Importancia de la carga vascular previa en la mortalidad intrahospitalaria y a largo plazo de pacientes con infarto de miocardio y segmento ST elevado |
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Authors: | Luciano Consuegra-Sánchez Antonio Melgarejo-Moreno José Galcerá-Tomás Nuria Alonso-Fernández Angela Díaz-Pastor Germán Escudero-García Leticia Jaulent-Huertas Marta Vicente-Gilabert |
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Institution: | 1. Servicio de Cardiología, Hospital Universitario de Santa Lucía, Cartagena, Murcia, España;2. Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, España;3. Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España |
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Abstract: | Introduction and objectivesPatients with a current acute coronary syndrome and previous ischemic heart disease, peripheral arterial disease, or cerebrovascular disease are reported to have a poorer outcome than those without these previous conditions. It is uncertain whether this association with outcome is observed at long-term follow-up.MethodsProspective observational study, including 4247 patients with ST-segment elevation myocardial infarction. Detailed clinical data and information on previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease («vascular burden») were recorded. Multivariate models were performed for in-hospital and long-term (median, 7.2 years) all-cause mortality.ResultsOne vascular territory was affected in 1131 (26.6%) patients and ≥ 2 territories in 221 (5.2%). The total in-hospital mortality rate was 12.3% and the long-term incidence density was 3.5 deaths per 100 patient-years. A background of previous ischemic heart disease (odds ratio = 0.83; P = .35), peripheral arterial disease (odds ratio = 1.30; P=.34), or cerebrovascular disease (stroke) (odds ratio = 1.15; P = .59) was not independently predictive of in-hospital death. In an adjusted model, previous cerebrovascular disease and previous peripheral arterial disease were both predictors of mortality at long-term follow-up (hazard ratio = 1.57; P < .001; and hazard ratio = 1.34; P = .001; respectively). Patients with ≥ 2 diseased vascular territories showed higher long-term mortality (hazard ratio = 2.35; P < .001), but not higher in-hospital mortality (odds ratio = 1.07; P = .844).ConclusionsIn patients with a diagnosis of ST-segment elevation acute myocardial infarction, the previous vascular burden determines greater long-term mortality. Considered individually, previous cerebrovascular disease and peripheral arterial disease were predictors of mortality at long-term after hospital discharge.Full English text available from: www.revespcardiol.org/en |
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Keywords: | ACV accidente cerebrovascular AP arteriopatí a perifé rica CI cardiopatí a isqué mica IAMCEST infarto agudo de miocardio con elevació n del segmento ST |
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