RESUMEN
OBJECTIVE: The aim of this study was to analyze the prognosis of patients presenting early ventricular fibrillation (VF) in the setting of ST elevation myocardial infarction (STEMI). PATIENTS AND METHODS: Among patients included in the ARIAM (Análisis del Retraso en el Infarto Agudo de Miocardio) registry with the diagnosis of STEMI, those who received primary revascularization and were admitted in the first 12 h were analyzed retrospectively. RESULTS: From January 2007 to January 2012, 8340 patients were included in the STEMI cohort and 680 (8.2%) of them presented with VF before admission to the ICU (VF). This group comprised younger patients with fewer comorbidities. They received more often primary angioplasty (33.7 vs. 24.9%; P<0.001), had more prevalence of Killip class greater than or equal to 2 at admission (37.5 vs. 17.8%; P<0.001), and suffered more often cardiogenic shock (18.5 vs. 5.9%, P<0.001). By logistic regression analysis, VF was associated with a greater in-hospital mortality [odds rate (OR): 2.08, 95% confidence interval (CI): 1.57-2.81, P<0.001]. After a propensity score matching process, VF was associated with in-hospital mortality (OR: 1.53, 95% CI: 1.05-2.25, P=0.028). However, when analyzing patients treated by primary angioplasty, the mortality was not significantly related to VF (OR: 0.86, 95% CI: 0.45-1.61, P=0.628). CONCLUSION: Our results show that VF before ICU admission was an independent predictor of in-hospital outcome in a cohort of patients in whom fibrinolysis was the most used revascularization therapy. However, this prognostic value was not found in patients treated with primary angioplasty.
Asunto(s)
Infarto del Miocardio con Elevación del ST/epidemiología , Fibrilación Ventricular/epidemiología , Anciano , Angioplastia Coronaria con Balón , Distribución de Chi-Cuadrado , Comorbilidad , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Admisión del Paciente , Intervención Coronaria Percutánea , Prevalencia , Puntaje de Propensión , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/terapia , Choque Cardiogénico/epidemiología , España/epidemiología , Terapia Trombolítica , Factores de Tiempo , Resultado del Tratamiento , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/mortalidadRESUMEN
INTRODUCTION AND OBJECTIVES: The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the "real world" remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). METHODS: A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models. RESULTS: The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P < .0001; 0.1% vs 0.5%, P = .025; 0.07% vs 0.5%, P = .025, respectively). There were no differences in the rate of total bleeding (3% vs 4%; P = NS). After propensity score matching, the mortality reduction with NAA persisted (OR, 0.37; 95%CI, 0.13 to 0.60; P < .0001) with no increase in total bleeding (OR, 1.07; 95%CI, 0.18 to 2.37; P = .094). CONCLUSIONS: In a "real world" setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel.
Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico , Adenosina/análogos & derivados , Inhibidores de Agregación Plaquetaria/administración & dosificación , Clorhidrato de Prasugrel/administración & dosificación , Adenosina/administración & dosificación , Adenosina/efectos adversos , Anciano , Unidades de Cuidados Coronarios , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Inhibidores de Agregación Plaquetaria/efectos adversos , Clorhidrato de Prasugrel/efectos adversos , Puntaje de Propensión , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Antagonistas del Receptor Purinérgico P2Y/efectos adversos , Sistema de Registros , Estudios Retrospectivos , Ticagrelor , Resultado del TratamientoRESUMEN
Primary antiphospholipid syndrome (APS) is a thrombophilic disorder not associated with connective tissue diseases or with autoimmune diseases. We report a 39-year-old female with a mechanical prosthetic mitral valve and a primary antiphospholipid syndrome. Anticoagulation with warfarin was changed for tinzaparine. Four days after the change, the patients was admitted in cardiogenic shock. A transesophageal echocardiogram showed a mass in the prosthetic valve suggestive of prosthetic thrombosis. The patient required two valve replacements due to thrombosis. Her anticardiolipin antibody titers were 84 UPL. She was discharged with a coagulation international normalized ratio of three.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral/cirugía , Trombosis/complicaciones , Adulto , Ecocardiografía Transesofágica , Femenino , Humanos , Trombosis/diagnóstico , Trombosis/tratamiento farmacológicoRESUMEN
Primary antiphospholipid syndrome (APS) is a thrombophilic disorder not associated with connective tissue diseases or with autoimmune diseases. We report a 39-year-old female with a mechanical prosthetic mitral valve and a primary antiphospholipid syndrome. Anticoagulation with warfarin was changedfor tinzaparine. Four days after the change, the patients was admitted in cardiogenic shock. A transesophageal echocardiogram showed a mass in the prosthetic valve suggestive of prosthetic thrombosis. The patient required two valve replacements due to thrombosis. Her anticardiolipin antibody titers were 84 UPL. She was discharged with a coagulation international normalized ratio of three.