Caracterización de pacientes con infarto agudo del miocardio con coronariografía normal en clínica de 4to nivel de atención en el periodo 2018-2 a 2019-2
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Fecha
2020
Autores
Abreo Arrieta, Salvador
Álvarez Mejía, Yair
Martelo León, Ingrid Tatiana
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Antecedentes: El dolor torácico es uno de los principales motivos de consulta en el servicio de urgencias, como principal causa tenemos el infarto agudo de miocardio (IAM) de los cuales hay un grupo de pacientes que debutan con reporte angiográfico de enfermedad coronaria no obstructiva o no significativa (MINOCA), definido como biomarcadores cardiacos positivos (troponina >0.014 ng/dl) asociados a datos clínicos, electrocardiográficos e imágenes compatibles de isquemia miocárdica. Par el año 2017 la Sociedad Europea de Cardiología ( ESC ) su grupo de Farmacoterapia Cardiovascular publicó un documento que quizás es la primera notificación autorizada sobre la definición, características clínicas e investigaciones recomendadas en pacientes con MINOCA, en la actualidad, con el concepto de esta entidad establecido, el siguiente paso clave es caracterizar e identificar su asociación con factores de riesgo, tanto sociodemográficos como cardiovasculares en la población colombiana.
Objetivos: Caracterizar los pacientes con diagnóstico de infarto agudo de miocardio con coronariografía normal o sin lesiones significativas (MINOCA), en dicha población. Metodología: Estudio observacional, descriptivo. Población: se incluyeron pacientes de una clínica de cuarto nivel de referencia en la ciudad de Barranquilla con diagnósticos de infarto agudo de miocardio que fueron manejados con alguna estrategia de estratificación coronaria entre 2018-2 a 2019-2, se seleccionaron paciente con niveles elevados de troponina i y con cateterismo cardiaco cuyo reporte fue normal o con lesión no significativa. Cálculo de Muestra: se tomó el número de habitantes de la ciudad de Barranquilla, se le saco el porcentaje de pacientes con IAM y se calculó el número de pacientes con MINOCA.
Resultados: De los 2108 pacientes, el 5.4% presentaron infarto agudo de miocardio con coronariografía normal o con lesión no significativa (MINOCA). La edad promedio fue de 63 ± 13 años. La relación hombre mujer fue de 1:2. El 78% de los pacientes la comorbilidad de mayor frecuenta en ambos sexos fue la Hipertensión Arterial (HTA), seguida de la Diabetes Mellitus Tipo 2 (DM2) 27,4%. La presentación clínica, vemos que el 62.83% cursaron con dolor torácico típico, el 79.65% mantuvieron una fracción de eyección (FEVI) conservada. El 82,3% sin obstrucción de arterias coronarias que muy probablemente esté relacionado con la enfermedad coronaria microvascular.
Conclusiones: El infarto agudo de miocardio con coronarias sanas o sin lesión significativa se presentó en el 5,4% en relación con lo descrito en la literatura, con una mayor afectación a la población femenina y una edad global promedio de 63 años. La hipertensión fue el factor de riesgo cardiovascular más frecuente y la diabetes mellitus tipo 2 en segunda instancia. La mayoría de los pacientes presentaron fracción ventricular conservada con arterias coronarias sanas, teniendo en cuenta la proporción de pacientes con MINOCA la cual viene en aumento en los últimos 3 años, pese algunas características que se describen aún resulta complejo diferenciar esta entidad de la enfermedad coronaria obstructiva significativa, dada la similitud de la presentación clínica y paraclínica, se requiere caracterizar mejor enfermedad coronaria microvascular.
