Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb
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2015-10-26
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Universidade Federal de Goiás
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Background: the specialized early treatment of acute myocardial infarction provides the best prognosis and enzyme values, during in-hospital phase, can correlate with cardiovascular events along the follow-up. The creatino-phosphokinase-MB is still widely used for diagnosis of acute myocardial infarction with ST-elevation. The percutaneous coronary intervention is the main therapeutic method, where the manual aspirative thrombectomy is a possibility of adjuvant treatment. Objectives: to evaluate the systematic chain of care in the myocardial infarction and the levels of CK-MB in cases treated with angioplasty and coronary thrombus aspiration, and assess 6 months follow-up survival. Assess also the association of CK-MB with the Blush grade, ST resolution and the concomitant correlation with delta-T and death. Methods: 835 patients with ST elevation myocardial infarction were analised, from March 2012 to June 2014 in two reference centers in Goiânia-GO. Only those who arrived within 12h underwent invasive treatment, where serial CK-MB and electrocardiogram were obtained and analyzed during the hospitalization. During the six months follow-up there were observed the events death and reinfarction in this group. For associative and correlation analysis there were used Mann-Whitney, Kruskall-Wallis and Spearman tests. For analysis of categorical variables, the Chi-square test or Fisher, and considered significant p<0.05. Results: out of 835 patients, only 51 (6%) presented within the delta T less than 12h, who were invasively treated immediately on admission. 507 (61%) were presented with more than 12h. The curve of the CK-MB showed peak around 12h. Of those treated with invasive aproach on admission, 6 deaths were observed (11.7%) and 1 re-infarction (2%), all of which occurred in the first month of follow-up. Lower Blush grade and resolution of less than 50% in ST-elevation were associated to significantly higher values of CK-MB. Higher values of CK-MB were significantly correlated with higher delta T and higher mortality. Conclusion: contrary to what recommend the guidelines, only few cases who reached the specialised centres had delta T less than 12h, impacting negatively on prognosis. The curve of CK-MB in patients with myocardial infarction invasivelly treated on admission had early peak. The highest levels were observed in the cases with low Blush grade, less than 50% resolution in ST-elevation and larger delta-T, which were related to the worst prognosis.
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CARVALHO, G. Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb. 2015. 104 f. Tese (Doutorado em Ciências da Saúde ) - Universidade Federal de Goiás, Goiânia, 2015.