RESUMO
The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.
RESUMO
Resumen Introducción y objetivo: la enfermedad coronaria se ha convertido en una de las principales causas de muerte en los individuos menores de 55 años en las últimas décadas, hecho que hace necesario ampliar el conocimiento en esta población creciente, su caracterización, factores de riesgo y desenlaces clínicos en el tiempo. Métodos: se realizó un estudio de cohorte para evaluar el efecto de los factores de riesgo cardiovasculares, así como las variables clínicas y angiográficas sobre la incidencia de un desenlace adverso cardiovascular mayor, en pacientes con un primer evento coronario agudo antes de los 55 años. Se realizó una asociación entre las variables y el tiempo libre a un desenlace cardiovascular mayor adverso. Resultados: se reclutaron 193 pacientes, con un seguimiento de 1,7 años por paciente. La mediana de edad fue 51 años. Se encontró asociación entre el tipo de evento coronario, infarto agudo del miocardio con elevación del ST (RR=8,4 IC95% 1,9-37,4) y puntaje de Killip > II (RR 5,57, IC 95% 1,2 - 25,2), con mayor número de complicaciones intrahospitalarias. Aquellos con compromiso de la arteria circunfleja (RR=4,5 IC95% 1,65 - 12,4) y requerimiento de implante de tres o más prótesis intracoronarias (RR 4,7 IC95% 1,7-12,7), presentaron mayor riesgo de sufrir nuevo evento cardiovascular mayor. Conclusión: los pacientes menores de 55 años con síndrome coronario agudo y compromiso de la arteria circunfleja o requerimiento de implante de más de tres stents, tienen mayor número de desenlaces cardiovasculares adversos.
Abstract Introduction and objective: Coronary disease has become one of the main causes of death in individuals less than 55 years-old in the last 20-30 years or so. This has led to the need to increase the knowledge in this growing population, as well as its characteristics, risk factors and eventual clinical outcomes. Methods: A cohort study was conducted in order to evaluate the effect of the cardiovascular risk factors, as well as the clinical and coronary angiography variables on the incidence of a major adverse cardiovascular outcome, in patients with a first acute coronary event before 55 years-old. Correlations were performed between the variables and the time free from a major adverse cardiovascular outcome. Results: The study included 193 patients, with a mean follow-up of 1.7 years per patient. The median age was 51 years. An association was found between the type of coronary event, acute myocardial infarction with ST elevation (RR=8.4, 95% CI; 1.9-37.4) and a Killip score > II (RR 5.57, 95% CI; 1.2 - 25.2), with a greater number of in-hospital complications. Those with circumflex artery involvement (RR=4.5, 95%CI; 1.65 - 12.4) and a requirement for three or more coronary stent implants (RR 4.7, 95%CI; 1.7-12.7), had a higher risk of suffering a new cardiovascular event. Conclusion: Patients less than 55 years-old with acute coronary syndrome and circumflex artery involvement, or the requirement of the implanting more than three stents, have a higher number of adverse cardiovascular outcomes.