Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFG |
Texto Completo: | http://repositorio.bc.ufg.br/tede/handle/tede/5562 |
Resumo: | Background: the specialized early treatment of acute myocardial infarction provides the best prognosis and enzyme values, during in-hospital phase, can correlate with cardiovascular events along the follow-up. The creatino-phosphokinase-MB is still widely used for diagnosis of acute myocardial infarction with ST-elevation. The percutaneous coronary intervention is the main therapeutic method, where the manual aspirative thrombectomy is a possibility of adjuvant treatment. Objectives: to evaluate the systematic chain of care in the myocardial infarction and the levels of CK-MB in cases treated with angioplasty and coronary thrombus aspiration, and assess 6 months follow-up survival. Assess also the association of CK-MB with the Blush grade, ST resolution and the concomitant correlation with delta-T and death. Methods: 835 patients with ST elevation myocardial infarction were analised, from March 2012 to June 2014 in two reference centers in Goiânia-GO. Only those who arrived within 12h underwent invasive treatment, where serial CK-MB and electrocardiogram were obtained and analyzed during the hospitalization. During the six months follow-up there were observed the events death and reinfarction in this group. For associative and correlation analysis there were used Mann-Whitney, Kruskall-Wallis and Spearman tests. For analysis of categorical variables, the Chi-square test or Fisher, and considered significant p<0.05. Results: out of 835 patients, only 51 (6%) presented within the delta T less than 12h, who were invasively treated immediately on admission. 507 (61%) were presented with more than 12h. The curve of the CK-MB showed peak around 12h. Of those treated with invasive aproach on admission, 6 deaths were observed (11.7%) and 1 re-infarction (2%), all of which occurred in the first month of follow-up. Lower Blush grade and resolution of less than 50% in ST-elevation were associated to significantly higher values of CK-MB. Higher values of CK-MB were significantly correlated with higher delta T and higher mortality. Conclusion: contrary to what recommend the guidelines, only few cases who reached the specialised centres had delta T less than 12h, impacting negatively on prognosis. The curve of CK-MB in patients with myocardial infarction invasivelly treated on admission had early peak. The highest levels were observed in the cases with low Blush grade, less than 50% resolution in ST-elevation and larger delta-T, which were related to the worst prognosis. |
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Rassi, Salvadorhttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4705156T2Rassi, SalvadorJardim, Paulo César Brandão VeigaBarroso, Weimar Kunz SebbaAfiune Neto, AbrahãoSousa, Ana Luiza Limahttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4750632D3Carvalho, Gustavo2016-05-13T11:51:25Z2015-10-26CARVALHO, G. Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb. 2015. 104 f. Tese (Doutorado em Ciências da Saúde ) - Universidade Federal de Goiás, Goiânia, 2015.http://repositorio.bc.ufg.br/tede/handle/tede/5562Background: the specialized early treatment of acute myocardial infarction provides the best prognosis and enzyme values, during in-hospital phase, can correlate with cardiovascular events along the follow-up. The creatino-phosphokinase-MB is still widely used for diagnosis of acute myocardial infarction with ST-elevation. The percutaneous coronary intervention is the main therapeutic method, where the manual aspirative thrombectomy is a possibility of adjuvant treatment. Objectives: to evaluate the systematic chain of care in the myocardial infarction and the levels of CK-MB in cases treated with angioplasty and coronary thrombus aspiration, and assess 6 months follow-up survival. Assess also the association of CK-MB with the Blush grade, ST resolution and the concomitant correlation with delta-T and death. Methods: 835 patients with ST elevation myocardial infarction were analised, from March 2012 to June 2014 in two reference centers in Goiânia-GO. Only those who arrived within 12h underwent invasive treatment, where serial CK-MB and electrocardiogram were obtained and analyzed during the hospitalization. During the six months follow-up there were observed the events death and reinfarction in this group. For associative and correlation analysis there were used Mann-Whitney, Kruskall-Wallis and Spearman tests. For analysis of categorical variables, the Chi-square test or Fisher, and considered significant p<0.05. Results: out of 835 patients, only 51 (6%) presented within the delta T less than 12h, who were invasively treated immediately on admission. 