Aspectos clínico epidemiológicos del síndrome coronario agudo: Hospital "Abel Santa María", 2006-2007 / Clinical-epidemiological aspects of the Acute Coronary Syndrome: "Abel Santamaría" University Hospital. 2006-2007

Bernardo Cruz Ledesma, Ariel E. Delgado Rodríguez, Irene C. Pastrana Román, Carlos Brown Sotolongo, William Quintero Pérez

Texto completo:

PDF HTML

Resumen

Se realizó un estudio prospectivo, longitudinal y descriptivo, a fin de caracterizar los aspectos clínicos epidemiológicos de la enfermedad coronaria aguda y los cuidados de enfermería en el Hospital "Abel Santamaría" de Pinar del Río, en el período del 1º. de Julio de 2006 al 30 de junio de 2007. El universo estuvo constituido por los 1784 pacientes ingresados en la Unidad de Cuidados Intensivos Emergentes y la muestra incluyó los 300 diagnosticados de Síndrome Coronario Agudo. Los datos fueron recolectados de los expedientes clínicos y se analizaron las siguientes variables: edad, sexo, color de la piel, intervalo de tiempo entre el inicio del dolor y admisión en la Unidad de Emergencias, tipo de evento coronario agudo y complicaciones. Se utilizó el Paquete Estadístico EPI Info 6 para el manejo de datos y análisis estadístico y solicitó consentimiento informado a los pacientes. Existió predominio de la enfermedad en hombres blancos de 60 años o más. La angina inestable aguda con cambios electrocardiográficos fue la enfermedad coronaria más diagnosticada, seguida del infarto agudo del miocardio. La mayoría de los pacientes acudieron antes de las seis horas de inicio del cuadro doloroso precordial. El fallo de bomba, las arritmias ventriculares malignas y el bloqueo aurículo ventricular, constituyeron las complicaciones más frecuentes y las que mayor mortalidad provocaron.

Palabras clave: Síndromes Coronarios Agudos/Epidemiología.

ABSTRACT

A prospective, longitudinal and descriptive study was carried out aimed at characterizing the clinical-epidemiological aspects of the Acute Coronary Syndrome at "Abel Santamaria" University Hospital, Pinar del Rio during July 1st 2006 to June 30th 2007. The universe of the study was constituted by 1 784 patients admitted at the Intensive Coronary Care Unit and the sample included 300 diagnosed with Coronary Acute Syndrome. Data were collected from the clinical records of the patients and the following variables were analyzed: age, sex, race, interval of time between the onset of the pain and admission in the Emergency Unit, type of the acute coronary event and complications. EPI Info-6 was used as a Statistical Package to the control of data and statistical analysis. The informed consent was requested to the patients. The disease prevailed in Caucasian, 60 years old or older men. Being Acute Unstable Angina with electrocardiographic changes was the coronary syndrome mostly diagnosed, followed by Acute Myocardial Infarction. Most of the patients attended to the hospital before the 6 hours of the onset of the precordial pain. The heart failure, malignant ventricular arrhythmias and the atrioventricular block were the most frequent complications and the ones provoking a greater mortality rate.

Key words: Acute Coronary Syndromes/Epidemiology

Referencias

Graff L, Joseph T, Andelman R, Bahr R, DeHart D, Espinosa J, et al. American College of Emergency Physicians Information Paper: chest pain units in emergency departments: a report from the short-term observation section. Am J Cardiol. 2003; 76:1036-9.

Zalensky RJ, Rydman RJ, Ting S, Kampe L, Selker HP. A national survey of emergency department chest pain centers in the United States. Am J Cardiol. 2005; 81:1305-9.

Lee TH, Rouan GW, Weisberg MC, Brand DA, Acampora D, Stasiulewicz C, et al.. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol. 2007; 60:219-24.

Farkouh ME, Smars PA, Reeder GS, Zinsmeister AR, Evans RW, Meloy TD, et al.. A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators. N Engl J Med. 2005; 339:1882-8

Neumann FS, Kastrati A, Pogatsa-Murray G, Mehilli J, Bollwein H, Bestehorn HP, et al. Evaluation of prolonged antithrombotic pretreatment ("Cooling-Off" Strategy) before intervention in patients with unstable coronary syndromes. JAMA. 2003; 290:1593-9.

Yarzebski J, Goldberg RJ, Gore JM, Alpert JS. Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study. Am Heart J. 2004; 128:255-263.

Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack Study. Arch Intern Med. 2000; 160:3217-3223.

Almagro J, Cabadés O'Callaghan A, López Merino V, De los Reyes M, San José Garagaza JM,et al. Angina de pecho. Concepto y clasificación. Rev Esp Cardiol. 2005; 48: 373-382.

Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. The task force on the management of acute coronary syndromes of the European Society of Cardiology. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2005; 23:1809-40.

Ryan TJ, Anderson JL, Antman EM, Braniff BA, Brooks NH, Califf RM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction. J Am Coll Cardiol. 2007; 28: 1328-1428.

Braunwald E, Jones RH, Mark DB, Brown J, Brown L, Cheitlin MD et al. Diagnosing and managing unstable angina. Circulation. 2004; 90: 613-622.

Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, et al, for the TACTICS-Thrombolysis in myocardial infarction 18 investigators. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001; 344:1879-87.

Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Space KR, et al. Routine vs selective invasive strategies in patients with coronary syndromes. A collaborative meta-analysis of randomized trials. JAMA. 2005; 293:2908-17.

Bovill EG, Terrin ML, Stump DC, Berke AD, Frederick M, Collen D, et al. Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction: results from the TIMI phase II trial. Ann Intern Med. 1991; 115:256-65.

White HD, Barbash GI, Califf RM, Simes RJ, Granger CB, Weaver WD, Kleiman NS, Aylward PE, Gore JM, Vahanian A, Lee KL, Ross AM, Topol EJ. Age and outcome with contemporary thrombolytic therapy: results from the GUSTO-I trial: Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries Trial. Circulation. 2006; 94:1826_1833.

Eagle KA, Goodman SG, Avezum A, Budaj A, Sullivan CM, Lopez-Sendon J; GRACE Investigators. Practice variation and missed opportunities for reperfusion in ST-segment_elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet. 2004; 359:373_377.

Dunckley M, Quinn T, Dickson R, Jayram R, Wright C, McDonald R. Acute coronary syndrome nurses: perceptions of other members of the health care team. Accid Emerg Nurs. 2006; 14(4):204-9.

Dracup K, McKinley S, Riegel B, Mieschke H, Doering LV, Moser DK. A nursing intervention to reduce prehospital delay in acute coronary syndrome: a randomized clinical trial. J Cardiovasc Nurs. 2006; 21(3):186-93.

Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986; 1: 397-402.

ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988; 2: 349-360.



Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.