Revista Colombiana de Cardiología (Jan 2006)
Incidencia y significado clínico del grado de perfusión miocárdica durante la angioplastia primaria en el paciente con inf arto agudo del miocardio Incidence and clinical signification of myocardial perfusion degree during primary angioplasty in patients with acute myocardial infarction
Abstract
Introducción y objetivos: un porcentaje variable de pacientes con infarto agudo del miocardio tratados con intervención coronaria percutánea primaria, tiene compromiso de la perfusión miocárdica a pesar de reestablecer el flujo coronario epicárdico. En este estudio se evalúa la relación que existe entre el grado de perfusión miocárdica y la probabilidad de aparición de eventos clínicos como angina, falla cardiaca, rehospitalización por causas cardiacas y muerte, tanto intrahospitalaria como a seis meses. Materiales y métodos: en 86 pacientes con infarto agudo del miocardio tratados con intervención coronaria percutánea primaria, se compararon los resultados angiográficos y clínicos de acuerdo con el grado de perfusión miocárdica. En todos ellos y durante la hospitalización, se evaluaron los niveles de enzimas cardiacas, se efectuó electrocardiograma de control en las primeras dos horas luego de la intervención coronaria percutánea y se observó la función ventricular por medio de ecocardiograma. El seguimiento clínico a seis meses se realizó en 80 (93%) pacientes y se evaluaron eventos clínicos como angina, falla cardiaca, rehospitalización por causas cardiacas y muerte. Resultados: en la hospitalización no ocurrió angina en los diferentes grupos tratados con intervención coronaria percutánea primaria. Se presentó falla cardiaca en 3 (23,1%) pacientes del grupo con grado de perfusión miocárdica 0-1 y en ninguno del grupo con grado de perfusión miocárdica 3 (pIntroduction and objectives: a variable percentage of patients with myocardial infarction treated with primary percutaneous coronary intervention have myocardial perfusion involvement, in spite of reestablishing the epicardium coronary flow. In this study, the relation between the grade of myocardial perfusion and the probability of clinical events such as angina, cardiac failure or the re-admission due to cardiac causes and intra-hospitalary death and that occurred after six months, are evaluated. Materials and methods: in 86 patients with acute myocardial infarction treated with primary percutaneous coronary intervention, the angiographic and clinical results were compared according to the grade of myocardial perfusion. In all of them, during the hospitalization, the cardiac enzymes’ levels were evaluated, an electrocardiogram in the first two hours after the percutaneous coronary intervention was performed, and the ventricular function was observed through echocardiography. Six months clinical follow-up was realized in 80 patients (93%) and clinical events such as angina, heart failure, re-admission due to cardiac causes and death were evaluated. Results: no angina was observed in the different groups treated with primary percutaneous coronary intervention during the hospitalization. Heart failure occurred in 3 patients (23.1%) from the 0-1 grade group of myocardial perfusion and in none from the grade 3 group of myocardial perfusion (p<0.01). There were 2 deaths (13.3%) in the group with 0-1 grade of myocardial perfusion and none in the group with grade 3 of myocardial perfusion (p=0.01). Seven patients (63.9%) from the group with degree 0-1 of myocardial perfusion and 2 patients (5%) from the group with myocardial perfusion grade 3 (p=0.01) developed heart failure. 7 patients (41.2) were re-hospitalized due to cardiac causes, with myocardial perfusion grade 0-1 and 2 patients (6.9%) with myocardial perfusion grade 3 (p < 0.01). Death occurred in 3 patients (27.3%) with myocardial perfusion grade 0-1 and in 1 patient (3.3%) with myocardial perfusion grade 3 (p=0.10). Conclusion: evaluation of myocardial perfusion grade allows to stratify the risk of clinical events and mortality in patients with acute myocardial infarction treated through primary percutaneous coronary intervention, both intra-hospitalary and six months after. In patients with acute myocardial infarction treated with primary percutaneous coronary intervention, we found that the grade of myocardial perfusion 0-1 predicts in direct way mortality and cardiovascular events.
