RESUMO
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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Angina Instável/complicações , Angina Instável/prevenção & controle , Infarto/epidemiologia , Infarto/prevenção & controle , Infarto do Miocárdio/prevenção & controle , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Revascularização Miocárdica/tendênciasRESUMO
Objetivo: Las guías actuales insisten en la relevancia de un tratamiento farmacológico optimizado para mejorar el pronóstico de los pacientes diagnosticados de síndrome coronario agudo sin elevación del segmento ST (SCASEST), pero son pocos los estudios que analizan sus resultados. El presente estudio analiza este aspecto. Método: Se incluyeron en una cohorte retrospectiva 1.118 pacientes ingresados en la unidad coronaria con el diagnóstico de SCASEST, y se analizaron sus (..) (AU)
Background and objective: Current guidelines emphasize the importance of optimal medical treatment for improving the prognosis of patients diagnosed with acute coronary syndrome without persistent ST-segment elevation, although few studies have analyzed the importance of implementing prescribing guidelines on (..) (AU)
Assuntos
Humanos , Síndrome Coronariana Aguda/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Prognóstico , Angina Instável/tratamento farmacológicoRESUMO
Up to 15% of patients with NSTEMI present at admission with heart failure. Scientific evidence for its management is limited but much progress has been made during the last years. Our purpose was to review the last data concerning heart failure in NSTEMI and perform an update on the subject, with the following findings as main highlights. As Killip classes III and IV, Killip class II onset in the context of NSTEMI has also proven bad prognosis significance. Beta-blocker therapy has proven benefit to patients with Killip class II in observational studies and small trials. Angiotensin-converting enzyme inhibitor therapy shows stronger evidence of benefit in patients with heart failure than in patients without it. Eplerenone is indicated for patients with left ventricular dysfunction and heart failure or diabetes mellitus. Implantable cardioverter defibrillators improve survival in patients with severe ventricular dysfunction after a myocardial infarction. Cardiac resynchronization therapy indications must be carefully assessed due to the high rate of implants that do not fulfill guidelines indications. In conclusion, heart failure during a NSTEMI is a common and meaningful situation which warrants careful management and further investigation to reach stronger evidence for clinical recommendations.