Estrategia farmacoinvasiva como tratamiento de reperfusión en áreas sin disponibilidad de angioplastia primaria

Abstract

espanolIntroduccion y objetivos: El tratamiento de reperfusion en un sindrome coronario agudo con elevacion del segmento ST (SCACEST) se puede realizar con agentes fibrinoliticos o con angioplastia primaria (ICPp). La ICPp es la estrategia de eleccion, pero muchos de los pacientes con SCACEST acuden inicialmente a hospitales sin ICPp. Se han desarrollado programas de asistencia al SCACEST en los que se integran ambos tratamientos, utilizando la trombolisis en casos indicados, seguida de un estudio angiografico (estrategia farmacoinvasiva). El objetivo del estudio es analizar los resultados del tratamiento del SCACEST segun sea diagnosticado en areas de salud con o sin disponibilidad de ICPp inmediata. Metodos: Estudio retrospectivo de una cohorte de pacientes diagnosticados de SCACEST en 3 areas de salud de Murcia: area I con ICPp (Hospital Clinico Universitario Virgen de la Arrixaca) y areas IV y V sin ICPp (Hospital Comarcal del Noroeste, Caravaca de la Cruz y Virgen del Castillo, Yecla). Resultados: Entre 2006 y 2010 se atendio por SCACEST a 679 pacientes de las areas I, IV y V de Murcia. De los 494 pacientes del area I, recibieron tratamiento con ICPp el 97,6% (482) y trombolisis el 2,4% (12). En los pacientes de las areas sanitarias IV y V se realizo trombolisis al 73% (135) e ICPp al resto 27% (50). De los pacientes sometidos a trombolisis, el 34% (46) precisaron angioplastia de rescate y al 58,5% (79) se les realizo coronariografia programada (estrategia farmacoinvasiva). No hubo diferencias en la mortalidad total a 30 dias (8,3% en el area I y 6% en las areas IV y V; p = 0,31) ni al ano (11,3 frente a 8,2%; p = 0,23); tampoco en la mortalidad por causa cardiaca. Conclusiones: A pesar de la menor accesibilidad a la ICPp en las areas sanitarias mas alejadas, la red asistencial regional de Murcia permite unos resultados comparables a los de las areas sanitarias con disponibilidad de ICPp. EnglishIntroduction and objectives: Reperfusion therapy during an ST-segment elevation acute coronary syndrome (STEACS) can be performed using fibrinolytic agents or primary percutaneous coronary intervention (pPCI). The pPCI is the reperfusion strategy of choice, but many patients with STEACS initially come to non-PCI capable hospitals. Regional networks have been launched with both reperfusion therapies using thrombolysis in indicated cases followed by routine angiographic studies (pharmacoinvasive strategy). Our objective was to analyze the results of treatment in patients with STEACS in the Region of Murcia, Spain based on the patient’s place of origin. Methods: Retrospective study of a cohort of patients admitted due to STEACS to 3 health areas: pPCI-capable Area 1 (Hospital Clinico Universitario Virgen de la Arrixaca), and non-pPCI capable Areas IV and V (Hospital Comarcal del Noroeste, Caravaca de la Cruz, and Virgen del Castillo, Yecla). Results: Six hundred and seventy-nine patients from health areas I, IV, and V of the Region of Murcia were treated of STEACS from 2006 through 2010. Out of the 494 patients from Area I, 97.6% (482 patients) were treated with pPCI while 2.4% (12 cases) received thrombolysis. In Areas IV and V, 73% (135) of patients were treated with pPCI and 27% (50) with thrombolysis. After thrombolysis, 46 patients (34%) required rescue angioplasty and 79 (58.5%) underwent a scheduled coronary angiography (pharmacoinvasive strategy). No statistically significant differences were reported in the overall mortality rate at 30-day (8.3% in Area I vs 6% in Areas IV and V; P = .31) or 1 year follow-up (11.3% vs 8.2%; P = .23) in Area I compared to Areas IV and V, nor for cardiac mortality. Conclusions: Although immediate pPCIs are less accessible in remote health areas, the healthcare network from the Region of Murcia can achieve similar mortality results compared to populations with pPCI availability.