Correlación clínico patológica de los fallecidos en el postoperatorio de revascularización miocárdica, período 2006 al 2009 del Hospital
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Universidad Industrial de Santander
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Introducción: en Cuba, al igual que en el resto del mundo, las enfermedades isquémicas cardiacas ocupan las primeras causas de muerte con un incremento del número de cirugías de revascularización miocárdica. El amplio uso de autopsia en Cuba y su eficacia, motivó establecer la correlación clínico patológica de los pacientes fallecidos operados de revascularización miocárdica como herramienta de control de la calidad en el quehacer profesional. Objetivo: determinar la correlación clínico patológica de los fallecidos en el postoperatorio de revascularización miocárdica en cirugía cardiovascular del Hospital “Hermanos Ameijeiras” entre 2006 a 2009. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo y de corte transversal, se analizaron causas básicas y directas de muerte, clínicamente y por autopsia; se compararon según parámetros de anatomía patológica para evaluar calidad del diagnóstico en coincidentes (total o parcial) o no coincidentes. Se obtuvieron 682 pacientes operados en este período; la muestra quedó constituida por 59 fallecidos para un 8,6% de mortalidad. Se contó con la aprobación del comité de ética. Resultados: más del 70% del total de fallecidos corresponde a mayores de 60 años. Se observó un incremento de fallecidos masculinos sobre femeninos con relación 7:2. Existe prevalencia en factores de riesgo como hipertensión arterial e infarto cardíaco previo. La primera causa directa de muerte tanto clínica como por autopsia fue el fallo multiorgánico seguido del choque cardiogénico. Según causas básicas de muerte la ateroesclerosis ocupó el primer lugar con 91,5% y 98,3% clínicamente y por autopsia respectivamente. No existió correlación clínico patológica en 20,3% de causas directas de muerte, y 8,5% en causas básicas de muerte. Conclusiones: los parámetros fueron adecuados para discrepancias diagnosticas en este estudio, con rango de aceptabilidad de 10 al 40%. Se diagnosticaron 20 infartos agudos del miocardio, solo siete pasaron desapercibidos. Las discrepancias para infarto agudo de miocardio, mundialmente oscilan entre 20 a 74%, en el estudio fue del 26%. Se diagnosticaron tres casos de tromboembolismo pulmonar y dos dejaron de diagnosticarse. Las discrepancias para tromboembolismo pulmonar, mundialmente oscilan del 50 a 89%, en este caso fue del 40%. (MÉD.UIS. 2011;24(3):239-45).Palabras clave: Revascularización Miocárdica. Correlación anatomopatológica. Mortalidad.
Clinical and pathological correlationship of deceased patients in postoperative myocardial revascularization. From 2006 to 2009 at “Hermanos Ameijeiras” Hospital, Cuba.Introduction: In Cuba like the rest of the world, the first cause of death are heart isquemic diseases and there is an increasing number of myocardial revascularization. We use autopsy regularly and we could use the results to establish clinical and pathological correlationship of deceased patients in postoperative myocardial revascularization to improves our medical and professional work. Objective: to determine Clinical and pathological correlation of deceased patients in postoperative myocardial revascularization. “Hermanos Ameijeiras” Hospital (January2006 – december 2009). Materials and Methods: a descriptive, transversal and retrospective study was realized, in the retrospective period dating from January 2006 to December 2009, In the Cardiology Center of Surgery Clinic Hospital “Hermanos Ameijeiras.” This work was approved by the Ethics Committee responsible for this investigation. The sample was constituted by 59 deceased patients, in each one we analyze clinical and pathological direct and basic causes of death, then a comparison was made according with international rules and we express the results in final coincidence (total, partial or not). Results: the predominant age of deceased patients after myocardial revascularization surpassed 60 years of age over 70%. The coronary risk factors largely associated were hypertension and acute myocardial infarction. The majority of patients were male over female with a relationship of 7:2. The first direct cause of death clinical and by autopsy was multiorgan failure followed by cardiogenic shock. The first basic cause of death clinical and by autopsy was Atherosclerosis coincidently. We cannot found clinical and pathological coincidence in 20.3% in direct causes of death, and 8,5% in basic causes of death. Conclusions: in our study we are in the acceptability range of not coincident diagnostics, even in the range from 10 to 40%. 20 acute myocardial infarction were identify and 7 of them were not. Clinical and pathological international disagreement for acute myocardial infarction is from 20 to 74% and we are in 26%. Three pulmonary embolisms were identify and two of them were not. Clinical and pathological international Disagreement for pulmonary embolism is from 50 al 89% and we are in 40%. (MÉD.UIS. 2011;24(3):239-45).Key words: Myocardial revascularization. Clinical and pathological correlationship. Mortality.
Clinical and pathological correlationship of deceased patients in postoperative myocardial revascularization. From 2006 to 2009 at “Hermanos Ameijeiras” Hospital, Cuba.Introduction: In Cuba like the rest of the world, the first cause of death are heart isquemic diseases and there is an increasing number of myocardial revascularization. We use autopsy regularly and we could use the results to establish clinical and pathological correlationship of deceased patients in postoperative myocardial revascularization to improves our medical and professional work. Objective: to determine Clinical and pathological correlation of deceased patients in postoperative myocardial revascularization. “Hermanos Ameijeiras” Hospital (January2006 – december 2009). Materials and Methods: a descriptive, transversal and retrospective study was realized, in the retrospective period dating from January 2006 to December 2009, In the Cardiology Center of Surgery Clinic Hospital “Hermanos Ameijeiras.” This work was approved by the Ethics Committee responsible for this investigation. The sample was constituted by 59 deceased patients, in each one we analyze clinical and pathological direct and basic causes of death, then a comparison was made according with international rules and we express the results in final coincidence (total, partial or not). Results: the predominant age of deceased patients after myocardial revascularization surpassed 60 years of age over 70%. The coronary risk factors largely associated were hypertension and acute myocardial infarction. The majority of patients were male over female with a relationship of 7:2. The first direct cause of death clinical and by autopsy was multiorgan failure followed by cardiogenic shock. The first basic cause of death clinical and by autopsy was Atherosclerosis coincidently. We cannot found clinical and pathological coincidence in 20.3% in direct causes of death, and 8,5% in basic causes of death. Conclusions: in our study we are in the acceptability range of not coincident diagnostics, even in the range from 10 to 40%. 20 acute myocardial infarction were identify and 7 of them were not. Clinical and pathological international disagreement for acute myocardial infarction is from 20 to 74% and we are in 26%. Three pulmonary embolisms were identify and two of them were not. Clinical and pathological international Disagreement for pulmonary embolism is from 50 al 89% and we are in 40%. (MÉD.UIS. 2011;24(3):239-45).Key words: Myocardial revascularization. Clinical and pathological correlationship. Mortality.