Relación del supradesnivel del segmento ST en aVR con las complicaciones cardiovasculares

Luis Mariano de la Torre Fonseca, Robert Alarcón Cedeño, Jorge Mederos Hernández, Lila Alicia Echevarría Sifontes, Ana María Barreda Pérez

Texto completo:

PDF

Resumen

Introducción: El patrón de “supradesnivel del segmento ST en aVR” en el síndrome coronario agudo se asocia con un aumento de la mortalidad.

Objetivo: Evaluar la relación entre el patrón de “supradesnivel del segmento ST en aVR” y las complicaciones cardiovasculares no letales.

Método: Estudio observacional de corte transversal, con componente analítico de todos los pacientes ingresados con síndrome coronario agudo sin elevación del segmento ST, en el Hospital Universitario “Manuel Fajardo” de la Habana entre los años 2016 y 2020.

Resultados: Predominó el sexo femenino en el primer grupo, con una mediana de 78 años. Hubo incidencia de cardiopatía isquémica (75 % y 56,4 %) e hipertensión arterial (78,8 % y 85,8 %). Se determinó una relación estadística significativa entre el patrón con elevación del segmento ST en aVR y las complicaciones cardiovasculares con un riesgo relativo de 5,769 veces.

Conclusiones: El patrón de supradesnivel del segmento ST en un síndrome coronario agudo sin elevación del segmento ST predice complicaciones intrahospitalarias cardiovasculares no letales.

Palabras clave

síndrome coronario; segmento ST; patrón de supradesnivel; predictores eléctricos.

Referencias

Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2021;42(14):1289-367. DOI: https://doi.org/10.1093/eurheartj/ehaa575

Fiol-Sala M, Birnbaum Y, Nikus K, Bayes A. Electrocardiography in ischemic heart disease: clinical and imaging correlations and prognostic implications. En: John Wiley, editor. New York, EE.UU:WILEY Blackwell; 2020. p. 7-229.

Kosuge M, Ebina T, Hibi K, Morita S, Endo M, Maejima N, et al. An early and simple predictor of severe left main and/or three-vessel disease in patients with non-STsegment elevation acute coronary syndrome. Am J Cardiol. 2011;107(4):495-00. DOI: https://doi.org/10.1016/j.amjcard.2010.10.005

Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, et al. Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography: ST segment elevation in lead aVR with less ST segment elevation in lead V1. J Am Coll Cardiol. 2001;38(5):1348-54. DOI: https://doi.org/10.1016/S0735-1097(01)01563-7

Harshash AA, Huang JJ, Reddy S, Ntarajan B, Balakrishnan M, Shetty R, et al. aVR ST segment elevation: acute STEMI or not? Incidence of an acute coronary occlusion. Am J Med. 2019;132(5):662-30. DOI: https://doi.org/10.1016/j.amjmed.2018.12.021

Berrabés JA, Figueras J, Moure C, Cortadellas J, Soler-Soler J. Prognostic value of lead aVR in patients with a first non-STsegment elevation acute myocardial infarction. Circul. 2003;108(7):814-9. DOI: https://doi.org/10.1161/01.CIR.0000084553.92734.83

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-64. DOI: https://doi.org/10.1016/j.jacc.2018.08.1038

Savonitto S, Ardissino D, Granger CB, Morando G, Prando MD, Mafrici A, et al. Prognostic value of the admission electrocardiogram in acute coronary syndrome. JAMA. 1999;281(8):707-13. DOI: https://doi.org/10.1001/jama.281.8.707

Cannon CP, McCabe CH, Stone PH, Rogers WJ, Schactman M, Thompson BW. The electrocardiogram predicts one-year outcome of patients with unstable angina and non–Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. J Am Coll Cardiol. 1997;30(1):133-40. DOI: https://doi.org/10.1016/s0735-1097(97)00160-5

Yan AT, Yan RT, Kennelly BM, Anderson FA Jr, Budaj A, Lopez-Sendon J, et al. Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes. Am Heart J. 2007;154(1):71-8. DOI: https://doi.org/10.1016/j.ahj.2007.03.037

Figtree GA, Vernon ST, Hadziosmanovic N, Sundström J, Alfredsson J, Arnott C, et al. Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet. 2021;397(10279):1085-94. DOI: http://doi.org/10.1016/S0140-6736(21)00272-5

Khand A, Frost F, Grainger R, Fisher M, Chew P, Mullen L, et al. Identification of hig-risk non-ST elevation myocardial infarction at presentation to emergency department. A prospective observational cohort study in Nort West England. BMJ Open. 2020;10(6):e030128. DOI: http://doi.org/10.1136/bmjopen-2019-030128

Taglieri N, Marzocchi A, Saia F, Marrozzini C, Palmerini T, Ortolani P, et al. Short- and long-term prognostic ignificance of ST-segment elevation in lead aVR in patients with non–ST-segment elevation acute coronary syndrome. Am J Cardiol. 2011;108(1):21-8. DOI: https://doi.org/10.1016/j.amjcard.2011.02.341

