Propuesta de manejo inicial del infarto de miocardio con elevación del segmento ST no complicado en centros sin capacidad de intervención coronaria percutánea en el Perú

Piero Custodio-Sánchez; David Miranda-Noé; L. Marco López-Rojas; Cynthia Paola Paredes Paucar; W. Germán Yábar Galindo; Paol Rojas De La Cuba; Jorge Orlando Martos Salcedo; Manuel Chacón-Diaz

doi:10.47487/apcyccv.v4i4.335

Authors

Piero Custodio-Sánchez Unidad de Cardiología Intervencionista, Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú. https://orcid.org/0000-0003-4215-7682
David Miranda-Noé Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR, Lima, Perú. https://orcid.org/0000-0003-4799-2134
L. Marco López-Rojas Hospital Nacional Hipólito Unanue, Lima, Perú. https://orcid.org/0000-0001-9123-2998
Cynthia Paola Paredes Paucar Unidad de insuficiencia cardiaca, Hospital Germans Trias i Pujol, Barcelona, España. https://orcid.org/0000-0003-0734-6437
W. Germán Yábar Galindo Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú. https://orcid.org/0000-0002-4239-2351
Paol Rojas De La Cuba Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú. https://orcid.org/0000-0002-2652-211X
Jorge Orlando Martos Salcedo Servicio de Cardiología. Hospital Regional Docente de Cajamarca, Cajamarca, Perú. https://orcid.org/0000-0001-8115-2556
Manuel Chacón-Diaz Unidad Cardiovascular. Clínica Delgado AUNA, Lima, Perú. https://orcid.org/0000-0002-5554-7578

DOI:

https://doi.org/10.47487/apcyccv.v4i4.335

Keywords:

ST Elevation Myocardial Infarction, Fibrinolysis, Peru, Community Networks

Abstract

ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.

Downloads

Download data is not yet available.

References

Sociedad Argentina de Cardiología. Consenso para el Manejo de Pacientes con Dolor Precordial. Rev Argent Cardiol. 2016;84:378-401. doi: 10.7775/rac.es.v84.i4.9074.

Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. Braunwald. Tratado de cardiología. Texto de medicina cardiovascular. 11.ª edición. Barcelona: Elsevier, 2019.

Delgado-Leal L, Reyes-Cortés H, Ramírez-Salazar A, López-Ramírez CJ, Hernández-Godínez E, Puentes-Puentes A, et al. Evaluación del dolor torácico por el servicio de cardiología en el Centenario Hospital Miguel Hidalgo. Rev Mex Cardiol. 2014;25(3):139-44.

Instituto de Evaluación de Tecnologías en Salud e Investigación, Seguro Social de Salud. Guía de Práctica Clínica de Síndrome Coronario Agudo [Internet]. GPC N° 4. Lima, Perú: EsSalud; 2017 [citado el 15 de setiembre 2023]. Disponible en: https://ietsi.essalud.gob.pe/wp-content/uploads/2017/10/GPC_SCA_Version-extensa-y-anexos.pdf

Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. doi: 10.1161/CIR.0000000000001029. Erratum in: Circulation. 2021;144(22):e455.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: 10.1093/eurheartj/ehx393.

Echeverri-Marín D, Ramirez Ramos CF, Miranda-Arboleda A, Castilla-Agudelo G, Saldarriaga-Giraldo C. Patrones electrocardiográficos de alto riesgo en pacientes con síndrome coronario agudo. Arch Peru Cardiol Cir Cardiovasc. 2020;1(4):240-49. doi: 10.47487/apcyccv.v1i4.82.

Asatryan B, Vaisnora L, Manavifar N. Electrocardiographic Diagnosis of Life-Threatening STEMI Equivalents: When Every Minute Counts. JACC Case Rep. 2019;1(4):666-68. doi: 10.1016/j.jaccas.2019.10.030.

Reyes M, Vlásica JA. Registro Nacional de Infarto de Miocardio III. Revista Peruana de Cardiología. 2018;XLIV(2):46 -64.

Chacón M, Vega A, Aráoz O, Ríos P, Baltodano R, Villanueva F, et al. Características epidemiológicas del infarto de miocardio con elevación del segmento ST en Perú: resultados del PEruvian Registry of STsegment Elevation Myocardial Infarction (PERSTEMI). Arch Cardiol Mex. 2018;88(5):403-12. doi: 10.1016/j.acmx.2017.11.009.

Chacón-Diaz M, Rodríguez Olivares R, Miranda-Noé D, Custodio-Sánchez P, Montesinos Cárdenas A, Yabar Galindo G, et al. Tratamiento del infarto agudo de miocardio en el Perú y su relación con eventos adversos intrahospitalarios: resultados del Segundo Registro Peruano de Infarto de Miocardio con elevación del segmento ST (PERSTEMI-II). Arch Peru Cardiol Cir Cardiovasc. 2021;2(2):86-95. doi:10.47487/apcyccv.v2i2.132.

