Review of clinical characteristics and management of patients with ST segment elevation myocardial infarction at atertiary care center.

摘要: Background: Information from recent multiple trials on the pathophysiology and outcome of ST-segment elevation myocardial infarction (STEMI) has changed its clinical perspective strategic management, leading to a revision 1999 ACC/AHA practice guidelines for that condition. Objective: Analyze characteristics, management strategies, timing therapeutic interventions patients with STEMI referred Cardiovascular Center Puerto Rico (CVCPR). Methods: Retrospective review medical records all admitted CVCPR diagnosis January 1, 2003 December 31, 2003. Results: A total 184 were reviewed. Seventy- six percent men, mean age was 62.1 ± 11.8 years. high prevalence coronary risk factors present: systemic hypertension (64%), diabetes mellitus (40%), dyslipidemia (35%), smoking (33%) previous CAD (32%). Less than 1/4 referral forms contained data indicative whether had received antiplatelet therapy, beta-blockers, ACE inhibitors or statins. Fifty arrived more 48 hours after diagnosis. Only forty-two (23%) within 12 hours. Thrombolytic therapy been used in 27% them. 179 (97%) underwent angiography, 69.2% which multivessel disease. 114 (62%) percutaneous (PCI) stenting. Patients submitted PCI stenting culprit lesion better survival ones not exposed those procedures (p=0.02). Approximately two-third secondary prevention medications upon discharge. Conclusions: Relevant findings this spite major factors, use proven benefit treatment at centers less recommended by current guidelines, significant delay transfer tertiary care facility (in most cases period exceeded diagnosis) reduced utilization thrombolytic therapy. Intensification education physicians throughout island regarding these matters is be encouraged. Additional measures should include, development written protocols assure expedite assessment patients, an enhancement their capability utilizing fibrinolytic agents suitable candidates timely PCI-capable facilities may still catheter reperfusion.