[Hospital course of acute myocardial infarction: significance of the therapeutic procedures of early reperfusion].
Reperfusion therapy has contributed to decreased morbidity and mortality in patients with acute myocardial infarction (AMI). Implementation of thrombolytic therapy; primary angioplasty and emergency coronary artery by-pass surgery have proved to be effective in well designed controlled clinical trials. There is little information, however, about the impact of reperfusion therapy in the general clinical population that is usually seen in the coronary care unit. In this paper we have compared the clinical course, morbidity and mortality of patients attended for a first AMI in 2 different periods. Group I comprised 431 patients seen during the period 1981-1986 and group II bad 113 patients seen during the period 1992-1993. Age, gender distribution and AMI location were similar in both groups. Patients in group I had a significantly higher incidence of tobacco use and previous angina pectoris. In group I, 4% of patients received streptokinase, 0.9% of patients had emergency by-pass surgery and none had primary angioplasty, whereas in group II, 29% of patients received trombolytics, 6.5% had primary angioplasty and 6.5% had by-pass surgery. Heart failure Killip class II-III occurred in 35% of patients in group I and in 13% of patients in group II (p < 0.05). Intrahospital mortality was 19.6% in group I and 11.5% in Group II (p < 0.045). There were no differences in the incidence of cardiogenic shock in both groups. Multivariate analysis showed that age and heart failure were significant independent predictors of mortality in both periods. Thus, there has been a significant change in the therapeutic approach to AMI patients in recent years. Widespread utilization of reperfusion therapy appears to be associated with decrease in morbidity and mortality in a general population of patients with a first AMI.
Almendares
C
C
Departamento de Enfermedades Cardiovasculares, Hospital Clínico de la P Universidad Católica de Chile, Santiago.
Corbalán
R
R
Castro
P
P
Rodríguez
A
A
Marchant
E
E
Kunstmann
S
S
Casanegra
P
P
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003325:Coronary Care Units; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D015425:Myocardial Reperfusion; D011379:Prognosis; D013300:Streptokinase / Q000008:administration & dosage*
D013300:Streptokinase
Evolución intrahospitalaria del infarto agudo del miocardio: importancia de las medidas terapéuticas de reperfusión precoz.