Custodio-Sánchez P, Miranda D, Murillo L. Impacto de la pandemia por COVID-19 sobre la atención del infarto de miocardio ST elevado en el Perú. Arch Peru Cardiol Cir Cardiovasc. 2020;1(2):67-74. doi: 10.47487/apcyccv.v1i2.22.

D´Imperio H, Gagliardi J, Charask A, Zoni R, Quiroga W, Castillo Costa Y, et al. Infarto agudo de miocardio con elevación del segmento ST en la Argentina. Datos del registro continuo ARGEN-IAM-ST. Rev Argen Cardiol. 2020;88:297-307. doi: 10.7775/rac.es.v88.i4.18501.

Filgueiras Filho NM, Feitosa Filho GS, Solla DJF, Argôlo FC, Guimarães PO, Paiva Filho IM, et al. Implementation of a Regional Network for ST-Segment-Elevation Myocardial Infarction (STEMI) Care and 30-Day Mortality in a Low-to Middle-Income City in Brazil: Findings From Salvador´s STEMI Registry (RESISST). J Am Heart Assoc. 2018;7:e008624. doi: 10.1161/JAHA.118.008624.

Martinez-Sanchez C, Borrayo G, Carrillo J, Juarez U, Quintanilla J, Jerjes-Sanchez C; RENASICA III Investigators. Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III). Arch Cardiol Mex. 2016;86:221-32. doi: 10.1016/j.acmx.2016.04.007.

Topol EJ, Kereiakes DJ. Regionalization of care for acute ischemic heart disease: a call for specialized centers. Circulation. 2003;107:1463-6.

Alexander T, Mullasari AS, Joseph G, Kannan K, Veerasekar G, Victor SM, Ayers C, Thomson VS, Subban V, Gnanaraj JP, Narula J, Kumbhani DJ, Nallamothu BK. A System of Care for Patients With ST-Segment Elevation Myocardial Infarction in India: The Tamil Nadu-ST-Segment Elevation Myocardial Infarction Program. JAMA Cardiol. 2017;2(5):498-505. doi: 10.1001/jamacardio.2016.5977.

Moyer P, Ornato JP, Brady WJ Jr, Davis LL, Ghaemmaghami CA, Gibler WB, et al. Development of systems of care for ST-elevation myocardial infarction patients: the emergency medical services and emergency department perspective. Circulation. 2007;116(2):e43-8. doi: 10.1161/CIRCULATIONAHA.107.184047.

Mehta S, Grines CL, Botelho R, Fernandez F, Cade J, Dusilek C, et al. STEMI telemedicine for 100 million lives. Catheter Cardiovasc Interv. 2021;1-6. doi: 10.1002/ccd.29896.

Solla DJ, Paiva Filho Ide M, Delisle JE, Braga AA, Moura JB, Moraes Xd Jr, et al. Integrated regional networks for ST-segment-elevation myocardial infarction care in developing countries: the experience of Salvador, Bahia, Brazil. Circ Cardiovasc Qual Outcomes. 2013;6(1):9-17. doi: 10.1161/CIRCOUTCOMES.112.967505.

Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826. doi: 10.1093/eurheartj/ehad191.

Kaifoszova Z, Kala P, Alexander T, Zhang Y, Huo Y, Snyders A, et al. Stent for Life Initiative: leading example in building STEMI systems of care in emerging countries. EuroIntervention. 2014 Suppl T:T87-95. doi: 10.4244/EIJV10STA14.

Candiello A. Care networks in ST-Segment elevation acute myocardial infarction: Why and how to organize them? Revista Conarec. 2019;34(152):256-60.

Instituto de Evaluación de Tecnologías en Salud e Investigación, EsSalud. Guía de práctica clínica para el manejo inicial del infarto agudo de miocardio con elevación persistente del segmento ST: Guía en Versión Corta [Internet]. Lima, Perú: EsSalud; 2022 [citado el 02 de setiembre 2023]. Disponible en: https://ietsi.essalud.gob.pe/wp-content/uploads/2022/05/GPC-IAM_Version-extensa-Anexos.pdf

Chandrashekhar Y, Alexander T, Mullasari A, Kumbhani DJ, Alam S, Alexanderson E, et al. Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Lowand Middle-Income Countries. Circulation. 2020;141(24):2004-2025. doi: 10.1161/CIRCULATIONAHA.119.041297.

Candiello A, Alexander T, Delport R, Toth GG, Ong PJL, Snyders A, et al. How to Set Up Regional STEMI Networks: a “Stent - Save a life!” initiative. EuroIntervention. 2021;17:1313-7. doi: 10.4244/EIJ-D-21-00694.

Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994;343(8893):311-22.

White HD, Van de Werf FJ. Thrombolysis for acute myocardial infarction. Circulation. 1998;97(16):1632-46. doi: 10.1161/01.cir.97.16.1632.

Silvain J, Collet JP, Nagaswami C, Beygui F, Edmondson KE, Bellemain-Appaix A, et al. Composition of coronary thrombus in acute myocardial infarction. J Am Coll Cardiol. 2011;57(12):1359-67. doi: 10.1016/j.jacc.2010.09.077.

Cardiac Care Network. STEMI Education for emergency department [Internet]. London: CCN; 2016 [citado el 02 de octubre 2023]. Disponible en: https://www.corhealthontario.ca/ED-STEMI-Education-for-Hospital-Educators.pdf

Borrayo-Sánchez G, Pérez-Rodríguez G, Martínez-Montañez OG, Almeida-Gutiérrez E, Ramírez-Arias E, Estrada-Gallegos J, et al. Protocolo para atención de infarto agudo de miocardio en urgencias: Código infarto*. Rev Médica Inst Mex Seguro Soc. 2017;55(2):233-46.

Siemieniuk RAC, Chu DK, Kim LH, Güell-Rous MR, Alhazzani W, Soccal PM, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169. doi: 10.1136/bmj.k4169.

Hofmann R, Witt N, Lagerqvist B, Jernberg T, Lindahl B, Erlinge D, et al. Oxygen therapy in ST-elevation myocardial infarction. Eur Heart J. 2018;39(29):2730-39.

O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425. doi: 10.1161/CIR.0b013e3182742cf6.

Actilyse [Internet]. Ingelheim am Rhein: Boehringer Ingelheim International GmbH; c2023 [citado el 06 de setiembre 2023]. Disponible en: https://content.boehringer-ingelheim.com/DAM/b20e6b5a-973e-42e2-bada-ad1e00e79b2a/pc-pe-100412%20cardiovascular%20actilyse.pdf

Institute for Safe Medication Practices. STEMI Alteplase Thrombolytic protocol [Internet]. Toronto, Canada: ISMP; c2020-2023 [citado el 06 de setiembre 2023]. Disponible en: https://www.ismp-canada.org/DrugShortage/Drug/TNK/alteplase%20protocol.pdf

Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2(8607):349-60.

Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al.; CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with STsegment elevation. N Engl J Med. 2005;352(12):1179-89. doi: 10.1056/NEJMoa050522.

Antman EM, Morrow DA, McCabe CH, Murphy SA, Ruda M, Sadowski Z, et al.; ExTRACT-TIMI 25 Investigators. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med. 2006;354(14):1477-88. doi: 10.1056/NEJMoa060898.

Lincoff AM, Topol EJ. Illusion of reperfusion. Does anyone achieve optimal reperfusion during acute myocardial infarction? Circulation. 1993;88(3):1361-74. doi: 10.1161/01.cir.88.3.1361.

Queensland Health. Thrombolysis for ST segment myocardial infarction (STEMI) when PPCI not available [Internet]. Gloucestershire Hospitals NHS foundation trust. Queensland, Australia: Queensland Health; 2020 [citado el 20 de octubre 2023]. Disponible en: https://www.gloshospitals.nhs.uk/documents/9677/Thrombolysis_for_STEMI_contingency_2020.pdf

Queensland Health. Thrombolysis for STEMI clinical pathway [Internet]. Queensland, Australia: Queensland Health; 2017 [citado el 19 de octubre 2023]. Disponible en: https://www.health.qld.gov.au/__data/assets/pdf_file/0022/437134/sw547-stemi-pathway.pdf

Washam JB, Herzog CA, Beitelshees AL, Cohen MG, Henry TD, Kapur NK, et al. Pharmacotherapy in chronic kidney disease patients presenting with acute coronary syndrome: a scientific statement from the American Heart Association. Circulation. 2015;131(12):1123-49. doi: 10.1161/CIR.0000000000000183.

Charpentier S, Galinski M, Bounes V, Ricard-Hibon A, El-Khoury C, Elbaz M, et al. Nitrous oxide/oxygen plus acetaminophen versus morphine in ST elevation myocardial infarction: open-label, cluster-randomized, non-inferiority study. Scand J Trauma Resusc Emerg Med. 2020;28(36). doi: 10.1186/s13049-020-00731-y.

Sposito AC, Chapman MJ. Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit. Arterioscler Thromb Vasc Biol. 2002;22(10):1524-34.

Mazón Ramos P. Del concepto de estatinas de alta potencia a los efectos extralipídicos de las estatinas. Rev Esp Cardiol. 2015;15(supl.A):22a-27a.

