Avaliação do bloqueio da atividade plaquetária na síndrome coronariana aguda
Avaliação do bloqueio da atividade plaquetária na síndrome coronariana aguda
Data
2017
Autores
Dutra, Maximiliano Freire
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: O bloqueio medicamentoso da atividade plaquetária (BAP) é utilizado como tratamento padrão das síndromes coronarianas agudas (SCA), porém não é avaliado rotineiramente, devido a falta de consenso na literatura médica. Objetivo: Descrever o perfil do BAP colhido à admissão dos pacientes internados com diagnóstico de Síndrome Coronariana Aguda (SCA) e avaliar a associação com a ocorrência de desfechos clínicos em até 6 meses, estratificados pelos escores de risco de trombose (GRACE e TIMI) e sangramento (CRUSADE) utilizados na Instituição. Materiais e Métodos: Foram incluídos todos os pacientes admitidos no Instituto Nacional de Cardiologia (INC) com diagnóstico de SCA entre o primeiro e o quinto dia do diagnóstico, no período entre outubro de 2015 a julho de 2016 e avaliada a gravidade a partir dos escores de risco. A avaliação do BAP foi realizada por meio do aparelho MULTIPLATE (ROCHE®). Os pacientes foram acompanhados durante seis meses, por meio de consulta medica ou por contato telefônico, questionando-se as seguintes variáveis: relato de angina, piora de classe funcional, reinternação hospitalar, necessidade de reintervenção coronariana (por angioplastia ou cirurgia de revascularização miocárdica), acidente vascular cerebral ou morte. Para a análise estatística foram empregados os testes de Fisher, como forma de verificar possíveis associações das variáveis do desfecho clínico composto e dos escores de risco com o BAP. Resultados: Foram avaliados 52 pacientes, com idade média de 63,8 anos, sendo 61,5% do sexo masculino e 40,4% de diabéticos. Em relação a forma de apresentação da SCA, 40,4% tiveram diagnóstico de SCA por Infarto Agudo do Miocárdio (IAM) com supradesnivelamento do segmento ST (IAM CSST), 28,8% com IAM sem supradesnivelamento do segmento ST (IAM SSST) e 30,8% por Angina Instável (AI). A população foi considerada como de moderado a alto risco (GRACE médio de 115, TIMI médio de 3,7 e CRUSADE médio de 34). Verificou-se resistência aos antiplaquetários em 10 pacientes (19,2%), sendo 4 ao ácido acetil salicílico (AAS), 3 ao Clopidogrel e 3 a ambas medicações. Não houve resistência ao Ticagrelor. Demonstrou-se associação entre o nível adequado de BAP para o ácido acetil salicílico (AAS) – o ASPI teste - e sobrevida em 6 meses (p=0,03). Dos 23 pacientes que apresentaram desfecho clínico em 6 meses, verificou-se associação com as seguintes variáveis: CRUSADE maior que 40 (p=0,0001), presença de disfunção de VE (p=0,03) e diabetes mellitus (DM) (p=0,006), assim como correlação positiva entre presença de diabetes mellitus e os escores TIMI (p=0,001) e CRUSADE (p=0,02). Ocorreram 06 óbitos onde houve associação com ASPI (p=0.03), assim como houve associação entre óbito e função do Ventrículo Esquerdo (VE) (p=0,01). Não se demonstrou associação de óbitos com os escores. Conclusão: Este estudo evidenciou 19,2% de resistência às medicações antiplaquetárias. Houve associação entre o nível de BAP e óbito cardiovascular assim como entre o nível adequado de BAP para o ácido acetil salicílico (AAS) e sobrevida em 6 meses e associação entre a presença de disfunção de VE e sobrevida em 6 meses. Não houve associação entre nível de BAP e os escores de risco.
