¿Se puede predecir el riesgo de muerte súbita luego de sufrir un infarto de miocardio?
Palabras clave:
MUERTE SÚBITA CARDÍACA, INFARTO DE MIOCARDIO, ESTRATIFICACIÓN DE RIESGOResumen
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.
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2006-12-31
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Vanerio Balbela G, Vidal Amaral JL, Fernández Banizi P, López Achigar G, Banina Aguerre D, Viana P, et al. ¿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 26 de diciembre de 2024];22(4):249-65. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/658
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