Resumen
Introducción: México es el país con mayor mortalidad por infarto agudo de miocardio (IAM), por lo que se han establecido guías para la reperfusión temprana en las que la fibrinólisis es el segundo método más accesible. Sin embargo, hay un porcentaje de pacientes que no alcanzan perfusión miocárdica aceptable y esto se asocia a desenlaces cardiovasculares adversos. Se han usado diferentes esquemas de adenosina como adyuvante para restaurar la adecuada perfusión miocárdica.
Objetivo: comparar el flujo angiográfico final en pacientes sometidos a intervención coronaria percutánea (ICP) farmacoinvasiva con uso de adenosina intracoronaria frente a pacientes sin su uso.
Material y métodos: estudio unicéntrico, prospectivo, longitudinal, simple ciego, en pacientes con IAM, trombolizados, con datos de reperfusión, enviados a un hospital de tercer nivel de marzo de 2022 a junio de 2023, aleatorizados a recibir adenosina intracoronaria preintervención. Se colocaron stents liberadores de fármacos en todos los pacientes. Se comparó el flujo angiográfico inicial y el final.
Resultados: se incluyeron 33 pacientes, aleatorizados 1:1 a grupo control e intervención. El 75.8% fueron hombres. La arteria que más frecuentemente provocó el infarto fue la descendente anterior (63.6%). Se utilizaron 350 mcg en promedio de adenosina intracoronaria en el grupo intervención y la complicación más frecuente en ambos grupos fue el fenómeno de no reflujo.
Conclusiones: debido al pequeño tamaño muestral no es posible concluir la utilidad de la adenosina para mejorar el flujo angiográfico final en ICP farmacoinvasiva. Se reportaron más efectos adversos en el grupo intervención, sin diferencia estadística significativa.
Abstract
Background: Mexico is the country with the highest mortality from acute myocardial infarction (AMI), which is why guidelines have been established for early reperfusion in which fibrinolysis is the second most accessible method. However, there is a percentage of patients who do not achieve acceptable myocardial perfusion and this is associated with adverse cardiovascular outcomes. Different adenosine schemes have been used as an adjuvant to restore adequate myocardial perfusion.
Objective: To compare the final angiographic flow in patients undergoing pharmacoinvasive percutaneous coronary intervention (PCI) with the use of intracoronary adenosine versus patients without its use.
Material and methods: Single-center, prospective, longitudinal, single-blind study carried out in patients with AMI, thrombolyzed, with reperfusion data, sent to a tertiary care center from March 2022 to June 2023, randomized to receive intracoronary adenosine previous to intervention. Drug-eluting stents were placed in all patients. Initial and final angiographic flow was compared.
Results: 33 patients were included, randomized 1:1 to control and intervention groups. 75.8% of the participants were male. The most frequent artery responsible for the infarction was the anterior descending (63.6%). An average of 350 mcg of intracoronary adenosine was used in the intervention group, and the most frequent complication in both groups was the presence of no-reflow phenomenon.
Conclusions: Due to the small sample size, it is not possible to conclude the usefulness of adenosine for improving final angiographic flow in pharmacoinvasive PCI. More adverse effects were reported in the intervention group, without a significant statistical difference.
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