Syed MA, Borzak S, Asfour A, Gunda M, Obeidat O, Murphy SA, et al. Single lead ST-segment recovery: a simple, reliable measure of successful fibrinolysis after acute myocardial infarction. Am Heart J. 2004;147(2):275-80. doi: 10.1016/j.ahj.2003.08.010.

Shaikh MK, Ali Shah SZ, Kumar C, Lohano M, Talpur AS, Zahoor A, et al. Accuracy of Resolution of ST-Segment Elevation in Electrocardiogram to Determine the Patency of Infarct-Related Artery. Cureus. 2021;13(4):e14448. doi: 10.7759/cureus.14448.

Khan A, Nadeem S, Kokane H, Thummar A, Lokhandwala Y, Mahajan AU, et al. Is accelerated idioventricular rhythm a good marker for reperfusion after streptokinase? Indian Heart J. 2016;68(3):302-305. doi: 10.1016%2Fj.ihj.2015.09.023.

Califf RM, O’Neil W, Stack RS, L Aronson, D B Mark, S Mantell, et al. Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis. Ann Intern Med. 1988;108:658-62.

Tavli T, Avsar A, Korkut B, Dogan A, Demir S, Ali Sari R, et al. Arrhythmia due to reperfusion after thrombolytic therapy in patients with acute myocardial infarction. East J Med. 2004;9(1):17-21.

Szummer K, Lundman P, Jacobson SH, Schön S, Lindbäck J, Stenestrand U, et al. Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from SWEDEHEART register. J Intern Med. 2010;268(1):40-49. doi: 10.1111/j.1365-2796.2009.02204.x.

Burlacu A, Artene B, Covic A. A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy? Cardiovasc Drugs Ther. 2018;32(5):463-475. doi: 10.1007/s10557-018-6824-8.

Engelbertz C, Feld J, Makowski L, Kühnemund L, Fischer AJ, Lange SA, et al. Contemporary in-hospital and long term prognosis of patients with acute ST-elevation myocardial infarction depending on renal function: a retrospective analysis. BMC Cardiovasc Disord. 2023;23(1):62. doi: 10.1186/s12872-023-03084-3.

Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW, et al. Acute coronary care in the elderly, part II: ST-segment elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115(19):2570-89. doi: 10.1161/CIRCULATIONAHA.107.182616.

Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, et al; STREAM Investigative Team. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379-87. doi: 10.1056/NEJMoa1301092.

Van de Werf F, Ristić AD, Averkov OV, Arias-Mendoza A, Lambert Y, Kerr Saraiva JF, et al. STREAM-2: Half dose Tenecteplase or primary percutaneous coronary intervention in older patients with ST-segmentelevation myocardial infarction: A randomized, open label trial. Circulation. 2023;148(9):753-64. doi: 10.1161/CIRCULATIONAHA.123.064521.

Buchta P, Kalarus Z, Mizia-Stec K, Myrda K, Skrzypek M, Ga Sior M. De novo and pre-existing atrial fibrillation in acute coronary syndromes: impact on prognosis and cardiovascular events in long-term follow-up. Eur Heart J Acute Cardiovasc Care. 2021;10(10):1129-39. doi: 10.1093/ehjacc/zuab091.

Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021;23(10):1612-76. doi: 10.1093/europace/euab065.

Krittanawong C, Hahn J, Kayani W, Jneid H. Fibrinolytic Therapy in Patients with Acute ST-elevation Myocardial Infarction. Intervent Cardiol Clin. 2021;10(3):381-90. doi: 10.1016/j.iccl.2021.03.011.

Gulati R, Behfar A, Narula J, Kanwar A, Lerman A, Cooper L, et al. Acute Myocardial Infarction in Young Individuals. Mayo Clin Proc. 2020;95(1):136-56. doi: 10.1016/j.mayocp.2019.05.001.

Jortveit J, Pripp AH, Langørgen J, Halvorsen S. Incidence, risk factors and outcome of young patients with myocardial infarction. Heart. 2020;106(18):1420-1426. doi: 10.1136/heartjnl-2019-316067.

Sinnaeve PR, Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Lambert Y, et al. ST-segment-elevation myocardial infarction

patients randomized to a pharmaco-invasive strategy or primary percutaneous coronary intervention: strategic Reperfusion Early After

Myocardial Infarction (STREAM) 1-year mortality follow-up. Circulation. 2014;130(14):1139-45. doi: 10.1161/CIRCULATIONAHA.114.009570.

Echavarría-Pinto M, Juárez-Herrera Ú, Meillón-García LA, Martínez-Sánchez C. Complicaciones hemorrágicas del tratamiento de los síndromes coronarios agudos. Arch Cardiol México. 2011;81(3):228-39.

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50:e344-e418. doi: 10.1161/STR.0000000000000211.