{"id":117749,"date":"2018-03-11T10:47:23","date_gmt":"2018-03-11T10:47:23","guid":{"rendered":""},"modified":"2018-03-11T10:47:23","modified_gmt":"2018-03-11T10:47:23","slug":"manejo-del-infarto-agudo-de-miocardio-con-elevacion-del-segmento-st-scacest-en-la-region-de-mur-cia-resultados-de-las-estrategias-de-reperfusion-en-las-areas-del-noroeste-y-altiplano-areas-iv-v","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cardiologia\/manejo-del-infarto-agudo-de-miocardio-con-elevacion-del-segmento-st-scacest-en-la-region-de-mur-cia-resultados-de-las-estrategias-de-reperfusion-en-las-areas-del-noroeste-y-altiplano-areas-iv-v\/","title":{"rendered":"Manejo del infarto agudo de miocardio con elevaci\u00f3n del segmento st (scacest) en la regi\u00f3n de mur cia. resultados de las estrategias de reperfusi\u00f3n en las \u00e1reas del noroeste y altiplano (\u00e1reas iv, v)"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Jose Nieto Tolosa <\/strong><\/h2>\n<p>Resumen:  introducci\u00f3n:  la reperfusi\u00f3n en caso de oclusi\u00f3n de una arteria coronaria se puede realizar con agentes fibrinol\u00edticos que recanalizan de forma farmacol\u00f3gica la oclusi\u00f3n tromb\u00f3tica asociada a scacest o mediante la eliminaci\u00f3n de forma mec\u00e1nica de la obstrucci\u00f3n con una angioplastia primaria (icpp). La icp primaria es la estrategia de reperfusi\u00f3n, pero desgraciadamente muchos de los pacientes acuden inicialmente a hospitales sin icp, siendo su principal limitaci\u00f3n la imposibilidad de ofertarla al total de la poblaci\u00f3n por su limitada disponibilidad geogr\u00e1fica y el retraso que supone el traslado desde centros sin disponibilidad de icpp a centros de referencia. Se han puesto en marcha programas regionales de asistencia al scacest en los que se integran ambos tratamientos de reperfusi\u00f3n, en funci\u00f3n del tiempo de evoluci\u00f3n de los s\u00edntomas y la demora a la angioplastia primaria, utilizando en casos indicados la trombolisis para lograr una r\u00e1pida recanalizaci\u00f3n de la arteria ocluida, seguido de un estudio angiogr\u00e1fico de forma rutinaria. En la regi\u00f3n de murcia existe un programa de atenci\u00f3n al scacest, cuyos resultados no han sido evaluados.   objetivos:  analizar los resultados del tratamiento del scacest en la regi\u00f3n de murcia. Para ello nos planteamos los siguientes objetivos: 1. Analizar  las caracter\u00edsticas cl\u00ednicas y evoluci\u00f3n de los pacientes en funci\u00f3n del \u00e1rea:  a.\t\u00e1reas dependientes de hospitales comarcales sin disponibilidad de icpp.  b.\t\u00e1rea con acceso inmediato a icpp.  2. Comparar las caracter\u00edsticas y resultados de dos estrategias espec\u00edficas de reperfusi\u00f3n: pacientes pertenecientes al huva tratados con icpp vs pacientes pertenecientes a hospitales comarcales tratados con trombolisis.  3. Estudiar los pacientes tratados con fibrinolisis, analizando las caracter\u00edsticas cl\u00ednicas y la evoluci\u00f3n de los enfermos con reperfusi\u00f3n exitosa frente a los que precisaron una icp de rescate. 4. Analizar los predictores de mortalidad a 30 d\u00edas en pacientes con scacest atendidos en nuestro medio.  m\u00e9todos: estudio retrospectivo de una cohorte de pacientes, ingresados por scacest durante los a\u00f1os 2006 al 2010 en los dos grupos de hospitales: grupo 1. Hospital con icpp: hospital universitario virgen de la arrixaca (el palmar, murcia). Grupo 2. Hospitales comarcales sin icpp: hospital comarcal del noroeste (caravaca de la cruz) y hospital virgen del castillo (yecla). Criterios de inclusi\u00f3n: pacientes con diagn\u00f3stico de scacest. Pacientes remitidos para realizaci\u00f3n de icpp a h.C.U.V.Arrixaca, o trombolisados. Duraci\u00f3n de los s\u00edntomas menor de 24 horas. se analizaron las siguientes variables: &quot;\tfase hospitalaria: variables demogr\u00e1ficas; antecedentes cardiovasculares y otras comorbilidades; presentaci\u00f3n iam (tiempos evoluci\u00f3n y variables ecg), caracter\u00edsticas ecocardiogr\u00e1ficas y angiogr\u00e1ficas; empleo de t\u00e9cnicas invasivas; evoluci\u00f3n hospitalaria.  o\tseguimiento: eventos cardiovasculares a corto (30 d\u00edas) y largo plazo (1 a\u00f1o): mortalidad total y cardiaca, reiam, acv, necesidad de nueva revascularizaci\u00f3n.   conclusiones: 1.\tLos pacientes diagnosticados de scacest en las \u00e1reas sanitarias de la regi\u00f3n de murcia m\u00e1s alejadas (iv y v) presentan unas caracter\u00edsticas cl\u00ednicas similares a los del \u00e1rea i. 2.\tA pesar de una menor accesibilidad a la icpp inmediata en las poblaciones pertenecientes a estas \u00e1reas sanitarias, la red asistencial regional al scacest permite lograr unos resultados comparables a los de las poblaciones pertenecientes a \u00e1reas sanitarias con disponibilidad de icpp. 3.\tLa estrategia f\u00e1rmacoinvasiva permite aplicar un tratamiento de reperfusi\u00f3n a las poblaciones pertenecientes a esas \u00e1reas sanitarias, sin disponibilidad de icpp, dentro de los tiempos recomendados por las sociedades cient\u00edficas, con tasas de supervivencia similares a las de la icpp, sin un aumento de las complicaciones, y con unos resultados a corto y largo plazo similares.  4.\tLos pacientes en los que la trombolisis no ha sido efectiva, la icp de rescate presenta unos resultados similares a corto y largo plazo, sin un aumento significativo de las complicaciones.  