Details

Autor(en) / Beteiligte

• Bianco, Henrique Tria
• Povoa, Rui
• Izar, Maria Cristina
• Alves, Claudia Maria Rodrigues
• Barbosa, Adriano Henrique Pereira
• Bombig, Maria Teresa Nogueira
• Gonçalves, Jr, Iran
• Luna Filho, Bráulio
• Aguirre, Ana Caroline
• Moraes, Pedro Ivo de Marqui
• Almeida, Dirceu
• Moreira, Flávio Tocci
• Povoa, Fernando Focaccia
• Stefanini, Edson
• Caixeta, Adriano Mendes
• Bacchin, Amanda S
• Moisés, Valdir Ambrósio
• Fonseca, Francisco A H

Titel

Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors

Ist Teil von

• Arquivos brasileiros de cardiologia, 2022-11, Vol.119 (5), p.691-702

Ort / Verlag

Brazil

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.