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Follow-up e acompanhamento de jovens submetidos a revascularização coronária após enfarte agudo do miocárdio com supradesnivelamento do segmento ST há mais de 10 anos
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Introdução: A incidência de EAM tem diminuído na população global, mas verifica-se um aumento dessa incidência nos doentes jovens. Ainda que o prognóstico a curto prazo nos jovens seja mais favorável do que nos idosos, esse benefício parece diminuir a longo prazo.
Objetivos: Caracterizar, numa população de doentes jovens com EAMcST e com follow-up >10 anos: fatores de risco, apresentação clínica e características eletrocardiográficas e angiográficas; terapêutica na alta e no follow-up; prevalência de novos eventos cardiovasculares; acompanhamento médico e adesão à cessação tabágica.
População e métodos: Estudo observacional, retrospetivo, unicêntrico de coorte. Os dados foram obtidos através de uma base de dados que inclui os doentes submetidos a coronariografia entre 2007 e 2012. Foram incluídos os doentes com diagnóstico de EAMcST e idade ≤45 anos. Posteriormente foi realizada entrevista telefónica complementada com informação do programa Soarian e da PDS.
Resultados: Dos 104 doentes com idade ≤45 anos, 91,2% apresentava pelo menos um FRCV sendo o sexo masculino (79,8%) e o tabagismo (82,4%) os mais prevalentes; 33,9% dos doentes apresentavam, adicionalmente, um fator de risco atípico. Após um internamento médio de 8 dias, com mortalidade intra-hospitalar de 4,8%, todos os doentes foram medicados com ≥1 antiagregante, 92,3% com iECA/ARA, 97,5% com β-bloqueante e 96,2% com estatina. À data do FUP observou-se uma diminuição significativa na adesão a todos esses fármacos. Durante um FUP médio de 12,1 anos, 44,3% dos doentes tiveram pelo menos um episódio de MACE. Dos 64 doentes contactados telefonicamente, 64,1% possuíam acompanhamento médico regular e 40,6% mantinha tabagismo ativo.
Conclusão: Entre a população jovem com EAMcST, o follow-up a longo prazo mostrou um número elevado de eventos cardiovasculares, uma redução significativa da adesão à terapêutica, manutenção de hábitos tabágicos num número significativo de doentes e uma percentagem elevada de doentes sem acompanhamento regular, sugerindo que esta população jovem, ativa, mas de elevado risco, deve provavelmente ser alvo de cuidados médicos dedicados, merecendo avaliação adicional em estudos de maior dimensão.
Introduction: The incidence of myocardial infarction has been decreasing in the world population, but there is an increase in younger patients. Although the short-term prognosis in young people is more favorable than in older people, this benefit seems to diminish in the long term. Objectives: To characterize, in a population of young patients with STEMI and with a follow-up >10 years: risk factors, clinical presentation, and electrocardiographic and angiographic characteristics; therapy at discharge and at follow-up; prevalence of new cardiovascular events; medical follow-up and adherence to smoking cessation. Population and methods: Observational, retrospective, single-center cohort study. Data was obtained from a database that includes patients who underwent coronary angiography between 2007 and 2012. Patients diagnosed with STEMI and aged ≤45 years were included. Afterwards, an individual telephone interview was carried out, supplemented with information from the Sorian® and the PDS. Results: Among the 104 patients aged ≤45 years, 91.2% had at least one CVRF, with male gender (79.8%) and smoking (82.4%) being the most prevalent; 33.9% of patients also had an atypical risk factor. After an average hospital stay of 8 days, with in-hospital mortality of 4.8%, all patients were medicated with ≥1 antiplatelet agent, 92.3 with ACEi/ARB, 97.5% with β-blocker and 96.2% with statin. At the time of the FUP, a significant decrease in adherence to all these drugs was observed. During a mean FUP of 12.1 years, 44.3% of patients had at least one MACE episode. Of the 64 patients contacted by telephone, 64.1% had regular medical follow-up and 40.6% were active smokers. Conclusion: Among the young population with STEMI, long-term follow-up showed a very high number of cardiovascular events, a significant reduction in adherence to therapy, the maintenance of smoking habits in a significant number of patients and a high percentage of patients without regular clinical follow-up. These data suggest that this young, active but high-risk population should probably be the target of dedicated medical care, deserving further evaluation in larger studies.
Introduction: The incidence of myocardial infarction has been decreasing in the world population, but there is an increase in younger patients. Although the short-term prognosis in young people is more favorable than in older people, this benefit seems to diminish in the long term. Objectives: To characterize, in a population of young patients with STEMI and with a follow-up >10 years: risk factors, clinical presentation, and electrocardiographic and angiographic characteristics; therapy at discharge and at follow-up; prevalence of new cardiovascular events; medical follow-up and adherence to smoking cessation. Population and methods: Observational, retrospective, single-center cohort study. Data was obtained from a database that includes patients who underwent coronary angiography between 2007 and 2012. Patients diagnosed with STEMI and aged ≤45 years were included. Afterwards, an individual telephone interview was carried out, supplemented with information from the Sorian® and the PDS. Results: Among the 104 patients aged ≤45 years, 91.2% had at least one CVRF, with male gender (79.8%) and smoking (82.4%) being the most prevalent; 33.9% of patients also had an atypical risk factor. After an average hospital stay of 8 days, with in-hospital mortality of 4.8%, all patients were medicated with ≥1 antiplatelet agent, 92.3 with ACEi/ARB, 97.5% with β-blocker and 96.2% with statin. At the time of the FUP, a significant decrease in adherence to all these drugs was observed. During a mean FUP of 12.1 years, 44.3% of patients had at least one MACE episode. Of the 64 patients contacted by telephone, 64.1% had regular medical follow-up and 40.6% were active smokers. Conclusion: Among the young population with STEMI, long-term follow-up showed a very high number of cardiovascular events, a significant reduction in adherence to therapy, the maintenance of smoking habits in a significant number of patients and a high percentage of patients without regular clinical follow-up. These data suggest that this young, active but high-risk population should probably be the target of dedicated medical care, deserving further evaluation in larger studies.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Enfarte agudo do miocárdio Jovens Follow-up Major Adverse Cardiovascular Event (MACE) Cardiologia