Estudio de caso: revascularización de paciente con enfoque en el proceso de atención de enfermería / Case study: Patient revascularization with focus on the nursing care process

Introducción: la cardiopatía isquémica fue la primera causa de muerte en México en el año 2020. Su prevalencia aumenta con la edad y es superior en los hombres que en las mujeres; se presenta mayormente en forma de infarto en edades entre 45 y 94 años. Objetivo: describir el caso de un paciente sometido a revascularización aorto-coronaria por cardiopatía isquémica con enfoque del proceso de atención de enfermería (PAE). Metodología: estudio de caso observacional y descriptivo con aplicación del PAE en el perioperatorio de un hombre de 50 años con cardiopatía isquémica crónica, enfermedad multivascular e hipertensión sistémica controlada de 6 años desde que inició, en un hospital público de tercer nivel en Mérida, Yucatán, México. Resultados: se demostró que si se aplica el PAE hay menor riesgo de shock hipovolémico ocasionado por sangrado activo y disminución de riesgo de infección del sitio de herida quirúrgica, evidenciado por el procedimiento quirúrgico extenso. Conclusiones: la metodología del PAE como método científico facilita innovaciones dentro de los cuidados enfermeros, además de las diferentes alternativas en las acciones a seguir para el tratamiento del paciente quirúrgico cardiovascular. También proporciona un método informativo para la atención de cuidados, desarrolla una autonomía para la enfermería y fomenta la consideración como profesional de salud.

Introduction: Ischemic heart disease was the leading cause of death in Mexico in 2020. Its prevalence increases with age and it is higher in men than in women; it is presented mostly as a heart attack between the ages of 45 and 94 years. Objective: To describe the case of a patient undergoing aorto-coronary revascularization for ischemic heart disease with a nursing care process (NCP) approach. Methodology: Observational and descriptive case study with application of NCP in the perioperative period of a 50-year-old man with chronic ischemic heart disease, multivessel disease and controlled systemic hypertension of 6 years since its onset, in a third level public hospital in Merida, Yucatan, Mexico. Results: It was demonstrated that by applying NCP there is a lower risk of hypovolemic shock caused by active bleeding and decreased risk of surgical wound site infection, evidenced by the extensive surgical procedure. Conclusions: The NCP methodology as a scientific method facilitates innovations within nursing care, in addition to the different alternatives in the actions to follow for the treatment of the cardiovascular surgical patient. It also provides an informative method for care, develops autonomy for nursing and promotes consideration as a health professional.

Carotid plaque is a predictor of major adverse cardiac and cerebrovascular events in patients undergoing coronary angiography / La presencia de placa carotídea es predictor de eventos adversos cardiacos y cerebrovasculares en sujetos sometidos a coronariografía

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

Sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction / Relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos hospitalizados com infarto agudo do miocárdio

ABSTRACT Objective: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. Methods: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. Results: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). Conclusion: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.

RESUMO Objetivo: Verificar a relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos com infarto agudo do miocárdio internados. Métodos: Estudo transversal envolvendo pacientes idosos com infarto agudo do miocárdio, hospitalizados no período de abril a julho de 2015, em serviço público, no Nordeste brasileiro. A sarcopenia foi determinada por meio das medidas de massa muscular, força muscular e desempenho físico. Foram utilizados os marcadores de risco cardiovascular e de prognóstico, como os valores de troponina e da isoenzima MB da creatinina quinase, classificação do infarto agudo do miocárdio de acordo com a elevação do segmento ST e o escore de risco de trombólise em infarto do miocárdio. Resultados: Foram avaliados 99 pacientes, com média de idade de 71,6 (±7,4) anos. Verificou-se prevalência de sarcopenia de 64,6% e 35,4% de obesidade sarcopênica. A sarcopenia foi mais prevalente no sexo masculino (p=0,017), na faixa etária >80 anos (p=0,008). Dentre os marcadores de risco cardiovascular, apenas o escore de risco trombólise em infarto do miocárdio esteve estatisticamente associado à sarcopenia (p=0,002). Conclusão: A prevalência da sarcopenia foi elevada e se associou com o escore de risco de trombólise em infarto do miocárdio. A obesidade sarcopênica acometeu cerca de um terço dos pacientes e não se associou a nenhum parâmetro preditor prognóstico.

Insuficiência cardíaca na população geriátrica: dados de um registro unicêntrico / Heart failure in the older population: data from a single-center registry

OBJETIVO: Analisar o perfil e o seguimento clínico de pacientes com insuficiência cardíaca. MÉTODOS: Estudo prospectivo observacional de pacientes com insuficiência cardíaca, que comparou a população geriátrica (≥ 65 anos) com o restante da amostra (18 a 64 anos). Todos eram acompanhados ambulatorialmente em clínica especializada de um hospital-escola e foram incluídos consecutivamente entre abril e novembro de 2013, tendo sido acompanhados por 3 anos ou óbito. RESULTADOS: Da amostra total de 100 pacientes, 56% eram idosos. Na comparação entre idosos (média de 74±7 anos) e não idosos (média de 52±8 anos), houve diferença significativa quanto a peso corporal (72,6±16 kg vs. 80,8±19kg; p=0,02), índice de massa corporal (28,6±5,7kg/m2 vs. 32,6±5,9kg/m2; p=0,001), fibrilação atrial (35,7% vs. 11,3%; p=0,005) e doença renal crônica (28,5% vs. 13,6%; p=0,04). A prescrição de betabloqueadores e de inibidores da enzima conversora de angiotensina ou bloqueadores do receptor de angiotensina não diferiu entre os grupos, e nem os dados ecocardiográficos e a ocorrência de desfechos no seguimento clínico. CONCLUSÃO: Idosos foram a maioria dentre pacientes com insuficiência cardíaca e apresentaram maior prevalência de doença renal crônica e fibrilação atrial, além de menores peso e índice de massa corporal. Tais diferenças não resultaram em maior incidência de desfechos adversos na evolução de médio prazo. (AU)

