A influencia de variaveis clinicas e angiograficas na sobrevida a longo prazo de pacientes com infarto agudo do miocardio submetidos a terapeutica trombolitica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

Background: Although thrombolisys reduced mortality in acute myocardial infarction long term outcome of survivors is istill spurr. Objective: to uncover the principal clinical and angiographic predictors of long term (>1 year) mortality of patients treated with thrombolytic in acute myocardial infarction. Material and methods: We reviewed and analyzed the records of 365 patients admitted with diagnosis of acute myocardial infarction between 1990 and 2000. Potential predictors of long term survival were age, sex, weight, height, body surface area, body mass index, blood pressure, risk factors, ejection fraction, artery patency, collateral circulation, number ofvessels with obstructive lesions and the infarted wall. Survival ana1ysis was undertaken with Kaplan Meier curves and Cox proportional hazard ratio models. Results: The mean follow-up period was 3.35 years (1-10 years) and mean global mortality rate was 18.6%. Univariate ana1ysisdisclosed as significant for the mean survival associated with following binary variables: ejection fraction >50% (865 vs 66.3 % p=0.0001), age bellow 70 years (83.1 vs 64.7 p=0.001), absence ofprevious myocardial infarction (84.0 vs 66.0% p=0.0003), absence diabetes (83.8 vs 74.5% p=0.03), single vessel disease (86.9 vs 75.5% p=0.001), presence of collateral circulation in single vessel disease (100 vs 83% p=0.028), absence of collateral circulation in multiple vessel disease and clinical therapy (78.0 vs 62.0% p=0.04), right wall coronary infarction (85.8 vs 76.9% p=0.01). Multivariate ana1ysis disclosed that ejection ftaction and age were significant independent predictors of survival p<0,001. Conclusion: Ejection fraction, age, diabetes, previous myocardial infarction, number of obstructed vessels and anterior wall infarction, were strong predictors of long term mortality in accordance with the literature. Collateral circulation as a predictor for mortality in patients with single vessel disease and this is as a new unreported finding. In multivariate analysesthe independent predictors of survival were: ejection fraction and age

ASSUNTO(S)

enfarte do miocardio angiografia

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