Background: Chest pain is one of the main reasons for consultation in the emergency department, as the main cause we have acute myocardial infarction (AMI) of which there is a group of patients who debut with angiographic report of non-obstructive or non-significant coronary disease (MINOCA), defined as positive cardiac biomarkers (troponin > 0.014 ng/dl) associated with clinical, electrocardiographic, and compatible images of myocardial ischemia. By 2017, the European Society of Cardiology (ESC), its Cardiovascular Pharmacotherapy group, published a document that is perhaps the first authorized notification on the definition, clinical characteristics and recommended research in patients with MINOCA, currently, with the concept of this established entity, the next key step is to characterize and identify its association with risk factors, both sociodemographic and cardiovascular in the Colombian population. Objectives: To characterize the patients diagnosed with acute myocardial infarction with normal coronary angiography or without significant lesions (MINOCA), in this population., in the clinic reference 2018 to 2019. Methodology: Observational, descriptive study. Population: Patients from a fourth reference level clinic in the city of Barranquilla with diagnoses of acute myocardial infarction who were managed with some coronary stratification strategy between 2018-2 to 2019-2 were included, patients with high levels of troponin i and with cardiac catheterization whose report was normal or with non-significant injury. Sample Calculation: the number of inhabitants of the city of Barranquilla was taken, the percentage of patients with AMI was removed and the number of patients with MINOCA was calculated. Results: Of the 2108 patients, 5.4% presented acute myocardial infarction with normal coronary angiography or with non-significant injury (MINOCA). The average age was 63 ± 13 years. The male to female ratio was 1: 2. In 78% of the patients, the most frequent comorbidity in both sexes was Arterial Hypertension (HT), followed by Type 2 Diabetes Mellitus (DM2) 27.4%. The clinical presentation shows that 62.83% had typical chest pain, 79.65% maintained a preserved ejection fraction (LVEF). 82.3% without coronary artery obstruction, most likely related to coronary microvascular disease. Conclusions: Acute myocardial infarction with healthy coronary arteries or without significant injury occurred in 5.4% in relation to that described in the literature, with greater affectation to the female population and an average global age of 63 years. Hypertension was the most frequent cardiovascular risk factor and type 2 diabetes mellitus in the second instance. Most of the patients presented preserved ventricular fraction with healthy coronary arteries, taking into account the proportion of patients with MINOCA which has been increasing in the last 3 years, despite some characteristics that are described, it is still complex to differentiate this entity from coronary disease Due to the significant similarity of the clinical and paraclinical presentation, it is necessary to better characterize microvascular coronary disease.
Background: Chest pain is one of the main reasons for consultation in the emergency department, as the main cause we have acute myocardial infarction (AMI) of which there is a group of patients who debut with angiographic report of non-obstructive or non-significant coronary disease (MINOCA), defined as positive cardiac biomarkers (troponin > 0.014 ng/dl) associated with clinical, electrocardiographic, and compatible images of myocardial ischemia. By 2017, the European Society of Cardiology (ESC), its Cardiovascular Pharmacotherapy group, published a document that is perhaps the first authorized notification on the definition, clinical characteristics and recommended research in patients with MINOCA, currently, with the concept of this established entity, the next key step is to characterize and identify its association with risk factors, both sociodemographic and cardiovascular in the Colombian population. Objectives: To characterize the patients diagnosed with acute myocardial infarction with normal coronary angiography or without significant lesions (MINOCA), in this population., in the clinic reference 2018 to 2019. Methodology: Observational, descriptive study. Population: Patients from a fourth reference level clinic in the city of Barranquilla with diagnoses of acute myocardial infarction who were managed with some coronary stratification strategy between 2018-2 to 2019-2 were included, patients with high levels of troponin i and with cardiac catheterization whose report was normal or with non-significant injury. Sample Calculation: the number of inhabitants of the city of Barranquilla was taken, the percentage of patients with AMI was removed and the number of patients with MINOCA was calculated. Results: Of the 2108 patients, 5.4% presented acute myocardial infarction with normal coronary angiography or with non-significant injury (MINOCA). The average age was 63 ± 13 years. The male to female ratio was 1: 2. In 78% of the patients, the most frequent comorbidity in both sexes was Arterial Hypertension (HT), followed by Type 2 Diabetes Mellitus (DM2) 27.4%. The clinical presentation shows that 62.83% had typical chest pain, 79.65% maintained a preserved ejection fraction (LVEF). 82.3% without coronary artery obstruction, most likely related to coronary microvascular disease. Conclusions: Acute myocardial infarction with healthy coronary arteries or without significant injury occurred in 5.4% in relation to that described in the literature, with greater affectation to the female population and an average global age of 63 years. Hypertension was the most frequent cardiovascular risk factor and type 2 diabetes mellitus in the second instance. Most of the patients presented preserved ventricular fraction with healthy coronary arteries, taking into account the proportion of patients with MINOCA which has been increasing in the last 3 years, despite some characteristics that are described, it is still complex to differentiate this entity from coronary disease Due to the significant similarity of the clinical and paraclinical presentation, it is necessary to better characterize microvascular coronary disease.
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Palabras clave
Síndrome coronario agudo, Infarto del miocardio, Troponina, Coronariografía Enfermedad micro vascular, Acute coronary syndrome, Myocardial infarction, Troponin, Coronary angiography