Influencia de las comorbilidades en la decisión del tratamiento invasivo en ancianos con SCASEST

  1. Vicente Pernias Escrig 1
  2. José María García Acuña 2
  3. Sergio Raposeiras Roubín 3
  4. José A. Barrabés 4
  5. Alberto Jesús Cordero Díaz 5
  6. Manuel Martínez-Sellés 6
  7. Alfredo Bardají Ruiz 7
  8. P. Díez Villanueva 8
  9. Francisco Marín 9
  10. Juan M. Ruiz-Nodar 10
  11. Nuria Vicente Ibarra 11
  12. Gonzalo Luis Alonso Salinas 12
  13. Pedro Rigueiro Veloso 2
  14. Emad Abu Assi 2
  15. Francesc Formiga Pérez 13
  16. Julio Núñez Feltrer 1
  17. Eduardo Núñez 1
  18. Albert Ariza Solé 14
  19. J.M. Sanchís García 1
  1. 1 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, España
  2. 2 Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
  3. 3 Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
  4. 4 Servicio de Cardiología, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, España
  5. 5 Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, España
  6. 6 Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, España
  7. 7 Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, España
  8. 8 Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
  9. 9 Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, España
  10. 10 Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, España
  11. 11 Servicio de Cardiología, Hospital General de Elche, Elche, Alicante, España
  12. 12 Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
  13. 13 Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
  14. 14 Servicio de Cardiología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
Revista:
REC: Interventional Cardiology

ISSN: 2604-7276 2604-7306

Ano de publicación: 2021

Volume: 3

Número: 1

Páxinas: 15-20

Tipo: Artigo

DOI: 10.24875/RECIC.M20000141 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Outras publicacións en: REC: Interventional Cardiology

Objetivos de desarrollo sostenible

Resumo

Introducción y objetivos: La comorbilidad en ancianos con síndrome coronario agudo sin elevación del segmento ST empeora el pronóstico. El objetivo fue analizar la influencia de la carga de comorbilidad en la decisión del tratamiento invasivo en ancianos con SCASEST. Métodos: Se incluyeron 7.211 pacientes mayores de 70 años procedentes de 11 registros españoles. Los datos se analizaron en una base de datos conjunta. Se evaluó la presencia de 6 enfermedades simultáneas y su asociación con la realización de coronariografía durante el ingreso. Resultados: La edad media fue de 79 ± 6 años y la puntuación GRACE media fue de 150 ± 21 puntos. Fueron tratados de manera conservadora 1.179 pacientes (16%). La presencia de cada enfermedad se asoció con un menor abordaje invasivo (ajustado por variables clínicas predictivas): enfermedad cerebrovascular (odds ratio [OR] = 0,78; intervalo de confianza del 95% [IC95%], 0,64-0,95; p = 0,01), anemia (OR = 0,64; IC95%, 0,54-0,76; p < 0,0001), insuficiencia renal (OR = 0,65; IC95%, 0,56-0,75; p < 0,0001), arteriopatía periférica (OR = 0,79; IC95%, 0,65-0,96; p = 0,02), enfermedad pulmonar crónica (OR = 0,85; IC95%, 0,71-0,99; p = 0,05) y diabetes mellitus (OR = 0,85; IC95%, 0,74-0,98; p = 0,03). Asimismo, el aumento del número de enfermedades (carga de comorbilidad) se asoció con menor realización de coronariografías, ajustado por la escala GRACE: 1 enfermedad (OR = 0,66; IC95%, 0,54-0,81); 2 (OR = 0,55; IC95%, 0,45-0,69); 3 (OR = 0,37; IC95%, 0,29-0,47); 4 (OR = 0,33; IC95%, 0,24-0,45); ≥ 5 (OR = 0,21; IC95%, 0,12-0,36); todos p < 0,0001, en comparación con ninguna enfermedad. Conclusiones: Conforme aumenta la comorbilidad disminuye la realización de coronariografías en ancianos con síndrome coronario agudo sin elevación del segmento ST. Se necesitan estudios que investiguen la mejor estrategia diagnóstico-terapéutica en estos pacientes.

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