¿Se puede predecir el riesgo de muerte súbita luego de sufrir un infarto de miocardio?

  • Gabriel Vanerio Balbela Centro de Asistencia del Sindicato Médico del Uruguay, Servicio de Arritmias
  • Juan Luis Vidal Amaral Centro de Asistencia del Sindicato Médico del Uruguay, Servicio de Arritmias
  • Pablo Fernández Banizi Centro de Asistencia del Sindicato Médico del Uruguay, Servicio de Arritmias
  • Gustavo López Achigar Médico Internista colaborador
  • Daniel Banina Aguerre Centro de Asistencia del Sindicato Médico del Uruguay, Servicio de Arritmias
  • Pablo Viana Centro de Asistencia del Sindicato Médico del Uruguay, Servicio de Arritmias
  • Ana Vanerio de León Médica Cardióloga colaboradora
  • Juan Carlos Bagattini Hospital Británico, Centro de Tratamiento Intensivo, Director. Médico Internista e Intensivista
Palabras clave: MUERTE SÚBITA CARDÍACA, INFARTO DE MIOCARDIO, ESTRATIFICACIÓN DE RIESGO

Resumen

La muerte súbita es responsable de más de la mitad de las muertes debidas a causas cardíacas. Nuestra habilidad para reconocer a los pacientes de alto riesgo de muerte súbita se ha incrementado, pero 90% de las muertes ocurren en sujetos sin factores de riesgo identificables. Además, sabemos que la mayoría tiene enfermedad coronaria preexistente y que la muerte súbita cardíaca es fundamentalmente un problema extrahospitalario. Una población de alta mortalidad y fácil de detectar es la que ya ha sufrido un infarto de miocardio. La mortalidad posinfarto de miocardio oscila entre 5% a 11%, dentro de los seis a 12 meses luego del alta y 20% a los cinco años. Numerosos marcadores se han identificado, pero su valor predictivo positivo es relativamente bajo. El más importante es la disfunción ventricular izquierda. Otras variables: clínicas, basadas en imágenes, autonómicas, electrocardiográficas, además de algunos biomarcadores, métodos invasivos y combinación de variables, se han descripto para estratificar el riesgo y se comentan en este trabajo. Desafortunadamente, aún desconocemos cuál es la combinación que tiene la capacidad predictiva más poderosa. Actualmente, la estratificación del riesgo de muerte súbita se lleva a cabo utilizando solamente la historia clínica, la clase funcional y la fracción de eyección ventricular izquierda (FEVI). En principio, los pacientes de alto riesgo deben recibir betabloqueantes, inhibidores de la enzima convertidora, espironolactona y antitrombóticos. En casos seleccionados se deberá considerar el implante de un cardiodesfibrilador. Otras variables se incorporarán para identificar mejor a los grupos de mayor riesgo.

Citas

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Publicado
2006-12-31
Cómo citar
1.
Vanerio Balbela G, Vidal Amaral JL, Fernández Banizi P, López Achigar G, Banina Aguerre D, Viana P, Vanerio de León A, Bagattini JC. ¿Se puede predecir el riesgo de muerte súbita luego de sufrir un infarto de miocardio?. Rev. Méd. Urug. [Internet]. 31 de diciembre de 2006 [citado 16 de mayo de 2022];22(4):249-65. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/658
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