507 (61%) were presented with more than 12h. The curve of the CK-MB showed peak around 12h. Of those treated with invasive aproach on admission, 6 deaths were observed (11.7%) and 1 re-infarction (2%), all of which occurred in the first month of follow-up. Lower Blush grade and resolution of less than 50% in ST-elevation were associated to significantly higher values of CK-MB. Higher values of CK-MB were significantly correlated with higher delta T and higher mortality. Conclusion: contrary to what recommend the guidelines, only few cases who reached the specialised centres had delta T less than 12h, impacting negatively on prognosis. The curve of CK-MB in patients with myocardial infarction invasivelly treated on admission had early peak. The highest levels were observed in the cases with low Blush grade, less than 50% resolution in ST-elevation and larger delta-T, which were related to the worst prognosis.o tratamento especializado e precoce no infarto agudo do miocárdio proporciona o melhor prognóstico e os valores enzimáticos, na fase intra-hospitalar, podem se correlacionar com eventos cardiovasculares durante o seguimento clínico. A creatino-fosfoquinase-MB ainda é muito utilizada para diagnóstico do infarto agudo do miocárdio com supra-de-ST. A intervenção coronária percutânea é o principal método terapêutico, onde a trombéctomia por aspiração manual é uma possibilidade de tratamento adjuvante. Objetivos: avaliar a sistemática na cadeia de atendimento do infarto do miocárdio, os níveis da CK-MB dos casos tratados com angioplastia e aspiração de trombo coronário e a sobrevida no seguimento de 6 meses. Avaliar também a associação da CK-MB com o Blush, resolução de ST e a correlação concomitante com o delta-T e morte. Métodos: foram analisados 835 pacientes com infarto do miocárdio com supra de ST atendidos de março de 2012 a junho de 2014 em dois centros de referência em Goiânia-GO. Apenas os que chegaram com delta de até 12h foram submetidos ao tratamento invasivo, onde CK-MB e ECG seriados foram obtidos e analisados durante a internação. No seguimento de seis meses foram observados os desfechos morte e reinfarto neste grupo. Para análises associativas e de correlação foram utilizados teste de Mann-Whitney, Kruskall-Wallis e Spearman. Para análise das variáveis categóricas, realizou-se o teste do qui-quadrado ou de Fisher, e considerados significativos p<0,05. Resultados: dos 835 pacientes, somente 51 (6%) apresentaram delta T menor que 12h e foram tratados invasivamente logo na admissão, sendo que 507 (61%) tinham delta T maior que 24h. A Curva da CK-MB mostrou pico próximo de 12h. Daqueles tratados invasivamente na admissão, foram observados 6 óbitos (11,7%) e 1 reinfarto (2%), sendo que todos ocorreram no primeiro mês de seguimento. Blush baixo e resolução de ST menor que 50% no ECG associaram-se significativamente aos valores mais elevados de CK-MB. Valores elevados de CK-MB estiveram significativamente correlacionados com maior delta T e maior mortalidade. Conclusão: contrariamente ao que recomenda as diretrizes, poucos foram os pacientes que chegaram aos centros especializados com delta T menor que 12h, impactando negativamente no prognóstico. A curva de CK-MB em pacientes com infarto tratados invasivamente na admissão teve pico precoce. Os níveis mais elevados foram constatados nos casos com baixo Blush, resolução de ST menor que 50% no ECG e maior delta-T, estando relacionados aos piores prognósticos.Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-05-12T19:51:27Z No. of bitstreams: 2 Tese - Gustavo Carvalho - 2015.pdf: 2258720 bytes, checksum: f768f508da3900a9036fa42deaadee25 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5)Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-05-13T11:51:25Z (GMT) No. of bitstreams: 2 Tese - Gustavo Carvalho - 2015.pdf: 2258720 bytes, checksum: f768f508da3900a9036fa42deaadee25 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5)Made available in DSpace on 2016-05-13T11:51:25Z (GMT). No. of bitstreams: 2 Tese - Gustavo Carvalho - 2015.pdf: 2258720 bytes, checksum: f768f508da3900a9036fa42deaadee25 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) Previous issue date: 2015-10-26application/pdfporUniversidade Federal de GoiásPrograma de Pós-graduação em Ciências da Saúde (FM)UFGBrasilFaculdade de Medicina - FM (RG)http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessCoronariopatiaInfarto agudo do miocárdioAngioplastiaCoronary heart diseaseAcute myocardial infarctionAngioplastyMEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICAInfarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mbAcute myocardial infarction : an assintance sample in Goiânia and the prognostic value of ck- mbinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis-100686431261774531060060060015457724759504863387337577453819502453reponame:Repositório Institucional da UFGinstname:Universidade Federal de Goiás (UFG)instacron:UFGLICENSElicense.txtlicense.txttext/plain; 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dc.title.por.fl_str_mv |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
dc.title.alternative.eng.fl_str_mv |
Acute myocardial infarction : an assintance sample in Goiânia and the prognostic value of ck- mb |
title |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
spellingShingle |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb Carvalho, Gustavo Coronariopatia Infarto agudo do miocárdio Angioplastia Coronary heart disease Acute myocardial infarction Angioplasty MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA |
title_short |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
title_full |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
title_fullStr |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
title_full_unstemmed |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
title_sort |
Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb |
author |
Carvalho, Gustavo |
author_facet |
Carvalho, Gustavo |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Rassi, Salvador |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4705156T2 |
dc.contributor.referee1.fl_str_mv |
Rassi, Salvador |
dc.contributor.referee2.fl_str_mv |
Jardim, Paulo César Brandão Veiga |
dc.contributor.referee3.fl_str_mv |
Barroso, Weimar Kunz Sebba |
dc.contributor.referee4.fl_str_mv |
Afiune Neto, Abrahão |
dc.contributor.referee5.fl_str_mv |
Sousa, Ana Luiza Lima |
dc.contributor.authorLattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4750632D3 |
dc.contributor.author.fl_str_mv |
Carvalho, Gustavo |
contributor_str_mv |
Rassi, Salvador Rassi, Salvador Jardim, Paulo César Brandão Veiga Barroso, Weimar Kunz Sebba Afiune Neto, Abrahão Sousa, Ana Luiza Lima |
dc.subject.por.fl_str_mv |
Coronariopatia Infarto agudo do miocárdio Angioplastia |
topic |
Coronariopatia Infarto agudo do miocárdio Angioplastia Coronary heart disease Acute myocardial infarction Angioplasty MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA |
dc.subject.eng.fl_str_mv |
Coronary heart disease Acute myocardial infarction Angioplasty |
dc.subject.cnpq.fl_str_mv |
MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA |
description |
Background: the specialized early treatment of acute myocardial infarction provides the best prognosis and enzyme values, during in-hospital phase, can correlate with cardiovascular events along the follow-up. The creatino-phosphokinase-MB is still widely used for diagnosis of acute myocardial infarction with ST-elevation. The percutaneous coronary intervention is the main therapeutic method, where the manual aspirative thrombectomy is a possibility of adjuvant treatment. Objectives: to evaluate the systematic chain of care in the myocardial infarction and the levels of CK-MB in cases treated with angioplasty and coronary thrombus aspiration, and assess 