Validación del puntaje de riesgo TIM Icomo predictor de mortalidad enpacientes chilenos con infarto agudo al miocardio con supradesnivel de ST

Mayo_2017

ARTÍCULO DE INVESTIGACIÓN 572 Rev Med Chile 2017; 145: 572-578 Validación del puntaje de riesgo TIMI como predictor de mortalidad en pacientes chilenos con infarto agudo al miocardio con supradesnivel de ST Héctor Ugalde1, María Cecilia Yubini2,a, Sebastián Rozas2,a, María Ignacia Sanhueza2,a, Hernán Jara3,b Prediction of hospital mortality of ST elevation myocardial infarction using TIMI score Background: Thrombolysis in myocardial infarction risk score (TIMI-RS) was designed to predict early mortality in patients with a ST elevation acute myocardial infarction (STEAMI). Aim: To evaluate the predictive capacity for hospital mortality of TIMI-RS. Material and Methods: Patients with ≤ 12- hour evolution STEAMI were selected from a prospective registry of all patients hospitalized in our coronary unity within January 1988 and December 2005. Observed mortality was analyzed according to TIMI-RS and its predictive capacity was estimated. Results: We analyzed 1125 consecutive patients aged 61 ± 13 years (76% men). Fifty one percent were smokers, 47% hypertensive and 40% had a history of angina. Fifty eight percent of patients underwent reperfusion therapy. Most patients had TIMI-RS scores ≤ 5 points and only 3.6% had scores ≥ 10 points. Overall mortality was 14.8% and there was an 80% concordance between observed mortality and that predicted with the TIMI-RS score. The area under the curve for the receiver operating characteristic (ROC) curve was 0.7. Conclusions: TIMI-RS was acceptably useful to predict in-hospital mortality in this group of patients with STEAMI. Differences between the observed and originally predicted mortality are explained by the clinical profile and therapeutic protocols applied to patients in different studies. Thus, caution needs to be taken when interpreting the risk associated to a specific score, particularly within non-reperfused patients whose risk might be underestimated. (Rev Med Chile 2017; 145: 572-578) Key words: Hospital Mortality; Mortality; Myocardial Infarction; Risk; Risk Assesment; Validation Studies. 1Servicio de Hemodinamia, Centro Cardiovascular, Hospital Clínico de la Universidad de Chile. 2Facultad de Medicina Universidad de Chile. Santiago, Chile. 3Universidad Adolfo Ibáñez, Santiago, Chile. aEstudiante de Medicina. bLicenciado en Ingeniería Civil. Máster en Ciencias. Recibido el 27 de febrero de 2017, aceptado el 2 de mayo de 2017. Correspondencia a: Héctor Ugalde Prieto. Helsby 8801 C. ugaldehector@gmail.com Las enfermedades cardiovasculares, entre ellas el infarto agudo al miocardio (IAM), representan la primera causa de muerte en Chile y el mundo1. La mortalidad del IAM con supradesnivel del ST (IAMSDST) es muy variable debido a las diversas condiciones en las que se presenta, por lo que una herramienta que permita predecir el riesgo de estos pacientes de manera rápida y efectiva resulta indispensable a la hora de definir conductas, sobre todo cuando el tiempo y los recursos son limitados. Lo anterior ha sido el objetivo de varios estudios a lo largo de los años, en los que se diseñan modelos analíticos multivariados para predecir mortalidad de pacientes


Mayo_2017
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