ST-segment elevation myocardial infarction: analysis of consecutive series of patients and later follow-up
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KeywordsAcute Coronary Syndrome Coronary Artery Bypass Graft Stent Implantation Coronary Angioplasty Consecutive Series
Arteriosclerotic coronary disease is one of the leading causes of death worldwide. In order to analyze patients admitted with ST-segment elevation myocardial infarction (STEMI) diagnosis, a databank was established to collect information about the clinical condition and late follow-up.
Materials and methods
One hundred and ninety-three patients with acute coronary syndromes (ACS) admitted to the ICU of Santa Lucia Hospital from October 2003 to October 2004 were analyzed. A total of 37.8% developed STEMI. The data were collected prospectively.
Seventy-three patients had STEMI. The mean age was 61.4 years, and 55 were men. The most common risk factor was hypertension (46/65.7%). Thirty-three patients (45.2%) showed previous history of ACS, and 14 out of this group had previous infarction. Nine patients had been submitted to coronary artery bypass graft (CABG) previously, and nine to angioplasty with stent implantation. The anterior descendent artery territory was the most common affected. Thirty-four patients (46.6%) were submitted to thrombolysis and 14 out of this group received this treatment in other hospitals. After thrombolysis, 17 patients realized rescue angioplasty and six realized CABG. Primary coronary angioplasty was made in 22 patients, and 77% of them had a stent placed immediately. The coronary arteriography was made in 93.2% of the patients admitted with STEMI. Patients were stratified by the TIMI score for STEMI, and 30.8% of them showed score ≥ 6. This series has a 12.3% mortality rate. The follow-up was made by telephone contact with 89.3% of the patients more than 6 months from the event. Twenty-eight of them were readmitted by cardiac causes and there was no late mortality.
The high TIMI score justifies the high mortality observed in this series. This occurs because Santa Lúcia Hospital is a reference center for cardiology in Brasília.