Angioplastia para o tratamento do infarto agudo do miocárdio : resultados imediatos e tardios

Abstract

The cardiovascular affections represent the main death cause in the western world, while the acute myocardial infarction (AMI) is one of the first villlains of these statistics. During the last. decade there has been a great discussion about the best form of attending infarct patients, whether by the thrombolytical therapy or by mechanic reperfusion with a catheter balloon or stent implantation. This essay will be a retrospective analysis of 354 AMI patients treated by means of primary angioplasty, catheter balloon and stent at the Heart Hospital of Sobral, from jtily 1997 to july 2001. It aims to evaluate the performance of this therapeutic pattern at the Instituto, as well as to discuss the abiJity of this approach to patients of the Single System of Health (SUS). Of the amount of 354 analysed patients, 210 (59.3%) were submitted to angioplasty with catheter balloon, and 144 (40.7%) to the implantation of one or more stents. The patients’ average age was 65 years, being 235 (66.3%) of the masculine gender. As to the risk factors of coronary disease we observed: 170 (48%) patients presented high blood pressure (HBP), 56 (15.8%) were diabetic, 127 (35.8%) dislipidemic, and 131 (37%) tabaconists. In point of previous coronary occurrences we stated: 105 (29.6%) patients were affected by previous angina, 25 (7.6%) had suffered a previous myocardium infarction, and 21 (5.9%) had already undergone a surgical myocardium revascularization. In 152 (42.9%) patients the infarction was situated on the inferior watt, in 150 (42.4%) on the anterior watt, and in 52 (14.7%) on the lateral wall. The average “AT” was of 300 minutes. The anterior descendant branch (AD) was the treated vase in 139 (39.2) patients, the right coronary artery in 135 (38.2%), the circumflex branch (CX) in 60 (16.9%), the left main coronary artery in 4 (1.1 %) and in 16 (4.6%) patients the primary angioplasty was realized in a saphena vein transplantation. Most of the patients were multiarterial, 193 (54.6%), and the average ejection fraction of the left ventride was of 47%. During the hospital period, the balloon and the stent had alíke performances. Our operation activity was successful in 89.5% of the patients. We registered 6.7% mortality, and the cardiogenic impact and TIMI flow intensity < 3 postperformance had a significam influence on the occurrence of this event. Reinfarct was verified in 5% of the patients, and TIMI flow intensity < 3 was the only variable predictor of this complication. in 1.4% of the patients there was the necessity of a coronary reintervention because of recurring ischemia; however, no patient was conducted to a revascularization surgery of urgency. As to the angiographic results, we evidenced a larger reference diameter (RD), a larger minimum iuminal diameter (MLD) after operating, and a greater acute iuminal profit in the patients who were treated by means of the stent implantation, in comparison with the balloon. We got TIMI flow intensity 3 after operating in 90% of the interventions. Six months after the procedure, 8.1% of the patients had died, and 29% had submitted themselves to on more revascularization; however, in only 18% of the patients there occurred the necessity of on more revascularization of the treated lesion. 72% of the patients were submitted to another angiographic study, where we registered a binary restenosis rate of 32.1%. The post operatina MLD had a sianificant influence on the occurrence of the restenosis. The angiographic a IO í 1 I aled a larger MLD (2.0$ ) mm re significant left ventride ejectic ) in the patient s who were stent treated. In oi .<1 J" % of the patients were diabetic. son wit :h the non-diabetic these pati ípnf c nfAW li-gher HBP and dislipidemia rat rtabbac jonist c >nes. As to the nospstal rt esLírts there no differences in comparison witi abetic. 1 Fhe laü s results presented worse effic iencyi n thh subgroup, mainly in mortality, e angiographic restenosis ( JT the patie ts, 12.4% were octogenarians. up was mainh i characterized by larger HBP rates and •wer tabbaconist, dislipidemia an< re not any sigroficani. chffi he in nediate and later results of thesí i compí 3rison 3 Mth younger patients. 7. b% ( )f the Is in cardiogenic shock were dim ary ang iopiast y. As to the clinica! charai tios Of 1 this s bgroup we fourid a greater prevs wious a ngina, previous myocardium inf ■n, HBI 3, as «ell as a statistic tendency to di itus, in compí arison with hemodynami aatiei s. There was a predominancy < al patier he hospital results we ob: d, with stati :ic significance, a lower success ities, and larger death ar infarct rates when cornpared with the patien lis clink ation. What came to pro minei nce in the te results was a significantly faro i u j in com parisor i with the other patients i ■ study . We ronclude with the affirmation that asty is * an excellent reperfusion tl ivforü le Af , fully possible in hospitais that 9?