Resultados clínicos comparativos de intervenciones en pacientes con infarto agudo de miocardio ST atendidos en un hospital público de Lima, Perú
Primary percutaneous coronary intervention in ST-segment elevation acute myocardial infarctionBarra lateral del artículo
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Introducción: la cardiopatía isquémica representa el subgrupo más frecuente dentro de las enfermedades cardiovasculares y la mayor proporción de muertes atribuibles a este grupo. Objetivo: Contrastar los resultados clínicos de pacientes con infarto agudo de miocardio con elevación del segmento ST atendidos en un hospital público de Lima entre 2021 y 2026 ante la aplicación de estrategia farmacoinvasiva precoz o intervención coronaria percutánea. Materiales y Métodos: Se utilizó un enfoque cuantitativo, de tipo observacional, analítico, longitudinal y retrospectivo, con 348 pacientes seleccionados por muestreo no probabilístico por conveniencia. Resultados: El evento combinado principal ocurrió en 19.4 % del grupo farmacoinvasivo y 29.0 % del grupo intervención. No obstante, no existieron diferencias significativas en mortalidad, evento combinado principal ni eventos adversos mayores, y la supervivencia a 30 días fue similar entre grupos. Conclusión: Se encontró resultados clínicos favorables de la estrategia fármaco invasiva precoz frente al ICP, se sugiere estudios multicéntricos y prospectivos para evaluar el evento principal combinado.
Introduction: Ischemic heart disease represents the most common subgroup of cardiovascular diseases and accounts for the largest proportion of deaths attributable to this group. Objective: To compare the clinical outcomes of patients with ST-segment elevation myocardial infarction treated at a public hospital in Lima between 2021 and 2026, specifically comparing an early pharmacoinvasive strategy versus percutaneous coronary intervention. Materials and Methods: A quantitative, observational, analytical, longitudinal, and retrospective study was conducted, involving 348 patients selected via non-probability convenience sampling. Results: The primary composite event occurred in 19.4% of the pharmacoinvasive group and 29.0% of the intervention group. However, there were no significant differences regarding mortality, the primary composite event, or major adverse events, and 30-day survival was similar between the groups. Conclusion: Favorable clinical outcomes were found with the early pharmacoinvasive strategy compared with PCI. Multicenter prospective studies are recommended to evaluate the main composite endpoint.
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Wang Y, Wang X, Wang C y Zhou J. Global, regional, and national burden of cardiovascular disease, 1990-2021: results from the 2021 global burden of disease study. Cureus. 2024;16(11). https://doi.org/10.7759/cureus.74333
Organización Mundial de la Salud. Enfermedades cardiovasculares (ECV) Ginebra: OMS; 2025. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
World Heart Federation. World Heart Report 2023- Confronting the worlds number one killer Ginebra: WHF; 2023. https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023-1.pdf
Jing S, Chen A, Xia Y, Ma J, Lu D, Chen Z,et al. Global burden of ischemic heart disease from 1990 to 2021: Findings from the Global Burden of Disease Study 2021 and predictions to 2030. Chinese Medical Journal. 2026;139(08):1181-90. https://mednexus.org/doi/full/10.1097/CM9.0000000000004006
Rodriguez AM, Solórzano L, Pérez GV, Ascarrunz D, Pavlovsky H, Gomez R, et al. Trends in primary percutaneous coronary intervention for the treatment of acute coronary ST-elevation myocardial infarction in Latin American countries: insights from the CECI consortium. Frontiers in cardiovascular medicine. 2024;11. https://doi.org/10.3389/fcvm.2024.1275907
Gil M, Ramos MI, Samayoa JF, Anleu EM, Overall P y Cornejo JA. The STEMI reperfusion status in Guatemala: An unanswered question. Archivos de cardiología de México. 2022;92(1):128-31. https://doi.org/10.24875/acm.21000002
