ABSTRACT
Las enfermedades cardiovasculares representan la primera causa de muerte en el mundo. El manejo de los síndromes coronarios ha avanzado formidablemente en los últimos 50 años, reduciendo el riesgo isquémico, a expensas del consiguiente aumento del riesgo hemorrágico. La Sociedad Europea de Cardiología publicó en el año 2020 la guía sobre el manejo de síndrome coronario agudo sin elevación del segmento ST, donde se destacan cambios en los algoritmos de estratificación de riesgo y la terapia antiplaquetaria y anticoagulante como dos de los aspectos principales. En el presente editorial se resumen las principales novedades publicadas en este documento.
Cardiovascular disease is the leading cause of death worldwide. The management of coronary syndromes has advanced dramatically in the last 50 years, reducing ischemic risk, but observing an increase in bleeding risk. The European Society of Cardiology published in 2020 the guideline on the management of acute coronary syndrome without ST-segment elevation, where changes in risk stratification algorithms and antiplatelet and anticoagulant therapy are highlighted as two of the main aspects. This editorial summarizes the main developments published in this document.
A doença cardiovascular é a principal causa de morte em todo o mundo. O manejo das síndromes coronarianas avançou dramaticamente nos últimos 50 anos, reduzindo o risco isquêmico, mas observando um aumento no risco de sangramento. A Sociedade Europeia de Cardiologia publicou em 2020 a diretriz sobre o manejo da síndrome coronariana aguda sem supradesnivelamento do segmento ST, onde as alterações nos algoritmos de estratificação de risco e na terapia antiplaquetária e anticoagulante são destacadas como dois dos principais aspectos. Este editorial resume os principais desenvolvimentos publicados neste documento.
Subject(s)
Humans , Practice Guidelines as Topic , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/therapy , EuropeABSTRACT
Resumen: Introducción Las fallas de los puentes venosos pueden llegar casi al 50% a 10 años y la angioplastía percutánea es el tratamiento de elección. Estos pacientes constituyen un grupo de muy alto riesgo cardiovascular con tasas de mortalidad cercanas al 30% en el mediano plazo. Objetivo Caracterizar a la población sometida a angioplastia de puentes coronarios (APC) y comparar su mortalidad con un grupo pareado de pacientes intervenidos con Infarto agudo al miocardio con elevación del segmento ST (IAMCEST). Métodos Estudio retrospectivo de tipo Caso-Control que incluyó a pacientes con APC entre los años 2010-2016 comparados con igual número de controles con IAMCEST pareados por edad y sexo. Se analizaron características clínicas del procedimiento y mortalidad, tanto global como de causa cardiaca usando T Student, Chi2 y curvas de Kaplan Meier. Resultados Se identificaron 63 pacientes sometidos a APC (total 76 procedimientos). Los puentes más comúnmente intervenidos fueron a la arteria circunfleja 48,7%. Hubo 18 (28,5%) pacientes fallecidos en el grupo APC y 6 (9,5%) pacientes en el grupo con IAM-CEST, lo que resultó en un exceso de mortalidad global en pacientes con APC (HR 3,02; IC 95% 1,11 - 8,22, p=0,02). Esta diferencia se debió a una mayor mortalidad de causa no cardiaca en el grupo APC (12,7% (n=8) vs 3,2% (n= 2) [p=0,04]). Conclusión Los pacientes sometidos a APC presentan una mortalidad 3 veces mayor que aquellos pacientes con IAMCEST, principalmente derivada de una mayor mortalidad no cardíaca.
Abstract: Background Failure rates of saphenous vein grafts can reach almost 50% at 10 years and percutaneous angioplasty is the treatment of choice. This is a group with a very high cardiovascular risk, with mid-term mortality rates close to 30%. Aim To describe the population undergoing coronary bypass angioplasty (CBA) and compare their mortality with an age and gender matched group of patients with acute myocardial infarction with ST segment elevation (STEMI) Methods This was a retrospective case-control study including patients with CBA between 2010-2016. This group was compared with the same number of controls with STEMI matched by age and sex. Clinical characteristics, procedure variables and overall mortality as well as cardiac mortality were analyzed using Student's T test, Chi squared test and Kaplan Meier curves (significance set at p <0.05). Results: We identified 63 patients undergoing CBA (76 procedures). The most commonly intervened bypasses were to the circumflex artery (48.7%). There were 18 (28.5%) patients who died in the CBA group and 6 (9.5%) patients in the STEMI group, which resulted in an excess of global mortality risk in patients with CBA (HR 3.02, 95% CI 1.11 - 8.22, p = 0.02). This difference was driven by a higher non-cardiac mortality in the CBA group (12.7% (n = 8) vs 3.2% (n = 2) [p = 0.04]) Conclusion Patients undergoing CBA have a mortality rate more than three times that of the STEMI patients, mainly due to a higher non-cardiac mortality.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary/mortality , ST Elevation Myocardial Infarction/mortality , Saphenous Vein , Case-Control Studies , Survival Analysis , Coronary Artery Bypass/mortality , Retrospective Studies , Cause of Death , Non-ST Elevated Myocardial Infarction/therapyABSTRACT
Coronary heart disease can manifest as stable or unstable forms, being these variations differentiated mainly by the underlying pathophysiological cause, their clinical presentation and the risk associated to each of these clinical presentations. In the unstable form, nowadays known as acute coronary syndrome, recommendations over its characterization and particularly its management are periodically updated in published international guidelines about this topic. Their epidemiological relevance makes important that these aspects should be known by anyone that sees patients in their practices, motivating this review in which we will summarize aspects of the clinical presentation, initial studies and management of the acute coronary syndrome without ST segment elevation emphasizing novelties from the last few years. (AU)