Análise da estratégia de reperfusão e desfechos de indivíduos com infarto do miocárdio com supradesnível do segmento ST e aplicabilidade do escore SAGE para predição de velocidade de onda de pulso elevada

Abstract

The present dissertation comprises reports of two scientific studies with the main theme of acute ST-segment elevation myocardial infarction (STEMI). The first was a cohort study that aimed to evaluate the prevalence of reperfusion therapy (RT), the clinical variables associated with non-RT, and the in-hospital outcomes of individuals with STEMI treated at a university hospital in southern Brazil. Data were collected through interviews during hospitalization between September, 2016 and February, 2020. The individuals were dichotomized in groups according to the reperfusion strategy (with and without RT). The univariate and multivariate analyses were performed to determine predictors of non-RT. It was also analyzed the impact of non-RT on in-hospital outcomes, compared to those who underwent RT. The total sample was 268 patients. The rate of non-RT was x (27.6%). Individuals with non-anterior wall STEMI and longer symptom onset had a higher probability of not undergoing RT. The non-RT was also associated with higher mortality and prolonged hospitalization. In conclusion, we observed that a significant percentage of individuals with STEMI did not receive RT, leading to worse outcomes. The second study aimed to evaluate the applicability of using the SAGE score in predicting elevated pulse wave velocity (PWV) (≥ 10m/s) for individuals who have experienced STEMI. A cross-sectional study was performed. The PWV was analyzed an oscillometric technique and to estimate the SAGE score. Data were collected between September, 2019 and February, 2021. Statistical analyses included obtaining the Youden's J statistic and receiver operating characteristic (ROC) curve to estimate the ideal cutoff SAGE score; binary logistic regression was also used to assess the correlation of SAGE score and PWV. Of the 39 individuals included in this study, 20.5% had a PWV ≥ 10 m/s. The SAGE scores distinguished individuals with high PWV with the ideal cutoff score estimated as ≥ 8 points. It is concluded the SAGE score showed adequate applicability in the identification of individuals with elevated PWV after STEMI.