Introduction: Drug-induced blockade of platelet activity (DIB) is used as the standard treatment for acute coronary syndromes (ACS), but it is not routinely evaluated because of lack of consensus in the medical literature. Objective: To describe the DIB profile collected at the admission of inpatients diagnosed with Acute Coronary Syndrome (ACS) and to assess the association with the occurrence of clinical outcomes within 6 months, stratified by thrombosis risk scores (GRACE and TIMI) and bleeding scores (CRUSADE) used in the Institution. Materials and methods: All patients admitted to the National Institute of Cardiology (NIC) with a diagnosis of ACS between the first and fifth day of the diagnosis were included in the period from October 2015 to July 2016, and severity was assessed from the risk scores. The DIB evaluation was performed using the MULTIPLATE device (ROCHE®). The patients were followed up for six months, through a medical consultation or by phone contact, questioning the following variables: reporting of angina, worsening of functional class, hospital readmission, need for coronary reintervention (by angioplasty or coronary artery bypass grafting), Stroke or death. For the statistical analysis Fisher's tests were used as a way of verifying possible associations of the variables of the composite clinical outcome and the risk scores with the BAP. Results: Fifty-two patients were evaluated, with a mean age of 63.8 years, being 61.5% male and 40.4% diabetic. Regarding the presentation of ACS, 40.4% had a diagnosis of acute myocardial infarction (AMI) with ST segment elevation (STEMI AMI), 28.8% with AMI without ST segment elevation (NSTEMI AMI) and 30.8% for Unstable Angina (UA). The population was considered to be moderate to high risk (mean GRACE of 115, mean TIMI of 3.7 and mean CRUSADE of 34). Resistance to antiplatelet agents was verified in 10 patients (19.2%), 4 being acetylsalicylic acid (ASA), 3 to Clopidogrel and 3 to both medications. There was no resistance to Ticagrelor. There was an association between the appropriate level of BAP for acetylsalicylic acid (ASP) - the ASPI test - and survival at 6 months (p = 0.03). Of the 23 patients who presented clinical outcome at 6 months, there was an association with the following variables: CRUSADE greater than 40 (p = 0.0001), presence of LV dysfunction (p = 0.03) and diabetes mellitus (DM) (P = 0.006), as well as a positive correlation between the presence of diabetes mellitus and the TIMI (p = 0.001) and CRUSADE scores (p = 0.02). There were 6 deaths where there was association with ASPI (p = 0.03), as well as association between death and LV function (p = 0.01). There was no association between deaths and scores. Conclusion: This study showed 19.2% resistance to antiplatelet medications. There was an association between the level of DIB and cardiovascular death as well as between the appropriate level of DIB for acetylsalicylic acid (ASA) and survival at 6 months and association between the presence of LV dysfunction and survival at 6 months. There was no association between BAP level and risk scores
Introduction: Drug-induced blockade of platelet activity (DIB) is used as the standard treatment for acute coronary syndromes (ACS), but it is not routinely evaluated because of lack of consensus in the medical literature. Objective: To describe the DIB profile collected at the admission of inpatients diagnosed with Acute Coronary Syndrome (ACS) and to assess the association with the occurrence of clinical outcomes within 6 months, stratified by thrombosis risk scores (GRACE and TIMI) and bleeding scores (CRUSADE) used in the Institution. Materials and methods: All patients admitted to the National Institute of Cardiology (NIC) with a diagnosis of ACS between the first and fifth day of the diagnosis were included in the period from October 2015 to July 2016, and severity was assessed from the risk scores. The DIB evaluation was performed using the MULTIPLATE device (ROCHE®). The patients were followed up for six months, through a medical consultation or by phone contact, questioning the following variables: reporting of angina, worsening of functional class, hospital readmission, need for coronary reintervention (by angioplasty or coronary artery bypass grafting), Stroke or death. For the statistical analysis Fisher's tests were used as a way of verifying possible associations of the variables of the composite clinical outcome and the risk scores with the BAP. Results: Fifty-two patients were evaluated, with a mean age of 63.8 years, being 61.5% male and 40.4% diabetic. Regarding the presentation of ACS, 40.4% had a diagnosis of acute myocardial infarction (AMI) with ST segment elevation (STEMI AMI), 28.8% with AMI without ST segment elevation (NSTEMI AMI) and 30.8% for Unstable Angina (UA). The population was considered to be moderate to high risk (mean GRACE of 115, mean TIMI of 3.7 and mean CRUSADE of 34). Resistance to antiplatelet agents was verified in 10 patients (19.2%), 4 being acetylsalicylic acid (ASA), 3 to Clopidogrel and 3 to both medications. There was no resistance to Ticagrelor. There was an association between the appropriate level of BAP for acetylsalicylic acid (ASP) - the ASPI test - and survival at 6 months (p = 0.03). Of the 23 patients who presented clinical outcome at 6 months, there was an association with the following variables: CRUSADE greater than 40 (p = 0.0001), presence of LV dysfunction (p = 0.03) and diabetes mellitus (DM) (P = 0.006), as well as a positive correlation between the presence of diabetes mellitus and the TIMI (p = 0.001) and CRUSADE scores (p = 0.02). There were 6 deaths where there was association with ASPI (p = 0.03), as well as association between death and LV function (p = 0.01). There was no association between deaths and scores. Conclusion: This study showed 19.2% resistance to antiplatelet medications. There was an association between the level of DIB and cardiovascular death as well as between the appropriate level of DIB for acetylsalicylic acid (ASA) and survival at 6 months and association between the presence of LV dysfunction and survival at 6 months. There was no association between BAP level and risk scores
Description
Palavras-chave
Terapêutica, Testes de função plaquetária, Síndrome coronariana aguda, Inibidores de agregação de plaquetas, Trombose coronária, Therapy, Platelet function tests, Acute coronary syndrome, Platelet aggregation inhibitors, Coronary thrombosis
Citação
Dutra MF. Avaliação do bloqueio da atividade plaquetária na síndrome coronariana aguda. Rio de Janeiro. Dissertação [Mestrado Profissional em ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2017.