Características clínicas y pronóstico a un año de pacientes con síndrome coronario agudo sin elevación del segmento ST y arterias coronarias sanas / Clinical characteristics and one year prognosis of patients with acute coronary syndrome without ST segment elevation and normal coronary arteries

Objetivo: describir las características clínicas y el pronóstico de los pacientes con infarto sin elevación del segmento ST y arterias coronarias normales. Métodos: estudio de cohorte en pacientes con infarto sin elevación del segmento ST con enfermedad coronaria o arterias coronarias normales (sin enfermedad coronaria), en el que se compararon: forma de presentación, intervenciones y desenlaces a un año. Resultados: cada cohorte estuvo compuesta por 24 pacientes. El grupo de pacientes sin enfermedad coronaria fue más joven (56±10 años vs. 63±10 años, p=0,026) y tuvo mayor cantidad de mujeres (62% vs. 29%, p=0,02). El puntaje de riesgo TIMI fue mayor en el grupo con enfermedad coronaria (3,3 vs. 2,5, p=0,02); sin embargo, no se tradujo en coronariografías más tempranas (sin enfermedad coronaria 19±18 h vs. con enfermedad coronaria 27±21 h, p=0,18). El número de vasos enfermos en los pacientes con enfermedad coronaria fue 1,6 y se implantaron 2,04 stents en promedio; en 75% de los casos éstos fueron no medicados. La estancia hospitalaria fue significativamente mayor en el grupo con enfermedad coronaria (3,5±1,7 vs. 2,3±1,1, p=0,01). Los pacientes sin enfermedad coronaria mostraron mejor fracción de eyección (0,57±0,06 vs. 0,50±0,12) y menor número de defectos segmentarios de contractilidad (8 vs. 15 pacientes, p=0,03). No hubo diferencias en cuanto a mortalidad por causa cardiovascular (con enfermedad coronaria 1 caso, sin enfermedad coronaria 0 casos), necesidad de nueva coronariografía (con enfermedad coronaria 1 caso, sin enfermedad coronaria 0 casos) y rehospitalización por dolor torácico (6 casos en ambos grupos). Conclusiones: la probabilidad de rehospitalización por dolor torácico, necesidad de nueva coronariografía y muerte no difirió entre los pacientes con infarto sin elevación del segmento ST con o sin enfermedad coronaria obstructiva.

Objective: to describe the clinical characteristics and prognosis of patients with acute myocardial infarction without ST-segment elevation and normal coronary arteries. Methods: cohort study in patients with myocardial infarction without ST-segment elevation with coronary disease or with normal coronary arteries (without coronary disease), in which we compared clinical presentation, interventions and outcomes at one year. Results: each cohort consisted of 24 patients. The group of patients without coronary disease was younger (56 ± 10 years vs. 63 ± 10 years, p = 0.026) and had more women (62% vs. 29%, p = 0.02). The TIMI risk score was higher in the group with coronary heart disease (3.3 vs. 2.5, p = 0.02); however, it did not result into earlier coronary angiography (without coronary disease 19 ± 18 hours, vs. with coronary artery disease 27 ± 21 hours, p = 0.18). The number of diseased vessels in patients with coronary artery disease was 1.6 and 2.04 stents were implanted on average; in 75% of cases these were not medicated. Hospital stay was significantly higher in the group with coronary heart disease (3.5 ± 1.7 vs. 2.3 ± 1.1, p = 0.01). Patients without coronary artery disease showed better ejection fraction (0.57 ± 0.06 vs. 0.50 ± 0.12) and lower number of segmental defects of contractility (8 vs. 15 patients, p = 0.03). There were no differences in mortality from cardiovascular causes (1 case with coronary artery disease; without coronary disease 0 cases), need for new coronary angiography (1 patient with coronary artery disease, without coronary disease 0 cases), and rehospitalization due to chest pain (6 cases in both groups). Conclusions: the probability of rehospitalization for chest pain, need for new coronary angiography and death did not differ between patients with infarction without ST-segment elevation with or without obstructive coronary disease.

Perfil dos pacientes com infarto do miocárdio, em um hospital universitário / Profile of patients with myocardial infarction in a university hospital

Objetivo: traçar o perfil epidemiológico dos pacientes com infarto agudo do miocárdio (IAM) observado em Uberlândia, considerando fatores de risco, características clínicas desse evento e o tratamento realizado. Métodos: foram observados pacientes com diagnóstico de IAM atendidos no HCU entre março e outubro de 2006 e analisados: gênero, idade, fatores de risco, dia e hora de ocorrência, suas características clínicas, tempo de retardo pré-hospitalar e tratamento. Resultados: foram estudados 45 pacientes, sendo 71,1, 64,5, 71,1, 68,9, 60,0, 28,9, 46,7, 44,4, 60,0 e 73,3%, respectivamente, homens, de faixa etária entre 60 e 80 anos, tabagistas, hipertensos, sedentários, com glicemia de jejum alterada, com alguma dislipidemia, com sobrepeso, com estresse psicossocial e com história familiar de IAM. A frequência de IAM foi maior na segunda-feira e entre 6:00 e 18:00 horas. O tempo de retardo médio foi de 26,4 horas. A parede do coração mais acometida foi a inferior e 33,3% do IAM apresentavam supradesnivelamento de ST. A maioria dos pacientes recebeu apenas tratamento clínico, que geralmente ocorreu nas primeiras 12 horas. Conclusões: a alta prevalência de fatores de risco cardiovascular em pacientes com IAM reforça a importância do controle desses preditores de eventos isquêmicos, enquanto o tempo verificado para o seu atendimento inicial indica a necessidade de melhoria do sistema de diagnóstico, transporte e tratamento.

Objective: to delineate the epidemiological profile of patients with acute myocardial infarction (AMI) observed in Uberlândia, considering risk factors, clinical features and treatment of this event. Methods: patients with AMI care in the HCU between March and October 2006 were observed and analyzed: gender, age, risk factors, day and time of the occurrence, clinical features, pre-hospital delay and treatment. Results: 45 patients were studied, 71,1, 64,5, 71,1, 68,9, 60,0, 28,9, 46,7 44,4, 60,0 and 73,3%, respectively, men aged between 60 and 80 years old, smokers, hypertensive, sedentary, with impaired fasting glucose, with some dyslipidemia, overweight, with psychosocial stress and family history of AMI. The AMI frequency was higher on Mondays and between 6:00 am and 6:00 pm. The average delay time was 26,4 hours . The heart lower wall was the most affected and 33,3% of AMI had ST elevation. Most patients received only clinical treatment that usually occurred within the first 12 hours. Conclusions: the high prevalence of cardiovascular risk factors in AMI patients underscores the importance of controlling these predictors of ischemic events, while the time spend for their initial care indicates the need for improving the diagnosis, treatment and transport system.