Intervenção coronária percutânea eletiva após fibrinólise: dados do REMAT (registro Madre Teresa)

Abstract

Elective Percutaneous Coronary Intervention after Fibrinolysis: REMAT Data (Madre Teresa Registry)Background: Acute myocardial infarction (AMI) has a high morbidity and mortality and represents a public health problem. We analyzed the results and predictors of in-hospital adverse events in patients undergoing elective percutaneous coronary intervention (PCI) after fibrinolysis. Methods: Three hundred and three patients with diagnosis of AMI undergoing pharmacological reperfusion and transferred to a tertiary center for elective PCI were selected. Results: The population included mostly men (76.6%), with mean age of 59.4 + 11.1 years, 18.1% were diabetic and 86.8% were in Killip class I. Streptokinase was used in 91.7%, the mean time to perform elective PCI was 5.6 + 3.7 days after fibrinolysis and TIMI 3 flow was achieved in 74.2% of the patients. Stents were implanted in 97.7% and angiographic success was obtained in 95.3% of the cases. Mortality was observed in 3.3%, reinfarction in 3.6%, target lesion revascularization in 1.3%, and major bleedings in 2% of the patients. Multivariate analysis indicated female gender, age > 65 years, TIMI 1 flow, thrombus in the treated vessel, Killip > I and severe left ventricular dysfunction were independent predictors of in-hospital adverse events. Conclusions:The pharmacological reperfusion strategy followed by transfer to perform elective PCI had low in-hospital adverse event rates and is an interesting alternative to primary PCI in Brazil. However, public policies are required to improve the logistics to better handle these patients and have them available to all low and medium complexity national hospitals.

Intervenção coronária percutânea após trombólise no infarto agudo do miocárdio: para quem e quando?

“…Como não dispomos de informações sobre a presença de isquemia residual no estudo de Lima et al 1 , não é possível caracterizar o grau de recomendação desses pacientes, que poderia ser IIa ou IIb. É importante ressaltar que a recomendação IIb não significa que o procedimento não deva ser realizado, mas apenas que provavelmente não seja recomendado na maioria dos pacientes.…”

“…Finalmente, para conciliar e colocar em perspectiva na realidade brasileira os resultados do estudo de Lima et al 1 e as recomendações da diretriz americana, é importante considerar dois cenários distintos. Atualmente, os pacientes com planos de saúde privados no Brasil em geral têm acesso adequado a exames e tratamentos preconizados pelas diretrizes.…”

“…Nesta edição, Lima et al 1 relatam os dados provenientes do Registro Madre Teresa de Belo Horizonte (MG), que avaliou 303 pacientes com diagnóstico de IAM submetidos a reperfusão química e transferidos para esse centro. O tempo médio de realização da ICP foi tardio (5 dias após o IAM), e três quartos dos pacientes apresentavam fluxo TIMI 3 antes dos procedimentos.…”