Factores pronósticos de la clase funcional de pacientes revascularizados por síndrome coronario agudo

Abstract

Mortality by cardiovascular diseases has increased from 12.59 million to 17.92 million from 1990 to 2015, mainly due to the increase in coronary ischemic diseases. Therefore, it is important to generate policies or intervention strategies to reduce the presence of these diseases. Objective: To identify prognostic factors of functional class in patients undergoing revascularization for acute coronary syndrome. Methodology: A retrospective cross-sectional study is carried out in subjects of legal age who underwent a stress test after a coronary revascularization process at the Instituto del Corazón de Bucaramanga (ICB). 34 records were included in the ICB database. The sample was selected through a non-probabilistic convenience sampling, the cases of patients who participated in a cardiac rehabilitation process in the period between January 2019 and December 2019 were recorded. The data collected was taken from the clinical records available in the database of the Instituto del Corazón de Bucaramanga, this information was entered in Excel, and the respective validation or double entry was carried out, to finally analyze the data obtained through stata 12.0. Variable distribution analysis was performed by means of the Shapiro Wilk test; the continuous ones were analyzed in measures of central tendency and dispersion, the categorical ones through absolute and relative frequencies. The characteristics of the population were compared according to gender using the Chi2 test for qualitative variables, and t-test or Willcoxon for quantitative variables according to their distribution. To estimate the influence of the different factors associated with the functional class of the population under study, a logistic regression (Odds Ratio-OR) was performed. Finally, to determine the associations between exercise tolerance and the variables of interest, the Pearson test was used. Those associations with p <0.05 were considered statistically significant. Results: It was possible to show that 79% of the analyzed population is male. In addition, it was observed that women had a lower average age and tolerance level to physical effort, p <0.05. On the other hand, in the male population a smaller number of obese subjects with functional limitation was reported, being a man can be considered a protective factor of presenting functional limitation in subjects revascularized for ACS. On the other hand, hypertensive subjects are 30 times more likely to present functional limitation compared to those in whom this diagnosis was not reported. A direct relationship between tolerance to physical effort can be observed with the FCM and% FCM; and indirect relationship between this same variable with the number of risk factors and PASM. On the other hand, the number of sessions carried out by the subjects presented an indirect relationship with the PADM. Conclusions: It is important to observe effort tolerance, but there are other parameters associated with functional class or physical capacity that indicate the cardiovascular health of these subjects. This study reiterates the functional class differences between women and men. Where the man is less likely to present functional class compromise. On the other hand, having HTN is considered a strong prognostic factor of functional limitation. Finally, there was no relationship between participation in CR and functional class, however, this treatment could improve the diastolic hypertensive response of the subjects during the stress test.