OBJECTIVE: To assess the clinical profile and follow-up of patients with heart failure. METHODS: This is a prospective, observational study that compared the geriatric population (≥ 65 years old) with the remaining portion of the sample (18 to 64 years old). All of them were assisted in a specialized outpatient clinic of a university hospital, and were included consecutively from April to November 2013, being followed for three years or until death. RESULTS: From the sample of 100 patients, 56% were older people. In the comparison between older people (average 74 ± 7 years old) and non-older people (average 52 ± 8 years old), a significant difference was found for body weight (72.6 ± 16Kg vs. 80.8 ± 19Kg, p=0.02), body mass index (28.6 ± 5.7Kg/m2 vs. 32.6 ± 5.9 Kg/m2, p=0.001), atrial fibrillation (35.7% vs. 11.3%, p=0.005), and chronic kidney disease (28.5% vs. 13.6%, p=0.04). The prescription of beta-blockers and angiotensin converting enzyme inhibitors, or angiotensin receptor blockers did not differ between the groups, neither did the echocardiographic values and the occurrence of outcomes at clinical follow-up. CONCLUSION: Older people were the majority among patients with heart failure, and presented a higher prevalence of chronic kidney disease and atrial fibrillation, and lower body weight and body mass index. Those differences did not result in greater incidence of adverse outcomes at mid-term follow-up. (AU)

Circunferencia abdominal y riesgo de enfermedad cardiovascular. Consultorio 22. Policlínico Docente "Aleida Fernández Chardiet". 2016 / Abdominal circumference and risk of cardiovascular disease in Doctor's Office 22. "Aleida Fernández Chardiet" Polyclinic. 2016

Introducción: Estudios epidemiológicos han señalado que la obesidad abdominal es el factor de riesgo más preponderante en los países latinoamericanos y el que mejor explica la ocurrencia de un primer infarto agudo de miocardio. Objetivo: Determinar el riesgo de enfermedad cardiovascular por la medición de la circunferencia abdominal en el Consultorio 22 del Policlínico Docente Aleida Fernández Chardiet del municipio La Lisa, La Habana, Cuba, en 2016. Material y métodos: Se realizó un estudio observacional descriptivo, de corte transversal en personas mayores de 17 años de edad. El universo estuvo constituido por 538 personas. Se utilizaron distribuciones de frecuencias, cálculos porcentuales y el test de Chi Cuadrado. Resultados: De acuerdo con el valor de la circunferencia abdominal, 42,9 por ciento de las personas presentó un riesgo de enfermedad cardiovascular incrementado. El riesgo incrementado predominó en el sexo masculino (48 por ciento). Solo el 16,5 por ciento de los pacientes diabéticos tuvo un riesgo bajo. El 50,6 por ciento de los pacientes con hipertensión arterial y 45,4 por ciento de los fumadores presentaron un riesgo de enfermedad cardiovascular incrementado. Conclusiones: El riesgo incrementado de enfermedad cardiovascular, según la medida de la circunferencia abdominal, predominó en la mayoría de los pacientes estudiados, fundamentalmente en los pacientes del sexo masculino, los diabéticos, los hipertensos y los fumadores. Se observó una relación estadísticamente significativa entre el riesgo de enfermedad cardiovascular, encontrado por la obesidad abdominal y la edad, el sexo, la Diabetes Mellitus y la hipertensión arterial(AU)

Introduction: Epidemiological studies have demonstrated that abdominal obesity is the most important risk factor and the one that best explains the occurrence of a first acute myocardial infarction in Latin American countries. Objective: To determine the risk of cardiovascular disease by measuring the abdominal circumference in Doctor's Office 22 of Aleida Fernández Chardiet Teaching Polyclinic, La Lisa municipality, Havana, Cuba, in 2016. Material and Methods: An observational descriptive cross-sectional study was conducted in people older than 17 years old. The universe of study was composed of 538 persons. Distributions of frequencies, percentage calculations, and the Chi-square test were used. Results: With regard to the value of abdominal circumference, 42,9 percent of people presented a high risk of cardiovascular disease, which predominated in the male sex (48,0 percent). Only 16,5 percent of diabetic patients presented a low risk. The 50,6 percent of patients with arterial hypertension, and the 45,4 percent of smokers presented a high risk. Conclusions: Regarding the evaluation of the abdominal circumference, a high risk of cardiovascular disease was observed in the majority of population studied, especially in the male sex, diabetics, hypertensive patients, and smokers. A statistically significant relationship was observed in patients with risk of cardiovascular disease due to abdominal obesity and age, sex, Diabetes Mellitus, and arterial hypertension.