Chacón A, Vargas R y Bendezu G. Study protocol of the PE ruvian R egistry of ST-segment E levation M yocardial I nfarction II (PERSTEMI-II) study. Plos one. 2021;16(9). https://doi.org/10.1371/journal.pone.0257618
Theofilis P, Oikonomou E, Chasikidis C, Tsioufis K y Tousoulis D. Pathophysiology of acute coronary syndromes—Diagnostic and treatment considerations. Life. 2023;13(7). https://doi.org/10.3390/life13071543
Mills NL, Kristin L, Zaman S, Almahmeed WA, Bucciarelli C, Colvin MM, et al. Fifth Universal Definition of Myocardial Infarction (2026): On Behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Circulation. 2026. https://doi.org/10.1161/CIR.0000000000001477
Byrne R, Rossello X, Coughlan J, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. COR ET VASA. 2024;66(2):170-232. https://doi.org/10.33678/cor.2024.029
Rao SV, O’Donoghue ML, Ruel M, Rab T, Tamis JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-e862. https://doi.org/10.1161/CIR.0000000000001309
Soriano DR, Tuco KG, Delgado CJ, Flores K, Ccami F, Quijano R, et al. Pharmacoinvasive strategy versus fibrinolytic therapy alone in adults with ST-elevation myocardial infarction: A systematic review and meta-analysis. Plos one. 2025;20(10). https://doi.org/10.1371/journal.pone.0334309
Alkhadra F, Bohaligah S, Alhashim Z, AlZahrani F, Alkhalifa M, Alsaihati F, et al. Door-to-Balloon Time and Clinical Outcome of Patients Presenting with ST-Segment Elevation Myocardial Infarction During on and off Hours: a Single Center Study. Medical Archives. 2025;79(3). https://doi.org/10.5455/medarh.2025.79.172-180
Herrera CJ, Levenson BJ, Natcheva A, Lucca AC, Olsson K, Miki K, et al. Improving STEMI management internationally: initial report of the American College of Cardiology-global heart attack treatment initiative. JACC: Advances. 2025;4(1). https://www.jacc.org/doi/abs/10.1016/j.jacadv.2024.101438
Van de Werf F, Ristić AD, Averkov OV, Arias A, Lambert Y, Kerr JF, et al. STREAM-2: half-dose tenecteplase or primary percutaneous coronary intervention in older patients with ST-segment–elevation myocardial infarction: a randomized, open-label trial. Circulation. 2023;148(9):753-64. https://doi.org/10.1161/CIRCULATIONAHA.123.064521
Bainey KR, Welsh RC, Zheng Y, Arias A, Ristic AD, Averkov OV, et al. Pharmaco-Invasive strategy with Half-Dose tenecteplase in patients with STEMI: prespecified pooled analysis of patients aged≥ 75 years in STREAM-1 and 2. Circulation: Cardiovascular Interventions. 2024;17(12). https://doi.org/10.1161/CIRCINTERVENTIONS.124.014251
Dias A, Pacheco A, Machado AC, Augusto AC, De Amorim A, Souzade MG, et al. Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective. Frontiers in cardiovascular medicine. 2025;11. https://doi.org/10.3389/fcvm.2024.1466961
Arias A, Ortega JA, Araiza D, González H, Martínez M, Hernández E, et al. Real-world evaluation of a pharmacoinvasive strategy for STEMI in Latin America: a cost-effective approach with short-term benefits. Therapeutics and Clinical Risk Management. 2023:903-11. https://doi.org/10.2147/TCRM.S432683
Sussman WB, Johnson CE y Weeda ER. In-Hospital Outcomes Associated With Initial Fibrinolysis Versus Primary Percutaneous Coronary Intervention Among Patients Residing in Rural Areas Presenting With ST-Segment Elevation Myocardial Infarction. Hospital Pharmacy. 2025;60(3):276-80. https://doi.org/10.1177/00185787241303485
Fiusa VC, Stephanus AD, Couto VF, Alexim GA, Severino TM, Nogueira AC, et al. Clinical Predictors of Heart Failure after STEMI: Data from a Middle-Income Country with Limited Access to Percutaneous Coronary Intervention. Arquivos Brasileiros de Cardiologia. 2025;122. https://doi.org/10.36660/abc.20240447i
Siddiqi HK, Defilippis EM, Biery DW, Singh A, Wu WY, Divakaran S, et al. Mortality and heart failure hospitalization among young adults with and without cardiogenic shock after acute myocardial infarction. Journal of cardiac failure. 2022;29(1):18. https://doi.org/10.1016/j.cardfail.2022.08.012
Koh HP, Nagarajah JR, Hassan H y Ross NT. Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis: a 5-year analysis in an Asian population. World Journal of Emergency Medicine. 2024;15(6). https://doi.org/10.5847/wjem.j.1920-8642.2024.077.
