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Síndromes coronarios agudos en Latinoamérica: lecciones aprendidas del registro ACCESS

Carlos Martínez-Sánchez, Carlos Jerjes-Sánchez, José Carlos Nicolau, Oscar Bazzino, Norka Antepara, Ricardo Mármol

Resumen


Introducción: se desconocen las características, la evolución y el tratamiento de pacientes latinoamericanos con síndromes coronarios agudos (SCA).

Métodos: registro internacional multicéntrico y prospectivo para evaluar riesgo, terapéutica y evolución en SCA. Punto primario: toda causa de mortalidad durante el primer año y mortalidad a 30 días. Ingresaron pacientes con síntomas de isquemia coronaria aguda en las primeras 24 horas del inicio de los síntomas y evidencia electrocardiográfica de isquemia. El diagnóstico final requirió pruebas invasivas o no invasivas.

Resultados: entre el 2007 y 2008 se ingresaron en ocho países latinoamericanos 4436 pacientes, 2562 con angina inestable o infarto sin elevación del ST y 2374 con infarto con elevación del ST. Al ingreso tuvieron síntomas agudos 79 y 90 %, respectivamente. Ambos grupos tuvieron retraso entre el inicio de síntomas y el ingreso hospitalario. En infarto y elevación del ST se observó baja accesibilidad a reperfusión farmacológica (29 %) y mecánica (32 %). Al ingreso en ambos el porcentaje de tratamiento basado en evidencia fue bajo. Las complicaciones hospitalarias fueron la insuficiencia cardiaca (angina inestable e infarto sin elevación del ST 10 % y el infarto con elevación del ST 20 %) e isquemia recurrente (8 y 11 %). La mortalidad a 30 días fue 2 % y a un año 8 %.

Conclusiones: el registro ACCESS ofrece información contemporánea sobre el espectro de pacientes, el manejo hospitalario y la evolución clínica subsecuente.


Palabras clave


Síndrome coronario agudo; Infarto del miocardio; Angina inestable; Isquemia miocárdica

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