The effect of periodontal therapy on neopterin and vascular cell adhesion molecule-1 levels in chronic periodontitis patients with and without acute myocardial infarction: a case-control study

Abstract The presence of neopterin in gingival crevicular fluid (GCF) is a marker for local and acute immune activation, and the presence of vascular cell adhesion molecule (VCAM-1) in GCF is accepted as a marker for chronic vascular inflammation. Objectives This study aimed to evaluate effects of periodontal treatment on GCF levels of neopterin and VCAM-1 in patients with chronic periodontitis (CP) with acute myocardial infarction (AMI) compared with systemically healthy CP patients. Material and methods Sixty subjects (20 CP patients with AMI, 20 healthy CP patients, and 20 healthy controls) were included. GCF samples were analyzed at baseline and after 3 and 6 months, and the probing pocket depth (PD), clinical attachment level (CAL), bleeding on probing, gingival (GI) and plaque (PI) indices were recorded. We determined neopterin and VCAM-1 levels (concentration and total amount) using enzyme-linked immunosorbent assay (ELISA). No significant differences were seen between the AMI+CP and CP groups for PI, GI, GCF levels of neopterin and VCAM-1 at baseline. Results The number of teeth with 5 mm≤CAL<7 mm and CAL≥7 mm were significantly increased in the AMI+CP group at baseline. There were no significant differences between the AMI+CP and CP for PI, CAL, GCF volumes, and the AMI+CP group had the highest clinical improvement in the number of teeth with 5 mm≤CAL<7 mm at the sixth month. There were significant positive correlations between clinical periodontal inflammation and the presence of neopterin and VCAM-1 in GCF prior to and following periodontal treatment, and between the GCF volume and clinical parameters. Conclusions Data suggest that the total amount and concentration of neopterin and VCAM-1 in GCF seemed to be closely associated with periodontal disease severity in CP patients with AMI. Moreover, the results of our study demonstrate that the past periodontal status is potentially correlated between groups, with similar periodontal disease severity.

Comparison of the ACC/AHA and Framingham algorithms to assess cardiovascular risk in HIV-infected patients

ABSTRACT The aim of this study was to compare the predictions of Framingham cardiovascular (CV) risk score (FRS) and the American College of Cardiology/American Heart Association (ACC/AHA) risk score in an HIV outpatient clinic in the city of Vitoria, Espirito Santo, Brazil. In a cross-sectional study 341 HIV infected patients over 40 years old consecutively recruited were interviewed. Cohen's kappa coefficient was used to assess agreement between the two algorithms. 61.3% were stratified as low risk by Framingham score, compared with 54% by ACC/AHA score (Spearman correlation 0.845; p < 0.000). Only 26.1% were classified as cardiovascular high risk by Framingham compared to 46% by ACC/AHA score (Kappa = 0.745; p < 0.039). Only one out of eight patients had cardiovascular high risk by Framingham at the time of a myocardial infarction event registered up to five years before the study period. Both cardiovascular risk scores but especially Framingham underestimated high-risk patients in this HIV-infected population.

Prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis in Southern Brazil / Prevalência de doença isquêmica cardíaca e fatores associados em pacientes com artrite reumatoide no Sul do Brasil

Abstract Objective: To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis. Methods: A cross-sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 2014. The presence of ischemic heart disease was defined as an acute myocardial infarction with percutaneous coronary intervention or coronary artery bypass graft surgery that has occurred after diagnosis. Fischer's exact test, Wald's linear trend test, and multivariate logistic regression analysis were used to test the associations. Results: Among 296 patients (83.1% female) with a mean age of 56.6 years and a mean rheumatoid arthritis duration of 11.3 years, 13 reported having acute myocardial infarction requiring a percutaneous or surgical reperfusion procedure, a prevalence of 4.4% (95% CI 2.0-6.7). Diabetes Mellitus (odds ratio [OR] 4.9 [95% CI 1.6-13.8]) and disease duration >10 years (OR 8.2 [95% CI 1.8-39.7]) were the only factors associated with an ischemic disease that remained in the final model, after the multivariate analysis. Conclusion: The prevalence of acute myocardial infarction was similar to that observed in other studies. Among the traditional risk factors, Diabetes Mellitus, and among the factors related to rheumatoid arthritis, disease duration, were the variables associated with comorbidity.

Resumo Objetivo: Estimar a prevalência da doença isquêmica cardíaca e os fatores associados em pacientes com artrite reumatoide. Métodos: Estudo transversal que usou o critério diagnóstico do Colégio Americano de Reumatologia para selecionar pacientes atendidos nas unidades de saúde da atenção primária ou secundária em Blumenau, Santa Catarina, sul do Brasil, em 2014. A presença de doença cardíaca isquêmica foi definida com infarto agudo do miocárdio com intervenção coronariana percutânea ou cirurgia de revascularização do miocárdio que tenha ocorrido depois do diagnóstico. Para testar as associações usou-se o teste exato de Fischer, o teste de tendência linear de Wald e a análise de regressão logística multivariada. Resultados: Entre 296 pacientes, 83,1% de mulheres, com média de 56,6 anos, tempo médio de artrite reumatoide de 11,3 anos, 13 relatam ter tido infarto agudo do miocárdio que necessitou de procedimento de reperfusão percutânea ou cirúrgica, prevalência de 4,4% (IC 95% 2,0-6,7). O diabetes melittus (razão de chance de 4,9 [IC 95% 1,6-13,8]) e o tempo de doença maior do que 10 anos (razão de chance de 8,2 [IC 95% 1,8-39,7]) foram os únicos fatores associados com a doença isquêmica que permaneceram no modelo final após análise multivariada. Conclusão: A prevalência de infarto agudo do miocárdio foi semelhante com a observada em outros estudos. Entre os fatores de risco tradicionais e entre os fatores relacionados à artrite reumatoide, o diabetes melittus e o tempo de doença foram as variáveis associadas à comorbidade

Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review / Associação entre Apneia Obstrutiva do Sono e Infarto do Miocárdio: Uma Revisão Sistemática

Abstract Obstructive sleep apnea (OSA) has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI). This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS -Biblioteca Virtual em Saúde (Virtual Health Library). The descriptors used were: 'obstructive sleep apnea' AND 'polysomnography' AND 'myocardial infarction' AND 'adults NOT 'treatment.' The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7%) of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI) are the most reliable markers.

