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Vol. 75. Issue 1.
Pages 50-59 (January 2022)
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Vol. 75. Issue 1.
Pages 50-59 (January 2022)
Original article
Outcome of patients with acute heart failure secondary to acute myocardial infarction treated with noninvasive mechanical ventilation
Evolución de los pacientes con insuficiencia cardiaca aguda secundaria a infarto agudo de miocardio tratados con ventilación mecánica no invasiva
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Luna Carrillo-Alemána, Antonia López-Martíneza, Andrés Carrillo-Alcaraza, Miguel Guiab,
Corresponding author
miguelguia7@gmail.com

Corresponding author: Rua Tenente General Zeferino Sequeira 20 - 13°A, 2790-047 Carnaxide, Lisbon, Portugal.
, Ana Renedo-Villarroyaa, Nuria Alonso-Fernándeza, Víctor Martínez-Pérezc, Juan Miguel Sánchez-Nietod, Antonio Esquinas-Rodrígueza, Domingo Pascual-Figale
a Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
b Serviço de Pneumologia, Hospital Professor Doutor Fernando Fonseca, Amadora, Lisbon, Portugal
c Departamento de Psicología Básica y Metodología, Universidad de Murcia, Murcia, Spain
d Sección de Neumología, Hospital General Universitario Morales Meseguer, Murcia, Spain
e Departamento de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
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Tables (5)
Table 1. Demographic and clinical variables, antecedents and previous treatment
Table 2. Neurologic, hemodynamic, respiratory, and laboratory variables
Table 3. Ventilatory settings
Table 4. Patient outcomes
Table 5. Comparison of demographic, clinical, and outcome characteristics in the 2 groups of patients in the groups matched by propensity analysis
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Abstract
Introduction and objectives

Noninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies.

Methods

Prospective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death.

Results

A total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P=.031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P=.478).

Conclusions

The presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support.

Keywords:
Noninvasive ventilation
Acute heart failure
Acute myocardial infarction
Abbreviations:
ACS
AHF
AMI
NIV
Resumen
Introducción y objetivos

La ventilación no invasiva (VNI) es capaz de reducir la necesidad de intubación endotraqueal y la mortalidad de los pacientes con insuficiencia cardiaca aguda (ICA). Sin embargo, de muchos de los ensayos clínicos se ha excluido a los pacientes con ICA secundaria a síndrome coronario agudo o infarto agudo de miocardio (SCA-IAM). El objetivo de este estudio es comparar la efectividad de la VNI entre pacientes con ICA desencadenada por SCA-IAM y por otras causas.

Métodos

Estudio prospectivo de cohortes, durante un periodo de 20 años, de todos los pacientes con ICA tratados con VNI ingresados en una unidad de cuidados intensivos. Se agrupó a los pacientes por la presencia o ausencia de SCA-IAM como causante del evento de ICA. Se definió el fracaso de la VNI por la necesidad de intubación endotraqueal o muerte.

Resultados

Se analizó a 1.009 pacientes, 403 (40%) con SCA-IAM y 606 (60%) con otras etiologías. La VNI fracasó en 61 casos (15,1%) del grupo de SCA-IAM y 64 (10,6%) del grupo sin SCA-IAM (p=0,031), sin diferencias en la mortalidad hospitalaria (el 16,6 y el 14,9%; p=0,478).

Conclusiones

El SCA-IAM como causa desencadenante de la ICA no influye en el pronóstico de los pacientes con insuficiencia respiratoria aguda que precisan asistencia respiratoria no invasiva.

Palabras clave:
Ventilación no invasiva
Insuficiencia cardiaca aguda
Infarto agudo de miocardio

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