher risk of AMI (HR: 1.76; CI 95%: 1.15-2.68; p=0.009 and HR: 1.90; 95% CI: 1.07-3.36; p=0.029 respectively). Conclusions. In patients with Non-STE-ACS and STEMI, the presence of Killip>I on admission is independently associated to an increased risk of long-term AMI(AU)
Asunto(s)
Humanos , Masculino , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Infarto/complicaciones , Infarto/diagnóstico , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico , Factores de Riesgo , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo , Estudios ProspectivosRESUMEN
BACKGROUND: Heart failure (Killip>I) in patients with acute coronary syndrome (ACS) is a recognized risk factor for death. However, its relationship with the risk of new acute ischemic events has not been well established. OBJECTIVE: The aim of this study has been to evaluate the association between Killip>I on admission and the risk of a new acute myocardial infarction (AMI) during follow-up due to ACS. PATIENTS AND METHODS: A total of 972 and 426 survivors of an ACS with non-ST segment evaluation (Non-STE-ACS) and AMI with ST segment elevation (STEMI) were studied prospectively and consecutively. The presence of Killip>I was determined on admission together with the classical prognostic variables. The relationship between Killip>I and subsequent post-discharge AMI was established with the Cox regression adapted for competitive events. RESULTS: During a median follow-up of 3 years, 135 (13.9%) and 53 (12.4%) patients with Non-STE-ACS and STEMI presented a new AMI. Patients with Non-STE-ACS and STEMI with Killip>I (15.6% and 21.3% respectively) showed a higher incidence of AMI (28.3 vs 6.3 and 10.6 vs 3.3 per 100 patients-years of follow-up, p<0.001, respectively). In the multivariate analysis, adjusted for traditional risk factors and controlled for competitive events (death and revascularization), confirmed that Killip>I subjects with Non-STE-ACS and STEMI showed a significantly higher risk of AMI (HR: 1.76; CI 95%: 1.15-2.68; p=0.009 and HR: 1.90; 95% CI: 1.07-3.36; p=0.029 respectively). CONCLUSIONS: In patients with Non-STE-ACS and STEMI, the presence of Killip>I on admission is independently associated to an increased risk of long-term AMI.