Samsky MD, Morrow DA, Proudfoot AG, Hochman JS, Thiele H y Rao SV. Cardiogenic shock after acute myocardial infarction: a review. JAMA. 2021;326(18):1840-50. https://doi.org/10.1001/jama.2021.18323.
Shalaby G, Niazi AK y Khaled S. Cardiogenic shock among patients with acute ST-segment elevation myocardial infarction in a middle eastern country: a single-center experience. Journal of the Saudi Heart Association. 2023;34(4). https://doi.org/10.37616/2212-5043.1323
Alves L, Ziegelmann PK, Ribeiro V y Polanczyk C. Hospital mortality from myocardial infarction in Latin America and the Caribbean: systematic review and meta-analysis. Arquivos brasileiros de cardiologia. 2022;119:970-8. https://doi.org/10.36660/abc.20220194
Gupta MD, Batra V, Muduli S, Mp G, Kunal S, Bansal A, et al. Epidemiological profile and clinical outcomes of very young (< 35 years) and young (35–50 years) patients with STEMI: Insights from the NORIN STEMI registry. Indian Heart Journal. 2024;76(2):128-32. https://doi.org/10.1016/j.ihj.2024.04.002
Medina MA, Jaramillo N, Jaramillo CF, Restrepo A, Prada G, Muñoz JA, et al. Factors that impact in-hospital mortality due to STEMI versus NSTEMI in a first percutaneous coronary intervention: survival analysis. Archivos de cardiología de México. 2026;96(1):6-14. https://doi.org/10.24875/acm.24000164
Tumminello G, D’Errico A, Maruccio A, Gentile D, Barbieri L y Carugo S. Age-related mortality in STEMI patients: insight from one year of HUB centre experience during the pandemic. Journal of Cardiovascular Development and Disease. 2022;9(12). https://doi.org/10.3390/jcdd9120432
Hassan A, Emam AY, Thabet M, Osman A, Shams KA, Labib MS y Elguindy A. Clinical characteristics and outcomes of elderly patients undergoing primary percutaneous coronary intervention: an observational cohort study. Global Heart. 2024;19(1). https://doi.org/10.5334/gh.1383
Velásquez J, Vicent L, Díez F, Valero MJ, Bruña V, Sousa I, et al. Prognostic implications of high-degree atrio-ventricular block in patients with acute myocardial infarction in the contemporary era. Journal of Clinical Medicine. 2023;12(14). https://doi.org/10.3390/jcm12144834
Saeed H, Sulaiman SA, Goyal P, Thakkar K, Sultan W, Mayo JZ, et al. Nationwide trends and disparities in deaths from second-or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data. American Heart Journal Plus: Cardiology Research and Practice. 2025. https://doi.org/10.1016/j.ahjo.2025.100680
Demidova MM, Rylance R, Koul S, Dworeck C, James S, Aasa M, et al. Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial. Heart rhythm O2. 2023;4(3):200-6. https://doi.org/10.1016/j.hroo.2022.12.008
El Ouaddi N, De Diego O, Labata C, Rueda F, Martínez MJ, Cámara ML, et al. Mechanical complications in STEMI: prevalence and mortality trends in the primary PCI era. The Ruti-STEMI registry. Revista Española de Cardiología. 2023;76(6):427-33. https://doi.org/10.1016/j.rec.2022.09.012
Damluji AA, Van Diepen S, Katz JN, Menon V, Tamis JE, Bakitas M, et al. Mechanical complications of acute myocardial infarction: a scientific statement from the American Heart Association. Circulation. 2021;144(2). https://doi.org/10.1161/CIR.0000000000000985