Variáveis associadas à área miocárdica infartada na estratégia fármaco-invasiva
Data
2023-07
Autores
Araujo, Guilherme Campos 
Orientadores
Fonseca, Francisco Antonio Helfenstein
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O infarto agudo do miocárdio com elevação do segmento ST (IAMCEST) é uma condição grave caracterizada pela morte de células miocárdicas e elevação persistente do segmento ST, resultando em significativa morbidade e mortalidade. Embora os fatores de risco e prognósticos sejam amplamente conhecidos, há uma necessidade de explorar mais a fundo as variáveis associadas a desfechos importantes, como a área miocárdica infartada (AMI) e a fração de ejeção do ventrículo esquerdo (FEVE). Objetivo: Avaliar a associação entre variáveis clínicas e laboratoriais com a AMI e FEVE após 30 dias do IAMCEST em pacientes submetidos à estratégia fármaco-invasiva. Métodos: Foram avaliados os dados de 134 participantes do estudo BATTLE-AMI, com idade entre 18 e 75 anos, que apresentaram IAMCEST primário e foram tratados com tenecteplase em até 6 horas. Todos os pacientes foram submetidos à angiografia coronariana invasiva em até 24 horas após o evento índice. Após 30 dias, a AMI e a FEVE foram avaliadas por meio de ressonância nuclear magnética cardíaca. Foram realizadas análises de associação entre esses desfechos e variáveis sociodemográficas, clínicas e bioquímicas coletadas na admissão hospitalar, bem como fatores relacionados ao infarto e seu tratamento. Resultados: A amostra foi composta principalmente por homens (73%), hipertensos (61%) e tabagistas (51%), com mediana de idade de 57 anos e índice de massa corporal (IMC) de 26,4 kg/m². A mediana da AMI foi de 14% da massa ventricular esquerda, e a mediana da FEVE foi de 51%. A artéria descendente anterior (ADA) foi identificada como a artéria culpada em 47% dos eventos. Observou-se uma associação significativa entre níveis mais elevados de troponina, relação neutrófilo/linfócito, IMC, escore de Killip II e maior AMI, assim como na presença da ADA como artéria culpada (p < 0,05). Da mesma forma, houve uma associação significativa entre níveis mais elevados de troponina, relação neutrófilo/linfócito e maior AMI, e menor FEVE (p < 0,05). Não foram observadas associações significativas entre esses desfechos e idade, sexo, perfil lipídico, proteína C reativa, vitamina D, creatinina e taxa de filtração glomerular, escore GRACE, hipertensão, diabetes, tabagismo ou fluxo TIMI após a intervenção. A troponina foi a única variável que se correlacionou linearmente tanto com a FEVE quanto com a AMI. Conclusão: Os resultados deste estudo indicam que pacientes com maiores níveis de troponina, relação neutrófilo/linfócito e IMC, assim como aqueles classificados como Killip II e com a ADA como artéria culpada, apresentaram piores desfechos em relação à AMI e FEVE. Tendo a troponina correlação linear tanto com a AMI quanto com a FEVE. A avaliação desses fatores pode ser importante para identificar os pacientes com maior risco de desenvolver aumento da AMI e complicações como a insuficiência cardíaca.
