Navegando por Palavras-chave "cardiogenic shock"

Agora exibindo 1 - 1 de 1
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Choque cardiogênico no infarto agudo do miocárdio tratado com estratégia fármaco-invasiva: características clínicas e análise angiográfica
    (Universidade Federal de São Paulo (UNIFESP), 2016-09-28) Souza, Marco Tulio de [UNIFESP]; Alves, Claudia Maria Rodrigues Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Primary PCI is the recommended treatment in acute myocardial infarction with ST elevation (STEMI) complicated by cardiogenic shock (CS), fibrinolytic therapy with tenecteplase (TNK) in pharmaco invasive therapy (PIT) strategy is used in many patients. Clinical and angiographic findings in this scenario are unknown. Our goal is to present angiographic characteristics and clinical outcomes in a large population submitted to PIT, identifying predictors of in-hospital mortality in the group with CS. Methods: Patients were included in a referral cardiology hub as part of a PIT strategy (STEMI network) of the public health system in Sao Paulo. Descriptive statistical analysis and multivariate logistic regression was used to identify predictors of in-hospital death in the CS group. A total of 1094 consecutive STEMI patients were treated between 2010-2014. Cardiogenic shock rate was 10% and all of them were due to ventricular failure. A significant difference in age (61 ± 13.1 vs 57 ± 11.3, p = 0.011), diabetes (43% vs. 30% p = 0.006) and chronic kidney disease (24% vs 10%, p<0.001) were observed in CS group. Angiographic findings of CS group were 30% single-vessel, 35% two-vessel, 32% three-vessel. The culprit artery was the left main in 3% and similar incidence of lesions in LAD, LCX and RCA. There was a low rate of successful reperfusion after TNK (46% vs 70% without CH, p<0.0001) and although TIMI flow grade 2/3 post PCI was achieved in 83% only 44% achieved BLUSH 2/3. Major complications related to catheterization were more frequent in group CS: stroke (ischemic or hemorrhagic): 7.6% vs 1.2%, p <0.001; death in the catheterization (6.6% vs 0.5%, p <0.001) and major bleeding (11.8% vs. 7.6%, p <0.001). In-hospital mortality was 40%. Predictors of mortality were: obesity (OR = 5.5 p = 0.009), peripheral arterial disease (PAD) (OR = 20.1 p = 0.003), pain-to-needle> 12 hours (OR 7.64 p = 0.022), time pain-shock> 6 hours (OR 14.1 p = 0.001), no-reflow (OR 7.094 p = 0.029), TNK in CS duration (OR=12.2, p=0.021). This unique population was characterized by predominance of multiarterial lesion, absence of mechanical complications, low rates of successful microvascular reperfusion. PIT is a suboptimal treatment for this high risk population and understanding its role and limitations is fundamental for its appropriate use when primary PCI is unavailable.