Resumo A apneia obstrutiva do sono (AOS) tem sido associada a fatores de risco cardiovascular, porém a relação entre a AOS e doença cardiovascular ainda é controversa. O objetivo do presente estudo foi verificar a associação entre AOS e infarto do miocárdio (IM). Revisão sistemática de literatura por meio das fontes de dados eletrônicas MEDLINE/PubMed, PubMed Central, Web of Science e Biblioteca Virtual em Saúde (BVS). Os descritores utilizados foram: "obstructive sleep apnea" AND "polysomnography" AND "myocardial infarction" AND "adults" NOT "treatment".O presente trabalho analisou três estudos prospectivos, selecionados dentre 142 artigos encontrados. Os estudos acompanharam uma amostra total de 5.067 pacientes diagnosticados com AOS, composta majoritariamente por participantes do sexo masculino. Todos os pacientes realizaram polissonografia noturna, e todas as pesquisas encontraram associação entre AOS e desfechos cardiovasculares fatais e não fatais. Assim, foi possível observar que 644 (12,7%) dos 5.067 pacientes sofreram IM ou acidente vascular cerebral, ou precisaram de procedimento de revascularização, sendo que 25,6% desses eventos cardiovasculares foram fatais. O IM foi responsável por 29,5% do total de 644 desfechos analisados. Existe associação entre AOS e IM, no sexo masculino, sendo o índice de apneia e hipopneia (IAH) um dos marcadores mais fidedignos.

Effects of Air Pollutant Exposure on Acute Myocardial Infarction, According to Gender / Efeitos da Exposição a Poluentes do Ar no Infarto Agudo do Miocárdio, Segundo Gêneros

Abstract Background: There is evidence of the effects of air pollution on hospital admissions due to cardiovascular diseases, including myocardial infarction. Objective: To estimate the association between exposure to air pollutants and hospital admissions due to myocardial infarction according to gender, between January 1st 2012 and December 31st 2013, in São Jose dos Campos-SP. Methods: An ecological time series study was carried out with daily data of admissions due to AMI, pollutants CO, O3, PM10, SO2, and NO2, according to gender. We used the Poisson regression generalized linear model to estimate the relative risks of hospital admissions with lags of 0-5 days, adjusted for temperature, humidity, seasonality and days of the week. Results: There were 1837 admissions for ischemic heart diseases, with 636 women and 1201 men. For females, the risks were significant for CO in lag 0 (RR = 1,09), lag1 (RR = 1,08) and lag 5 (RR = 1,10) and SO2 in lag 0 (RR = 1,10) and 3 (RR = 1,09). For men there was significance of the CO in, lag 3 and lag 5 (RR = 1,05). There was significance, regardless of gender, for CO at lag 1 (RR = 1,05) and lag 5 (RR = 1,07) and lag 0 for SO2 (RR = 1,06). Conclusion: The data presented show the important role of CO and SO2 in the genesis of myocardial infarction admissions, and responses to pollutant exposure are different if analyzed by gender and together - hence the importance of a stratified analyses.

Resumo Fundamento: Existem evidências sobre os efeitos da poluição do ar nas internações por doenças cardiovasculares, entre elas o infarto do miocárdio. Objetivo: Estimar a associação entre exposição a poluentes do ar e internações por infarto segundo gêneros, entre 01 de Janeiro de 2012 e 31 de Dezembro de 2013, em São José dos Campos - SP. Métodos: Estudo ecológico de série temporal com dados diários de internações por IAM dos poluentes CO, O3, PM10, SO2, NO2, segundo gêneros. Utilizou-se modelo linear generalizado da Regressão de Poisson para estimar os riscos relativos para internações com defasagens de 0 a 5 dias, ajustados por temperatura, umidade, sazonalidade e dias da semana. Resultados: Foram 1837 internações por doenças isquêmicas do coração, sendo 636 mulheres e 1201 homens. Para o gênero feminino, os riscos foram significativos para o CO nos lag 0 (RR = 1,09), lag1 (RR = 1,08) e lag 5 (RR = 1,10) e para o SO2 no lag 0 (RR = 1,10) e 3 (RR = 1,09). Para o gênero masculino houve significância para o CO no lag 3 e lag 5 (RR = 1,05). Sem distinção de gênero houve significância para o CO no lag 1 (RR = 1,05) e lag 5 (RR = 1,07) e no lag 0 para o SO2 (RR = 1,06). Conclusão: Os dados apresentados mostram o importante papel do CO e do SO2 na gênese das internações por infarto e que as respostas à exposição aos poluentes são diferentes se analisadas por sexo e em conjunto, daí a importância de se estratificarem as análises.

