RESUMEN
BACKGROUND: Ischemic heart disease is a growing health problem in Latin America. We aimed to analyze risk factors, acute management, and short-term outcome of Mexicans with ST-elevation myocardial infarction (STEMI). HYPOTHESIS: Modifiable risk factors are associated with the occurrence of STEMI in Mexicans, and potentially preventable acute complications are responsible for most short-term deaths. METHODS: Among 8600 patients enrolled in Registro Nacional de los Síndromes Coronarios Agudos II (RENASICA II) with a suspected acute coronary syndrome, we analyzed 4555 patients (56%; age 21-100 y) with confirmed STEMI who presented within 24 hours from symptoms' onset. RESULTS: Smoking (66%), hypertension (50%), and diabetes (43%) were the main risk factors. Most patients (74%) presented with Killip class I (class IV in 4%). Anterior-located STEMI occurred in 56% of cases, and posterior-inferior in 40% of cases. Significant Q waves were present in 43%, right bundle branch block in 7%, left bundle branch block in 5%, first-degree atrioventricular block in 2%, and high-degree atrioventricular block in 2%. A total of 1685 (37%) patients received fibrinolytic therapy (streptokinase, 82%; alteplase, 17%; tenecteplase, 1%), with 31% of patients receiving therapy in <2 hours, 36% in 2-4 hours, 19% in 4-6 hours, and 15% in >6 hours. Thirty percent of patients received either percutaneous coronary intervention or coronary artery bypass grafting during hospitalization. Major adverse cardiovascular events were recurrent ischemia (12%), reinfarction (4%), cardiogenic shock (4%), and stroke (1%). The main predictors of 30-day mortality (10%) in multivariate analysis were age ≥65 years (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.94-3.13), Killip class IV (OR: 10.60, 95% CI: 6.09-18.40), and cardiogenic shock (OR: 18.76, 95% CI: 10.60-33.20). CONCLUSIONS: Largely modifiable risk factors and preventable short-term complications are responsible for most STEMI cases and outcomes in this Mexican population.
Asunto(s)
Infarto de la Pared Anterior del Miocardio/terapia , Puente de Arteria Coronaria , Hospitalización , Infarto de la Pared Inferior del Miocardio/terapia , Intervención Coronaria Percutánea , Terapia Trombolítica , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto de la Pared Anterior del Miocardio/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Femenino , Bloqueo Cardíaco/mortalidad , Bloqueo Cardíaco/terapia , Mortalidad Hospitalaria , Humanos , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/mortalidad , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Recurrencia , Sistema de Registros , Factores de Riesgo , Choque Cardiogénico/mortalidad , Choque Cardiogénico/terapia , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Regardless significant therapeutic advances, mortality and morbidity after myocardial infarction (MI) are still high. For a long time, the importance of right ventricle (RV) function has been neglected. Recently, RV dysfunction has also been associated with poor outcomes in the setting of heart failure. The shape, location, and contraction conditions make the RV chamber assessment technically challenging. METHODS: Our study identified clinical characteristics and left ventricle (LV) echocardiographic data performed 3-5 days after MI that could be associated with RV dysfunction (RV fractional area change [FAC] < 35%) 6 months after MI. RESULTS: The RV dysfunction group consisted of 11 patients (RV FAC 29.4% ± 5.2) and the no RV dysfunction group of 71 patients (RV FAC 43.7% ± 5.1); (P < 0.001). Both groups presented the same baseline clinical characteristics. Left atrium (LA), interventricular septum (IVS), and left ventricular posterior wall (LVPW) were larger in RV dysfunction than in no RV dysfunction. Conversely, E wave deceleration time (EDT) was lower in RV dysfunction when compared with no RV dysfunction. Left atrium(adj) (adjusted by gender, age, infarct size, and body mass index) (odds ratio [OR], 1.22; confidence interval [CI], 1.016-1.47; P = 0.032), interventricular septum(adj) (OR, 1.49; CI, 1.01-2.23; P = 0.044), and E wave deceleration time(adj) (OR, 0.98; CI, 0.97-0.98; P = 0.029) assessed soon after MI predicted RV failure after 6-months. CONCLUSIONS: LV diastolic dysfunction, resulting from anterior MI and assessed 3-5 days after the event, may play an important role in predicting RV dysfunction 6 months later.