5.\tLos predictores de mortalidad a 30 d\u00edas fueron una fracci\u00f3n de eyecci\u00f3n del ventr\u00edculo izquierdo (fevi) deprimida, la ausencia de flujo coronario timi iii al final del procedimiento intervencionista y la clase funcional killip durante el ingreso.                         abstract: rapid diagnosis of st elevation myocardial infarction (stemi) followed by a quick restoration of a timi 3 coronary flow in the occluded artery is associated with a short and long term improvement in survival. Restoration of myocardial perfusion can be done pharmacologically with thrombolitics agents or by a mechanical elimination of a thrombus with a primary angioplasty (ppci). Several clinical trials have shown that primary angioplasty is the preferred reperfusion strategy in patients with stemi. However, many patients with stemi arrive to hospitals without ppci or it cannot be performed in a timely manner according to clinical guidelines. Regional systems of stemi care have been developed using both methods of reperfusion depending on the time of symptoms onset and the delays to a ppci. When thrombolysis is indicated to open the occluded artery routine angiography should be done in the first 24-48 hours (pharmacoinvasive strategy). In region de murcia we have had for several years a stemi attention program with different methods of reperfusion depending on the place where the diagnosis is made. The results of this program have not been evaluated.  objectives:  the main aim of the study is to analyze the results of stemi treatment in regi\u00f3n de murcia. We propose the following more specific objectives: 1.\tAnalyze clinical characteristics and outcomes of the patients depending on the sanitary area where they were first attended: a.\tHospitals without ppci.   b.\tHospital with ppci.  2.\tCompare clinical characteristics and outcomes of the two different reperfusion strategies: a.\tPatients treated with primary pci from sanitary area i (huva) b.\tPatients treated with fibrinolysis from regional hospitals (areas iv and v).  3.\tAnalyze clinical characteristics and outcomes of patients with successful fibrinolysis vs rescue pci after failed fibrinolysis 4.\tAnalyze mortality predictors in patients with stemi treated in our regional network  methods restrospective cohort study of patients with stemi from 2006-2010 in two different groups of hospitals. Group 1: hospital with ppci (hospital universitario virgen de la arrixaca). Group 2: regional hospitals without ppci (hospital virgen del castillo and comarcal del noroeste). All of them have the same reference icu in hospital virgen de la arrixaca. Inclusion criteria: patients with the diagnosis of stemi based in classical criteria and duration of symptoms less than 24 hours. we analyze the following variables:  hospitalization:  demographic variables, previous cardiac disease and cardiovascular risks factors, other comorbidities; stemi presentation (time from symptoms onset to reperfusion and ekg), angiographic and echocardiographic features, invasive technics, in-hospital outcomes.  conclusions:  1.\tStemi patients in populations further away from hospital with ppci (areas iv and v) present clinical features similar than area i patients.   2.\tDespite of less availability of ppci in regional hospitals, after the organization of a regional network for the treatment of stemi the results obtained were similar to the patients from a hospital with ppci. 3.\tPharmacoinvasive strategy allows to apply a reperfusion treatment in populations further away from a hospital with ppci within the time limits recommended by scientific societies. The  reperfusion rate and short and long term results were similar to ppci without an increase in complications. 4.\tIn patients in which thrombolysis has not been effective, rescue pci, has similar short and long term results than pharmacoinvasive strategy, without a significant increase in complications. 5.\tMortality predictors at 30 days were low left ventricle ejection fraction, lack of timi iii flow at the end of the interventional procedure and killip class during hospitalization.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Manejo del infarto agudo de miocardio con elevaci\u00f3n del segmento st (scacest) en la regi\u00f3n de mur cia. resultados de las estrategias de reperfusi\u00f3n en las \u00e1reas del noroeste y altiplano (\u00e1reas iv, v)<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Manejo del infarto agudo de miocardio con elevaci\u00f3n del segmento st (scacest) en la regi\u00f3n de mur cia. resultados de las estrategias de reperfusi\u00f3n en las \u00e1reas del noroeste y altiplano (\u00e1reas iv, v) <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Jose Nieto Tolosa <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 30\/06\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li> Cambronero Sanchez Francisco Jose<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: jose Galcera tomas <\/li>\n<li>Rafael Florenciano s\u00e1nchez (vocal)<\/li>\n<li>manel Sabate tenas (vocal)<\/li>\n<li>alfredo G\u00f3mez jauma (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Jose Nieto Tolosa Resumen: introducci\u00f3n: la reperfusi\u00f3n en caso de oclusi\u00f3n de una arteria coronaria se puede [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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