[Influence of comorbidity on admission management and pharmacological treatment prescribed at discharge in acute myocardial infarction]. / Influencia de la comorbilidad en el tratamiento intrahospitalario y al alta de los pacientes con infarto de miocardio.

BACKGROUND AND OBJECTIVE: The management of cardiac ischemic patients differs depending on their comorbidity. The Charlson Index (ChI) and its adaptations are well established and widely used tools to quantify a patient comorbidity. The aim of this study is to evaluate the influence of comorbidity quantified by the ChI in the treatment administered at admission and in the pharmacological treatment prescribed at discharge in the setting of an acute myocardial infarction with and without ST segment elevation. PATIENTS AND METHOD: We studied a total of 955 patients consecutively admitted in our hospital with the diagnosis of acute myocardial infarction. Comorbidity was obtained at the first day of admission applying the ChI. According to this value patients were classified from minor to major in 2 subgroups (ChI or= 2) and differences in the admission and discharge treatments between both groups were analyzed. RESULTS: Patients admitted with acute myocardial infarction without ST segment elevation and ChI > 2 received less frequently betablockers at discharge, but there were no significant differences in the use of ACE inhibitors, calcium channel blockers or statins. In addition they were submitted less frequently to revascularization procedures or treadmills, and no differences were found in the use of echocardiograms. Patients with ST segment elevation and ChI > 2 were less frequently treated with betablockers or statins at discharge, and were submitted to less treadmills or echocardiograms; furthermore, in these patients, there were no significant differences in the use of ACE inhibitors, calcium channel blockers, thrombolytics or revascularization procedures. CONCLUSIONS: Comorbidity quantified on admission by the ChI is an independent factor that modifies in-hospital and ambulatory management of patients with acute myocardial infarction. There is a lower use of invasive techniques as well as a lower prescription of betablockers at discharge in patients with greater comorbidity.

Influencia de la comorbilidad en el tratamiento intrahospitalario y al alta de los pacientes con infarto de miocardio / Influence of comorbidity on admission management and pharmacological treatment prescribed at discharge in acute myocardial infarction

FUNDAMENTO Y OBJETIVO: El tratamiento del paciente cardiológico varía según su comorbilidad. Elíndice de Charlson (ICh) y sus adaptaciones son herramientas utilizadas y contrastadas globalmenteque intentan objetivar la comorbilidad de un paciente. El objetivo del presente trabajoes evaluar la influencia de la comorbilidad, cuantificada mediante el ICh, en el tratamiento intrahospitalarioy farmacológico prescrito al alta hospitalaria en el infarto de miocardio con o sinelevación del segmento ST.PACIENTES Y MÉTODO: Se estudió a 955 pacientes consecutivos ingresados en un hospital por infartode miocardio. Se analizó la comorbilidad obtenida el primer día del ingreso mediante laaplicación del ICh, se clasificó a los pacientes en 2 subgrupos de menor o mayor comorbilidad(ICh ≤ 2; ICh > 2) y se determinó si había diferencias entre ambos subgrupos según el tratamientointrahospitalario y al alta.RESULTADOS: Los pacientes ingresados por infarto agudo de miocardio sin elevación del ST e IChsuperior a 2 recibieron con menor frecuencia bloqueadores beta al alta, mientras que no existendiferencias significativas en el tratamiento con inhibidores de la enzima de conversión de laangiotensina, antagonistas del calcio o estatinas. Además, se les practicaron menos procedimientosde revascularización y menos ergometrías, mientras que no hubo diferencias en la realizaciónde ecocardiogramas. Los pacientes con elevación del segmento ST e ICh superior a 2era menos probable que fueran tratados al alta con bloqueadores beta y estatinas, y se les realizaronmenos ergometrías y ecocardiogramas, mientras que no hubo diferencias significativasen el tratamiento con inhibidores de la enzima de conversión del la angiotensina, antagonistasdel calcio, trombólisis o tratamiento intervencionista (revascularización).CONCLUSIONES: La comorbilidad presente en el momento del ingreso y cuantificada mediante elICh condiciona de manera independiente el tratamiento intrahospitalario y el alta de los pacientescon infarto de miocardio. Hay un menor uso de técnicas invasivas, junto con una menorprescripción de bloqueadores beta al alta en los pacientes con mayor comorbilidad

BACKGROUND AND OBJECTIVE: The management of cardiac ischemic patients differs depending ontheir comorbidity. The Charlson Index (ChI) and its adaptations are well established and widelyused tools to quantify a patient comorbidity. The aim of this study is to evaluate the influenceof comorbidity quantified by the ChI in the treatment administered at admission and in thepharmacological treatment prescribed at discharge in the setting of an acute myocardial infarctionwith and without ST segment elevation.PATIENTS AND METHOD: We studied a total of 955 patients consecutively admitted in our hospitalwith the diagnosis of acute myocardial infarction. Comorbidity was obtained at the first day ofadmission applying the ChI. According to this value patients were classified from minor to majorin 2 subgroups (ChI 2) and differences in the admission and discharge treatmentsbetween both groups were analyzed.RESULTS: Patients admitted with acute myocardial infarction without ST segment elevation and ChI> 2 received less frequently betablockers at discharge, but there were no significant differences inthe use of ACE inhibitors, calcium channel blockers or statins. In addition they were submittedless frequently to revascularization procedures or treadmills, and no differences were found in theuse of echocardiograms. Patients with ST segment elevation and ChI > 2 were less frequently treatedwith betablockers or statins at discharge, and were submitted to less treadmills or echocardiograms;furthermore, in these patients, there were no significant differences in the use of ACEinhibitors, calcium channel blockers, thrombolytics or revascularization procedures.CONCLUSIONS: Comorbidity quantified on admission by the ChI is an independent factor that modifiesin-hospital and ambulatory management of patients with acute myocardial infarction.There is a lower use of invasive techniques as well as a lower prescription of betablockers atdischarge in patients with greater comorbidity