Caracterización clínico epidemiológica de pacientes con infarto agudo del miocardio no trombolizados en el Hospital General Orlando Pantoja Tamayo, del municipio Contramaestre / Clinical-epidemiologic characterization of non thrombolyzed patients with acute myocardium infarct at the General Hospital Orlando Tamayo Pantoja, municipality of Contramaestre

La cardiopatía isquémica tiene una alta morbimortalidad en todo el mundo. Se realizó un estudio descriptivo transversal con el objetivo de caracterizar clínica y epidemiológicamente a 43 pacientes con diagnóstico de infarto agudo del miocardio que no recibieron tratamiento trombolítico en el Hospital General Orlando Pantoja Tamayo, del municipio Contramaestre, provincia Santiago de Cuba, desde enero a diciembre de 2012, donde predominó el sexo masculino y el grupo de edades de 61 a 70 años, con 2 o más factores de riesgo coronario. Fue significativa la dislipemia, obesidad y la hipertensión arterial. El tiempo de demora mayor de 12 horas fue la causa fundamental que inhabilitó la aplicación de la trombolisis, teniendo como génesis principal el desconocimiento por parte del enfermo de las señales de alarma que lo motivaron acudir al facultativo. Predominó el infarto de la cara inferior y la estadía hospitalaria superior a los 12 días como promedio.

The ischemic cardiopathy has a high morbimortality all around the world. A cross-sectional descriptive study was carried out with the objective of clinically and epidemiologically characterizing 43 patients diagnosed with acute myocardial infarct who did not received thrombolytic treatment in the General Hospital Orlando Pantoja Tamayo of the municipality of Contramaestre, from January to December 2012, with a predominance of the male sex and the age group from 61 to 70 years old, with 2 or more coronary risk facts, being significant dyslipidemia, obesity and arterial hypertension. The arrival time delayed more than 12 hours was the main cause disqualifying thrombolysis application, mainly caused by the ignorance of the alarm signs motivating the visit to the doctor from the part of the patient. There was a predominance of the lower side infarct and an average hospital staying of more than 12 days.

Copa do mundo de futebol como desencadeador de eventos cardiovasculares / World soccer cup as a trigger of cardiovascular events

FUNDAMENTO: Síndromes coronarianas agudas são a maior causa de mortalidade no mundo. Estímulos externos, também conhecidos como gatilhos, como estado emocional ou atividade física, podem produzir mudanças fisiopatológicas desencadeantes. Dentre os gatilhos estudados, eventos estressantes, como campeonatos de futebol, são controversos na literatura e não há dados efetivos para a população brasileira. OBJETIVO: Avaliar os efeitos agudos do estresse ambiental induzido pelos jogos da Copa do Mundo de Futebol no aumento da incidência de doenças cardiovasculares no Brasil. MÉTODOS: Foram obtidos dados publicamente disponíveis do Sistema Único de Saúde referentes às internações hospitalares com código internacional de doenças, referentes às síndromes isquêmicas agudas, no período de maio a agosto de 1998 a 2010 (155.992 internações). Restringiu-se a análise aos pacientes maiores que 35 anos e internados por especialidades clínicas. Comparou-se a incidência de infarto e óbito entre os dias sem copa (Grupo I: 144.166; 61,7 ± 12,3 anos; 59,4%masculino), dias de copa sem jogos do Brasil (Grupo II: 9.768; 61,8 ± 12,3 anos; 60,0% masculino) e dias de jogos do Brasil (Grupo III: 2.058; 61,6 ± 12,6 anos; 57,8% masculino). Utilizou-se regressão logística e de Poisson para ajustar por idade, gênero, densidade populacional e número de postos de atendimento. RESULTADOS: Houve aumento da incidência de infarto para jogos de copa do mundo (1,09; IC95% = 1,05-1,15) e do Brasil (1,16; IC95% = 1,06-1,27). Não houve impacto sobre mortalidade - copa (1,00; IC95% = 0,93-1,08) e Brasil (1,04; IC95% = 0,93-1,22). CONCLUSÃO: A copa do mundo e, especialmente, os jogos da seleção brasileira implicam maior incidência de infarto agudo do miocárdio, mas não de mortalidade intra-hospitalar.

BACKGROUND: Acute coronary syndromes are the major cause of death in Brazil and in the world. External stimuli, known also as triggers, such as emotional state and activity, may generate physiopathological changes that can trigger acute coronary syndromes. Among the studied triggers, the impact of stressful events, such as soccer championships, are controversial in literature and there is no effective data on the Brazilian population. OBJECTIVE: To evaluate the acute effects of environmental stress induced by soccer games of the World Soccer Cup on increased incidence of cardiovascular diseases in Brazil. METHODS: Public data were obtained from the Unified Health System (Sistema Único de Saúde), regarding hospital admissions that had the International Code Disease of acute coronary syndromes from May to August, in 1998, 2002, 2006 and 2010 (155,992 admissions). Analysis was restricted to patients older than 35 years and admitted by clinical specialties. The incidence of myocardial infarction, angina and mortality were compared among days without World Cup soccer games (Group I: 144,166; 61.7 ± 12.3; 59.4% males); on days when there were no Brazil's soccer team matches (Group II: 9,768; 61.8±12.3; 60.0% males); and days when there were Brazil's soccer team matches (Group III; 2,058; 61.6±12.6; 57.8% males). Logistic regression was used to adjust to age, gender, population density and number of medical assistance units. RESULTS: The incidence of myocardial infarction increased during the period of World Cup soccer games (1.09; 95%CI = 1.05-1.15) and days when there were Brazil's matches (1.16; 95%CI = 1.06-1.27). There was no impact on mortality during the Cup (1.00; CI95% = 0.93-1.08) and Brazil's matches (1.04; 95%CI = 0.93-1.22). CONCLUSION: World Cup soccer games and, specially, Brazil's matches have an impact on the incidence of myocardial infarction, but not on in-hospital mortality.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Costos por ausentismo laboral atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social y en México, 2006-2009 / Absenteeism attributable to smoking in the Mexican Social Security Institute, 2006-2009