Kosuge M, Ebina T, Hibi K, Endo M, Komura N, Hashiba K, et al. ST-segment elevation resolution in lead aVR: a strong predictor of adverse outcomes in patients with non-ST-segment elevation acute coronay syndrome. Circ J. 2008;72(7):1047-53. DOI: https://doi.org/10.1253/circj.72.1047

García RA, Rivero L, Hernández M, Aldama LI, Aroche R, Martínez JO. Severidad de la enfermedad arterial coronaria y variación del segmento ST en la derivación aVR en el síndrome coronario agudo sin elevación del ST. Rev Cub Cardiol Cir Cardiov. 2019 [acceso 18/06/2021];25(4). Disponible en: https://revcardiologia.sld.cu/index.php/revcardiologia/article/view/884/pdf

Chang HJ, Lin FY, Lee SE, Andreini D, Bax J, Cademartiri F, et al. Coronary atherosclerotic precursors of acute coronary syndromes. J Am Coll Cardiol. 2018;71(22):2511-22. DOI: https://doi.org/10.1016/j.jacc.2018.02.079

Belle L, Cayla G, Cottin Y, Coste P, Khalife K, Labèque JN, et al. French Registry on Acute ST-elevation and non-ST-elevation Myocardial Infarction 2015 (FAST-MI 2015). Design and baseline data. Arch Cardiovasc Dis. 2017;110(6-7):366-78. DOI: https://doi.org/10.1016/j.acvd.2017.05.001

Sörensen NA, Neumann JT, Ojeda F, Schäfer S, Magnussen C, Keller T, et al. Relations of sex to diagnosis and outcomes in acute coronary syndrome. J Am Heart Assoc. 2018;7(6):e007297. DOI: https://doi.org/10.1161/JAHA.117.007297

Ten Haaf ME, Bax M, Ten Berg JM, Brouwe J, Van´t Hof AW, van der Schaaf RJ, et al. Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands. Nert Heart J. 2019;27(5):263-71. DOI: https://doi.org/10.1007/s12471-019-1271-0

Chandrasekhar J, Mehran R. Sex-Based differences in acute coronary syndromes: insights from invasive and noninvasive coronary technologies. JACC Cardiov Imagin. 2016;9(4):451-64. DOI: https://doi.org/10.1016/j.jcmg.2016.02.004

Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, et al. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J. 2020 Apr 1;41(13):1328-36. DOI: https://doi.org/10.1093/eurheartj/ehz898

Schmidt FP, Schmitt C, Hochadel M, Giannitsis E, Darius H, Maier LS, et al. Invasive treatment of NSTEMI patients in German Chest Pain Units - Evidence for a treatment paradox. Int J Cardiol. 2018;255:15-19. DOI: https://doi.org/10.1016/j.ijcard.2017.11.018

Foraker RE, Guha A, Chang H, O'Brien EC, Bower JK, Crouser ED, et al. Survival after MI in a community cohort study: contribution of comorbidities in NSTEMI. Glob Heart. 2018;13(1):13-18. DOI: https://doi.org/10.1016/j.gheart.2018.01.002

Ahmed E, Alhabib KF, El-Menyar A, Asaad N, Sulaiman K, Hersi A, et al. Age and clinical outcomes in patients presenting with acute coronary syndromes. J Cardiov Dis Res. 2013;4(2):134-9. DOI: https://doi.org/10.1016/j.jcdr.2012.08.005

Simms AD, Batin PD, Kurian J, Durham N, Gale CP. Acute coronary syndromes: an old age problem. J Geriatr Cardiol. 2012;9(2):192-6. DOI: https://doi.org/10.3724/SP.J.1263.2012.01312

Inohara T, Kohsaka S, Miyata H, Sawano M, Ueda I, Maekawa Y, et al. Prognostic impact of subsequent acute coronary syndrome and unplanned revascularization on long-term mortality after an index percutaneous coronary intervention: A report from a Japanese multicenter registry. J Am Heart Assoc. 2017;6(11):e006529. DOI: https://doi.org/10.1161/JAHA.117.006529

Lettino M, Andell P, Zeymer U, Widimsky P, Danchin N, Bardaji A, et al. Diabetic patients with acute coronary syndromes in contemporary European registries: characteristics and outcomes. Eur Heart J Cardiov Pharm. 2017;3(4):198-213. DOI: https://doi.org/10.1093/ehjcvp/pvw049

Zhou M, Liu J, Hao Y, Liu J, Huo Y, Smith SC Jr, et al. Prevalence and in-hospital outcomes of diabetes among patients with acute coronary syndrome in China: findings from the improving care for cardiovascular disease in China-Acute Coronary Syndrome Project. Cardiov Diab. 2018;17(1):147. DOI: https://doi.org/10.1186/s12933-018-0793-x

Gibbs MA, Leedekerken JB, Litmann L. Evolution of our understanding of the aVR sign. J Electroc. 2019;56:121-4. DOI: https://doi.org/10.1016/j.jelectrocard.2019.07.014



Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.