6 months follow-up survival. Assess also the association of CK-MB with the Blush grade, ST resolution and the concomitant correlation with delta-T and death. Methods: 835 patients with ST elevation myocardial infarction were analised, from March 2012 to June 2014 in two reference centers in Goiânia-GO. Only those who arrived within 12h underwent invasive treatment, where serial CK-MB and electrocardiogram were obtained and analyzed during the hospitalization. During the six months follow-up there were observed the events death and reinfarction in this group. For associative and correlation analysis there were used Mann-Whitney, Kruskall-Wallis and Spearman tests. For analysis of categorical variables, the Chi-square test or Fisher, and considered significant p<0.05. Results: out of 835 patients, only 51 (6%) presented within the delta T less than 12h, who were invasively treated immediately on admission. 507 (61%) were presented with more than 12h. The curve of the CK-MB showed peak around 12h. Of those treated with invasive aproach on admission, 6 deaths were observed (11.7%) and 1 re-infarction (2%), all of which occurred in the first month of follow-up. Lower Blush grade and resolution of less than 50% in ST-elevation were associated to significantly higher values of CK-MB. Higher values of CK-MB were significantly correlated with higher delta T and higher mortality. Conclusion: contrary to what recommend the guidelines, only few cases who reached the specialised centres had delta T less than 12h, impacting negatively on prognosis. The curve of CK-MB in patients with myocardial infarction invasivelly treated on admission had early peak. The highest levels were observed in the cases with low Blush grade, less than 50% resolution in ST-elevation and larger delta-T, which were related to the worst prognosis. |
publishDate |
2015 |
dc.date.issued.fl_str_mv |
2015-10-26 |
dc.date.accessioned.fl_str_mv |
2016-05-13T11:51:25Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
CARVALHO, G. Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb. 2015. 104 f. Tese (Doutorado em Ciências da Saúde ) - Universidade Federal de Goiás, Goiânia, 2015. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/5562 |
identifier_str_mv |
CARVALHO, G. Infarto agudo do miocárdio: uma amostra de atendimento na cidade de Goiânia e o valor prognóstico da ck-mb. 2015. 104 f. Tese (Doutorado em Ciências da Saúde ) - Universidade Federal de Goiás, Goiânia, 2015. |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/5562 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
-1006864312617745310 |
dc.relation.confidence.fl_str_mv |
600 600 600 |
dc.relation.department.fl_str_mv |
1545772475950486338 |
dc.relation.cnpq.fl_str_mv |
7337577453819502453 |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.publisher.program.fl_str_mv |
Programa de Pós-graduação em Ciências da Saúde (FM) |
dc.publisher.initials.fl_str_mv |
UFG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Medicina - FM (RG) |
publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFG instname:Universidade Federal de Goiás (UFG) instacron:UFG |
instname_str |
Universidade Federal de Goiás (UFG) |
instacron_str |
UFG |
institution |
UFG |
reponame_str |
Repositório Institucional da UFG |
collection |
Repositório Institucional da UFG |
bitstream.url.fl_str_mv |
http://repositorio.bc.ufg.br/tede/bitstreams/7071e8b5-68f4-463b-abcd-737b2b64d525/download http://repositorio.bc.ufg.br/tede/bitstreams/544c3045-34f3-4135-ae88-7b3cfcda861d/download http://repositorio.bc.ufg.br/tede/bitstreams/13490a20-35d4-4c2f-94fd-36472c1bfd1b/download http://repositorio.bc.ufg.br/tede/bitstreams/9596905c-dc03-4634-a05e-654d607277a2/download http://repositorio.bc.ufg.br/tede/bitstreams/6438a746-43d0-431e-ba4c-1b7b4974cec0/download |
bitstream.checksum.fl_str_mv |
bd3efa91386c1718a7f26a329fdcb468 321f3992dd3875151d8801b773ab32ed b19767193fa05eb8852808b812c188a0 38cb62ef53e6f513db2fb7e337df6485 f768f508da3900a9036fa42deaadee25 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositório Institucional da UFG - Universidade Federal de Goiás (UFG) |
repository.mail.fl_str_mv |
tasesdissertacoes.bc@ufg.br |
_version_ |
1798044350911873024 |