OBJETIVO: Calcular los costos por ausentismo laboral atribuibles al tabaquismo en los asegurados del IMSS y población ocupada en México para el periodo 2006-2009. MATERIAL y MÉTODOS: Los costos se estimaron usando fracciones atribuibles para cáncer pulmonar, enfermedad cerebrovascular, enfermedad pulmonar obstructiva crónica e infarto agudo de miocardio, así como registros de salarios y días de incapacidad por esas enfermedades en asegurados del IMSS. Los parámetros encontrados se extrapolaron a la población ocupada. RESULTADOS: El IMSS erogó 143.9 millones de pesos a precios de 2009 atribuibles al tabaquismo como subsidio por incapacidad en el período 2006-2009. La productividad perdida atribuible al tabaquismo en asegurados del IMSS ascendió a 298.2 millones de pesos y a 437.8 millones de pesos en población ocupada del país en el mismo período. CONCLUSIONES: El tabaquismo impone costos importantes a las instituciones de seguridad en el país y causa pérdidas en la productividad. Por tanto, deben fortalecerse las políticas gubernamentales de control del tabaco incluidas en el Convenio Marco para el Control del Tabaco.

OBJECTIVE: To calculate the absenteeism costs by lung cancer, cerebrovascular disease, chronic obstructive pulmonary disease and acute myocardial infarction attributable to smoking in the Mexican Social Security Institute (IMSS) and the occupied population from 2006 to 2009. MATERIALS AND METHODS: Productivity loss data from selected illnesses were obtained from IMSS records. The smoking attributable fraction was used, and extrapolation to occupied population was conducted. RESULTS: IMSS paid $143.9 million pesos (2009 prices) attributable to smoking between 2006 and 2009. The productivity loss was $298.2 million pesos and $437.8 million pesos in the occupied population, attributable to smoking. CONCLUSIONS: Tobacco smoking implies costs to the individual, families and society, which urge to strengthen policies contained in the Framework Convention on Tobacco Control by the WHO.

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio / Absence of nocturnal dipping is associated with stroke and myocardium infarction / La ausencia de descenso nocturno de la presión arterial se asocia a accidente cerebrovascular e infarto de miocardio

Fundamento: A pressão arterial (PA) varia de acordo com o ciclo circadiano, apresentando quedas fisiológicas durante o sono (descenso noturno - DN). A ausência dessa queda se associa a maior incidência de lesões em órgãos-alvo. Objetivo: Analisar a prevalência de DN em indivíduos hipertensos, correlacionar DN aos níveis pressóricos, variáveis clínicas, fatores sociodemográficos e bioquímicos e associá-lo a eventos cardiovasculares (acidente vascular cerebral - AVC e infarto agudo do miocárdio - IAM). Métodos: Foram avaliados 163 hipertensos, submetidos a monitorização ambulatorial da pressão arterial. DN foi definido como queda >10 por cento da PA sistólica do período da vigília para o de sono. Resultados: Os pacientes foram divididos em grupos dipper (D) e não dipper (ND). Não houve diferença significante entre os grupos quanto a idade, sexo, raça, tempo de hipertensão, glicemia, LDL-colesterol, colesterol total, triglicérides, escolaridade, tabagismo, história de diabetes. Grupo dipper apresentou PA superior a ND durante a vigília e inferior durante o sono. Grupo ND cursou com maior índice de massa corpórea (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) e maior pressão de pulso durante o sono (p=0,0025). História de AVC ou IAM foram mais frequentes em ND. À regressão logística, apenas a ausência de descenso noturno associou-se independentemente a AVC ou IAM. Conclusão: A ausência de DN associou-se de maneira independente às lesões em órgãos-alvo analisadas, o que demonstra a sua importância e reforça a necessidade de tratamento mais agressivo com objetivo de se atingir as metas pressóricas e, consequentemente, evitar o desenvolvimento de novos eventos cardiocerebrovasculares.

Background: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. Objective: To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). Methods: Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10 percent of the systolic BP of the day for sleep. Results: 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. Conclusion: ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.

Fundamento: La presión arterial (PA) varía de acuerdo al ciclo circadiano, presentando descensos fisiológicos durante el sueño (descenso nocturno - DN). La ausencia de ese descenso se asocia a mayor incidencia de lesiones en órganos blanco. Objetivo: Analizar la prevalencia de DN en individuos hipertensos, correlacionar DN a los niveles de presión, variables clínicas, factores sociodemográficos y bioquímicos y asociarlos a eventos cardiovasculares (accidente cerebrovascular - ACV e infarto agudo de miocardio - IAM). Métodos: Fueron evaluados 163 hipertensos, sometidos a monitoreo ambulatorio de la presión arterial. El DN fue definido como descenso > 10 por ciento de la PA sistólica del período de vigilia al de sueño. Resultados: Los pacientes fueron divididos en grupos dipper (D) y no dipper (ND). No existió diferencia significativa entre los grupos en cuanto a edad, sexo, raza, tiempo de hipertensión, glucemia, LDL-colesterol, colesterol total, triglicéridos, escolaridad, tabaquismo, historia de diabetes. El Grupo dipper presentó PA superior al ND durante la vigilia e inferior durante el sueño. El Grupo ND cursó con mayor índice de masa corporal (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) y mayor presión de pulso durante el sueño (p=0,0025). Historia de ACV o IAM fueron más frecuentes en ND. En la regresión logística, sólo la falta de descenso nocturno se asoció independientemente del ACV o del IAM. Conclusión: La ausencia de DN se asoció de manera independiente a las lesiones en órganos blanco analizadas, lo que demuestra su importancia y refuerza la necesidad de tratamiento más agresivo con el objetivo de alcanzar las metas tensionales y, en consecuencia, evitar el desarrollo de nuevos eventos cardio y cerebrovasculares.