Introduction: Acute ST-segment elevation myocardial infarction (STEMI) occurs when there is myocardial cell death associated with persistent ST-segment elevation and is associated with significant morbidity and mortality. While risk factors and prognostic factors are well known, variables associated with outcomes such as infarcted myocardial area (IMA) and left ventricular ejection fraction (LVEF) remain relatively unexplored. Objective: To evaluate the association between clinical and laboratory variables with IMA and LVEF after 30 days of STEMI in patients undergoing a pharmaco-invasive strategy. Methods: Data from 134 participants in the BATTLE-AMI study, aged between 18 and 75 years, with primary STEMI treated with tenecteplase within 6 hours, and undergoing invasive coronary angiography within 24 hours of the index event were evaluated. IMA and LVEF were assessed 30 days after the index event using cardiac magnetic resonance imaging. Associations between these outcomes and sociodemographic, clinical, and biochemical variables collected upon hospital admission, as well as factors inherent to the infarction and its treatment, were evaluated. Results: Most of the sample comprised males (73%), had hypertension (61%), and were smokers (51%), with a median age of 57 years and a body mass index (BMI) of 26.4 kg/m². The median AMI of the left ventricular mass was 14%, and the median LVEF was 51%. The left anterior descending artery (LAD) was the culprit artery in 47% of the events. A significant association was observed between higher levels of troponin, neutrophil/lymphocyte ratio, BMI, Killip class II, and larger IMA, as well as the presence of LAD as the culprit artery (p < 0.05). Similarly, lower LVEF was observed in patients with higher levels of troponin, neutrophil/lymphocyte ratio, and larger IMA (p < 0.05). No significant associations were found between these outcomes and age, sex, lipid profile, C-reactive protein, vitamin D, creatinine, glomerular filtration rate, GRACE score, hypertension, diabetes, smoking, or TIMI flow after intervention. Troponin was the only variable that linearly correlated with both LVEF and IMA. Conclusion: Worse outcomes in terms of IMA and LVEF were observed in patients with higher levels of troponin, neutrophil/lymphocyte ratio, and BMI, as well as those classified as Killip class II and with LAD as the culprit artery. Troponin having a linear correlation with both IMA and LVEF The assessment of these factors may be important in identifying patients at higher risk of developing increased IMA and complications such as heart failure.
Introduction: Acute ST-segment elevation myocardial infarction (STEMI) occurs when there is myocardial cell death associated with persistent ST-segment elevation and is associated with significant morbidity and mortality. While risk factors and prognostic factors are well known, variables associated with outcomes such as infarcted myocardial area (IMA) and left ventricular ejection fraction (LVEF) remain relatively unexplored. Objective: To evaluate the association between clinical and laboratory variables with IMA and LVEF after 30 days of STEMI in patients undergoing a pharmaco-invasive strategy. Methods: Data from 134 participants in the BATTLE-AMI study, aged between 18 and 75 years, with primary STEMI treated with tenecteplase within 6 hours, and undergoing invasive coronary angiography within 24 hours of the index event were evaluated. IMA and LVEF were assessed 30 days after the index event using cardiac magnetic resonance imaging. Associations between these outcomes and sociodemographic, clinical, and biochemical variables collected upon hospital admission, as well as factors inherent to the infarction and its treatment, were evaluated. Results: Most of the sample comprised males (73%), had hypertension (61%), and were smokers (51%), with a median age of 57 years and a body mass index (BMI) of 26.4 kg/m². The median AMI of the left ventricular mass was 14%, and the median LVEF was 51%. The left anterior descending artery (LAD) was the culprit artery in 47% of the events. A significant association was observed between higher levels of troponin, neutrophil/lymphocyte ratio, BMI, Killip class II, and larger IMA, as well as the presence of LAD as the culprit artery (p < 0.05). Similarly, lower LVEF was observed in patients with higher levels of troponin, neutrophil/lymphocyte ratio, and larger IMA (p < 0.05). No significant associations were found between these outcomes and age, sex, lipid profile, C-reactive protein, vitamin D, creatinine, glomerular filtration rate, GRACE score, hypertension, diabetes, smoking, or TIMI flow after intervention. Troponin was the only variable that linearly correlated with both LVEF and IMA. Conclusion: Worse outcomes in terms of IMA and LVEF were observed in patients with higher levels of troponin, neutrophil/lymphocyte ratio, and BMI, as well as those classified as Killip class II and with LAD as the culprit artery. Troponin having a linear correlation with both IMA and LVEF The assessment of these factors may be important in identifying patients at higher risk of developing increased IMA and complications such as heart failure.
Descrição
Citação
ARAUJO, Guilherme Campos. Variáveis associadas à área miocárdica infartada na estratégia fármaco-invasiva. 2023. 69 f. Dissertação (Mestrado em Cardiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.