Papel dos inibidores da glicoproteína IIb/IIIa na resolução do segmento ST em pacientes submetidos a angioplastia primária / The Role of Glycoprotein IIb/IIIa Inhibitor on ST Segment Resolution of Patients Submitted to Primary Angioplasty

RESUMO

A combinação de amgioplastia (ATC) e inhibidores da glicoproteina IIb/IIIa no tratamento do infarto agudo do miocárdio (IAM) com supradesnivelamento do segmento ST ainda apresenta reultados conflitantes. Objetivo: Determinar se o uso da glicoproteina IIb/IIIa adjunto à ATC primária está associado a maior resolução do segmento ST (RST) do eletrocardiograma (ECG). Método: No período compreendido ente 2000 e 2002, 85 pacientes foram submetidos a ATC primária, dos quais 35 utilizaram inibidores da glicoproteína IIb/IIIa de forma adjunta ao procedimento e 50 não receberam o fármaco (grupo controle). Os grupos foram comparados quanto às variáveis clínicas, eletrocardiográfica e angiográficas, demonstrando-se semelhantes. Os desfechos analisados foram RST do ECG precoce (nas primeiras seis horas após a ATC) e tardio (em 12 a 40 horas), eventos clínicos adversos maiores intra-hospitalares (ECAM) e pico enzimático. Considerou-se significativo p menor 0,05. Resultados: O grupo que recebeu inibidores da glicoproteína IIb/IIIa apresentou tendência a maior RST no ECG precoce (73 por cento vs. 62 por cento, p igual 0,08), diferença não observada quando analisado o ECG tardio (72 por cento vs. 73 por cento, p igual ns). A diferença entre a RST no ECG precoce versus tardio no grupo controle foi estatísticamente significativo (62 por cento vs. 73 por cento, p igual 0,006). Foram preditores de RST completa no ECG (maior 70 por cento), ausência de diabetes melito,...

ABSTRACT

Introduction: Combination of angioplasty PTCA and glycoprotein IIb/IIIa inhibitors (IGpIIb/IIIa) already had conflicting results in treatment of patients (pts) with ST-elevation segment myocardial infarction (STEMI). Objective: Determine if IIb/IIIa as an adjunctive therapy to the primary PTCA is associated with a better ST segment (STSR) resolution in the electrocardiogram (EKG). Methods: Of 85 patients submitted to a primary PTCA between 2000-2002, 35 used IIb/IIIa as an adjunct therapy and 50 did not use the drug (control group). Baseline characteristics were compared, and clinical, electrocardiographic and angiographic variables were similar between the groups. Outcomes analyzed were STSRs of early (first 6 hours after PTCA) and late EKGs (12 to 40 hours), in-hospital major adverse clinical cardiovascular events (MACE) and serum enzimatic peak. Significance was set at p < 0.05. Results: The IIb/IIIa group showed a trend to a better STSR in early EKGs (73% vs 62%, p = 0.08), not observed when compared late EKGs (72% vs 73%, p = ns). A significant difference was found when the STSR between early vs. late EKGs in the control group (62% vs 73%, p = 0.006), but not in in the IIb/IIIa group. Diabetes, inferior AMI, onset of symptoms in less then 6 hours and IIb/IIIa were predictors to a complete STSR (p = 0.04; OR = 3.1; IC 95% = 1 to 10). No differences were observed in the presence of in-hospital MACE or enzymatic peak. Conclusion: IIb/IIIa as an adjunctive therapy to the primary PTCA in the treatment of STEMI is associated with a better STSR in early EKG, which may indicate that the drug accelerates myocardial reperfusion in these patients.