Escore de risco Dante Pazzanese para síndrome coronariana aguda sem supradesnivelamento do segmento ST / Dante Pazzanese risk score for non-st-segment elevation acute coronary syndrome

FUNDAMENTO: Em síndrome coronariana aguda (SCA), é importante estimar a probabilidade de eventos adversos. OBJETIVO: Desenvolver um escore de risco em uma população brasileira com SCA sem supradesnivelamento do segmento ST (SST). MÉTODOS: Foram avaliados prospectivamente 1.027 pacientes em um centro brasileiro de cardiologia. Um modelo de regressão logística múltipla foi desenvolvido para prever o risco de morte ou de (re)infarto em 30 dias. A acurácia preditiva do modelo foi determinada pelo C statistic. RESULTADOS: O evento combinado ocorreu em 54 pacientes (5,3 por cento). O escore foi criado pela soma aritmética de pontos dos preditores independentes, cujas pontuações foram designadas pelas respectivas probabilidades de ocorrência do evento. As seguintes variáveis foram identificadas: aumento da idade (0 a 9 pontos); antecedente de diabete melito (2 pontos) ou de acidente vascular cerebral (4 pontos); não utilização prévia de inibidor da enzima conversora da angiotensina (1 ponto); elevação da creatinina (0 a 10 pontos); e combinação de elevação da troponina I cardíaca e depressão do segmento ST (0 a 4 pontos). Foram definidos quatro grupos de risco: muito baixo (até 5 pontos); baixo (6 a 10 pontos); intermediário (11 a 15 pontos); e alto risco (16 a 30 pontos). O C statistic para a probabilidade do evento foi de 0,78 e para o escore de risco em pontuação de 0,74. CONCLUSÃO: Um escore de risco foi desenvolvido para prever morte ou (re)infarto em 30 dias em uma população brasileira com SCA sem SST, podendo facilmente ser aplicável no departamento de emergência.

BACKGROUND: The probability of adverse events estimate is crucial in acute coronary syndrome condition. OBJECTIVES: To develop a risk score for the brazilian population presenting non-ST-segment elevation acute coronary syndrome. METHODS: One thousand and twenty seven (1,027) patients were investigated prospectively at a cardiology center in Brazil. A multiple logistic regression model was developed to estimate death or (re)infarction risk within 30 days. Model predictive accuracy was determined by C statistic. RESULTS: Combined event occurred in 54 patients (5.3 percent). The score was created by the arithmetic sum of independent predictors points. Points were determined by corresponding probabilities of event occurrence. The following variables have been identified: age increase (0 to 9 points); diabetes mellitus history (2 points) or prior stroke (4 points); no previous use of angiotensin converting enzyme inhibitor (1 point); creatinine level increase (0 to 10 points); the combination of troponin I level increase and ST-segment depression (0 to 4 points). Four risk groups were defined: very low (up to 5 points); low (6 to 10 points ); intermediate (11 to 15 points ); high risk (16 to 30 points ). The C statistic was 0.78 for event probability, and 0.74 for risk score. CONCLUSION: A risk score of easy application in the emergency service was developed to predict death or (re)infarction within 30 days in a brazilian population with non-ST-segment elevation acute coronary syndrome.

Letalidad del infarto agudo del miocardio: Hospital Militar Docente Mario Muñoz: Matanzas 2005-2007 / Lethality of acute myocardial infarct at the hospital Mario Muñoz: Matanzas 2005-2007

Se realizó un estudio analítico transversal de los pacientes con Infarto Agudo del Miocardio ingresados en la Unidad de Cuidados Intensivos del Hospital Militar Dr Mario Muñoz Monroy durante el período 2005–2007, con el objetivo fundamental de describir el comportamiento de la letalidad del Infarto Agudo del Miocardio en estos pacientes y su relación con los factores de riesgo más frecuentes y determinar la utilización y eficacia de la trombolisis y las complicaciones presentadas. El sexo más afectado fue el masculino con un 74,6 por ciento (53). La mayor incidencia de infarto fue de pacientes con edades entre los 59–68 años para un 32,33 por ciento. El factor de riesgo más frecuente fue la Hipertensión Arterial con un 70,4 por ciento, sin embargo el antecedente de Cardiopatía Isquémica fue el que mostró diferencia estadísticamente significativa. Hubo 45 pacientes complicados lo que representó el 63,4 por ciento. Se trombolizaron 31 pacientes que representaron el 48,4 por ciento, de ellos fallecieron el 22,5 por ciento. El estudio de la evolución de pacientes con infarto continúa siendo un arma de irrenunciable valor para el mejoramiento de la calidad médica.

