Incidencia de eventos cardiovasculares mayores en pacientes con infarto agudo del miocardio manejados con stent y su relación con la fracción de eyección ventricular

Abstract

Background: Acute myocardial infarction and left ventricular dysfunction carry an increased risk of major adverse cardiovascular events ( MACE) and drug eluting stent used in this subgroup of patients is controversial. Objectives: To compare the effectiveness of drug eluting stent (DES) vs bare metal stents (BMS) in patients with acute myocardial infarction (AMI). and to assess the impact of left ventricular ejection fraction on the incidence of MACE. Methods: Data on a prospective cohort study of acute myocardial undergoing percutaneous coronary intervention with DES or BMS stents in a high complexity institution was analyzed. The incidence of MACE in the first year of follow-up and the effect of ejection fraction was assessed in relation to stent type and presence of left ventricular dysfunction. Results: There were 1084 patients with AMI from January 2002 to October 2013. 70.12% (758 patients) had BMS and 29.88% DES. In a multivariate analysis there was no benefit of DES vs BMS (HR 0.75 95 % CI 0.54 to 1.05 p = 0.102). However, hypertension and ventricular dysfunction were independent predictors of MACE (HR 1.51 95 % CI 1.15 to 2.0 p = 0.003 and HR 1.61 95 % CI 1.22 to 2.13 p = 0.001 respectively). Conclusions: The use of DES was not associated with lower risk of MACE in patients with AMI. Left ventricular dysfunction was a predictor of MACE in the first year of follow up.