Recomendaciones para el manejo del infarto de miocardio con elevación del segmento ST luego de la reperfusión

Frank W. Britto

doi:10.47487/apcyccv.v6i3.508

Autores/as

Frank W. Britto Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular – INCOR, EsSalud. Lima, Perú. https://orcid.org/0009-0004-2191-4829

DOI:

https://doi.org/10.47487/apcyccv.v6i3.508

Palabras clave:

Síndrome Coronario Agudo, Infarto de Miocardio, Insuficiencia Cardiaca, Revascularización Miocárdica

Resumen

El manejo del infarto agudo de miocardio con elevación del ST tras la reperfusión implica decisiones clave en pacientes con enfermedad de múltiples vasos (EMV), falla cardiaca aguda y trombo en ventrículo izquierdo (VI). Se recomienda la revascularización completa de las lesiones no culpables ≥70% durante la intervención inicial o en los primeros 19 días, especialmente en pacientes estables. La cirugía de bypass está indicada en anatomías de alto riesgo o lesiones complejas tras intervención coronaria exitosa, en las que la estrategia híbrida combina intervención percutánea con cirugía, ajustando tiempos según si se implantó un stent. La falla cardiaca posinfarto es frecuente (28-31%) y requiere tratamiento urgente. El monitoreo continuo y la pronta intervención reducen complicaciones. En situaciones de shock o complicaciones mecánicas, puede ser necesario el uso de balón intraaórtico y soporte inotrópico. El infarto de ventrículo derecho se maneja con soporte de volumen, revascularización urgente y, si es necesario, apoyo farmacológico o marcapasos. El trombo en VI, más frecuente en infartos anteriores con FEVI <50%, requiere diagnóstico precoz con ecocardiografía y/o tomografía y anticoagulación temprana, preferentemente con warfarina, considerando triple terapia en casos de alto riesgo trombótico. Este manuscrito presenta recomendaciones que buscan optimizar el pronóstico mediante una intervención precoz y personalizada, basada en la evidencia más reciente.

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