It was developed an analytic transversal study of the patients with acute myocardial infarct entering the Intensive Care Unit of the Military Hospital Dr Mario Muñoz Monroy during the period 2005-2007, with the main objective of describing lethality behavior of Acute Myocardial Infarct in these patients and its relation with the most frequent risk facts, and determining thrombolysis usage and efficacy and presented complications. The most affected sex was the male sex with 74.6 per cent (53). The highest infarct incidence was in patients with ages between 59-68 years old (32.33 per cent). The most frequent risk fact was arterial hypertension with 70,4 per cent, but the antecedent of ischemic heart disease was the fact that showed a significant statistical difference. There were 45 patients with complications, representing a 63,4 per cent. 31 patients were thrombolysed, representing the 48,4 per cent; 22,5 per cent of them died. Studying the evolution of the patients with infarct is still a valuable weapon to improve medical quality.

Implante de stents farmacológicos na artéria descendente anterior: indicadores de eventos tardios / Implante de stents farmacológicos en la arteria descendente anterior: indicadores de eventos tardíos / Pharmacological stent deployment in the left anterior descending artery: late event indicators

FUNDAMENTO: A eficácia dos stents farmacológicos em reduzir os índices de eventos cardíacos não é uniforme a todos os subgrupos de lesões ou pacientes. OBJETIVO: Avaliar a evolução clínica tardia dos pacientes submetidos a implante de stents farmacológicos nas lesões ateroscleróticas da artéria descendente anterior e identificar, entre as características clínicas, angiográficas e do ultra-som intravascular, quais as que permitem predizer risco de eventos cardíacos. MÉTODOS: De maio de 2002 a agosto de 2005, foram tratados 205 pacientes com implante de 236 stents farmacológicos guiados pelo ultra-som intravascular. RESULTADOS: Com um acompanhamento médio de 711 dias, a taxa de trombose do stent foi de 0,48 por cento, a mesma observada para infarto agudo do miocárdio ou cirurgia de revascularização. A taxa de revascularização da lesão tratada foi de 7,31 por cento e a taxa global de eventos de 10,24 por cento. Os indicadores de eventos, conforme análise multivariada, foram o implante de mais de um stent na mesma artéria, lesões concêntricas e área mínima intra-stent medida pelo ultra-som intravascular menor que 3,88 mm². CONCLUSÃO: Baseados nos dados obtidos, concluímos que a revascularização da artéria descendente anterior com implante de stents farmacológicos escolhidos e otimizados pelo ultra-som intravascular apresenta baixo índice de eventos tardios. O implante de dois stents farmacológicos para o tratamento das lesões longas foi o principal fator independente para a ocorrência de eventos tardios. A área luminal final maior que 3,88 mm² obtidos nos segmentos de pequenos diâmetros de referência é um indicador independente de evolução livre de eventos.

BACKGROUND: The efficacy of pharmacological stents in decreasing the incidence of cardiac events is not homogeneous for all lesions or patient subgroups. OBJECTIVE: 1) To evaluate the late clinical evolution of patients submitted to pharmacological stent implantation in atherosclerotic lesions of the left anterior descending artery; 2) to identify, among the clinical, angiographic and intravascular ultrasonographic characteristics, the ones predictive of cardiac event risk. METHODS: From May 2002 to August 2005, 205 patients were treated with 236 pharmacological stent implants, guided by the intravascular US (IVUS). RESULTS: After a mean follow-up period of 711 days, the rate of stent thrombosis was 0.48 percent, the same observed for acute myocardial infarction or revascularization surgery. The revascularization rate of the treated lesion was 7.31 percent and the general event rate was 10.24 percent. The event indicators, according to the multivariate analysis were the implant of more than one stent in the same artery, concentric lesions and the minimal intra-stent area measured by IVUS < 3.88 mm². CONCLUSION: Based on the data obtained, we conclude that the revascularization of the left anterior descending artery with pharmacological stent implant, chosen and optimized by IVUS, presents a low incidence of late events. The implant of two pharmacological stents for the treatment of long lesions was the main independent factor for the occurrence of late events. The final luminal area > 3.88 mm² obtained in the small reference-diameter segments is an independent indicator of event-free evolution.

FUNDAMENTO: La eficacia de los stents farmacológicos para reducir los índices de eventos cardiacos no es la misma para todos los subgrupos de lesiones o pacientes. OBJETIVO: Evaluar la evolución clínica tardía de los pacientes sometidos a implante de stents farmacológicos en las lesiones ateroscleróticas de la arteria descendente anterior e identificar, entre las características clínicas, angiográficas y de ultrasonido intravascular, cuales son las que permiten predecir riesgos de eventos cardiacos MÉTODOS: De mayo de 2002 a agosto de 2005, se trataron a 205 pacientes con implante de 236 stents farmacológicos guiados por ultrasonido intravascular. RESULTADOS: Con un seguimiento promedio de 711 días, la tasa de trombosis del stent fue del 0,48 por ciento, la misma que se observó para infarto agudo de miocardio o cirugía de revascularización. La tasa de revascularización de la lesión tratada fue del 7,31 por ciento y la tasa global de eventos fue del 10,24 por ciento. Los indicadores de eventos, conforme análisis multivariada, fueron el implante de más de un stent en la misma arteria, lesiones concéntricas y área mínima intrastent medida por el ultrasonido intravascular menor que 3,88 mm². CONCLUSIÓN: Tomando como base los datos obtenidos con esta investigación, concluimos que la revascularización de la arteria descendente anterior con implante de stents farmacológicos, elegidos y optimizados por el ultrasonido intravascular, presenta un bajo índice de eventos tardíos. El implante de dos stents farmacológicos para el tratamiento de las lesiones largas fue el principal factor independiente para la ocurrencia de eventos tardíos. El área luminal final mayor que 3,88 mm², obtenida en los segmentos de pequeños diámetros de referencia es un indicador independiente de evolución libre de eventos.