Predictores del uso de la estrategia invasiva precoz en mujeres con síndrome coronario agudo sin elevación de ST / Predictors of the use of the early invasive strategy in women with non-ST-elevation acute coronary syndrome
Med. intensiva (Madr., Ed. impr.)
; 38(8): 483-491, nov. 2014. tab
Article
em Es
| IBECS
| ID: ibc-129665
Biblioteca responsável:
ES1.1
Localização: BNCS
RESUMEN
OBJETIVO:
Identificar los determinantes asociados a la estrategia invasiva precoz (EIP) en mujeres con síndrome coronario agudo sin elevación de ST (SCASEST).DISEÑO:
Estudio de cohortes retrospectivo. Análisis crudo y ajustado de la realización de EIP mediante regresión logística no condicional. Ámbito Unidades coronarias participantes en 2010-2011 en el registro ARIAM-SEMICYUC. PACIENTES Cuatrocientas cuarenta mujeres con SCASEST. Se excluyeron 16 por datos insuficientes y 58 con coronariografía electiva (> 72 h). Variables analizadas Demográficas, factores de riesgo coronario, medicación previa, comorbilidad. Características clínicas, analíticas, hemodinámicas y electrocardiográficas del episodio.RESULTADOS:
Las mujeres tratadas conservadoramente presentaban mayor edad, mayor prevalencia de anticoagulación oral, diabetes, lesiones coronarias previas e insuficiencia cardiaca (p < 0,005), mayor riesgo hemorrágico e isquémico basal (p = 0,05) y mayor frecuencia cardiaca al ingreso (p < 0,05). Tras el ajuste solo la edad mayor de 80 años (OR 0,48; IC 95% 0,27-0,82; p = 0,009), las lesiones coronarias conocidas (OR 0,47; IC 95% 0,26-0,84, p = 0,011) y la frecuencia cardiaca (OR 0,98; IC 95% 0,97-0,99, p = 0,003) se asociaron de forma independiente al tratamiento conservador. El tabaquismo (OR 2,50; IC 95% 1,20-5,19; p = 0,013) y el electrocardiograma de alto riesgo (OR 2,96; IC 95% 1, 72-4,97; p < 0,001) se asociaron a la EIP. La exclusión de muertes precoces (< 24 h) no alteró estos resultados.CONCLUSIONES:
En mujeres con SCASEST el tabaquismo y el electrocardiograma de alto riesgo al ingreso son factores independientes asociados a la EIP. Las lesiones coronarias previas conocidas, la edad > 80 años y el aumento de la frecuencia cardiaca son factores independientes asociados al tratamiento conservadorABSTRACT
OBJECTIVE:
To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS).DESIGN:
A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression.SETTING:
Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry. PATIENTS A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72h). Variables analyzed Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode.RESULTS:
Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p < 0,005), increased baseline bleeding and ischemic risk (p = 0,05) and a higher heart rate upon admission (p < 0,05). After adjustment, only age > 80 years (OR 0,48, 95% CI 0,27 to 0,82, p = 0,009), known coronary lesions (OR 0,47, 95% CI 0,26-0,84, p = 0,011), and heart rate (OR 0,98, 95% CI 0,97-0,99, p = 0,003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p = 0,013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p < 0,001) were associated to the early invasive strategy. The exclusion of early deaths (<24h) did not alter these results.CONCLUSIONS:
In women with NSTE ACS, smoking and a high-risk electrocardiogram upon admission were independent factors associated to the early invasive strategy. Previous coronary lesions, age > 80 years and increased heart rate were independent factors associated to conservative treatment
Texto completo:
1
Coleções:
06-national
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ES
Base de dados:
IBECS
Assunto principal:
Angiografia Coronária
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Eletrocardiografia
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Síndrome Coronariana Aguda
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Intervenção Coronária Percutânea
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Female
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Humans
Idioma:
Es
Revista:
Med. intensiva (Madr., Ed. impr.)
Ano de publicação:
2014
Tipo de documento:
Article