ENFOQUE ACTUAL DEL TRATAMIENTO FARMACOLÓGICO DEL SÍNDROME CORONARIO AGUDO SIN ELEVACIÓN DEL SEGMENTO ST. DE LA FISIOPATOLOGÍA AL MANEJO
DOI:
https://doi.org/10.18041/2390-0512/bioc..2.2560Palabras clave:
Infarto del miocardio, enfermedad coronaria, troponina, ateroesclerosisResumen
Los síndromes coronarios agudos son un problema mayor de salud pública en todo el mundo. El síndrome coronario agudo (SCA) incluye infarto agudo del miocardio (IAM), con o sin elevación del ST (SEST) y la angina inestable. La incidencia anual de IAM sin elevación del segmento ST es de 565.000 nuevos eventos y 300.000 ataques recurrentes cada año. La evaluación inicial de un SCA SEST debe enfocarse en el dolor torácico, signos y síntomas asociados y factores de riesgo para SCA. Los marcadores biológicos de lesión miocárdica han evolucionado en la actualidad para una mejor precisión del abordaje diagnóstico y aportan datos para el pronóstico de los pacientes. El uso de nuevas drogas disminuye la mortalidad, mejora la calidad de vida y el pronóstico de los pacientes. Esta revisión bibliográfica se realizó con el propósito de actualizar los conocimientos sobre la fisiopatología, diagnóstico y tratamiento del SCA SEST.
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Referencias
1. Robert P. Giugliano, Christopher P. Cannon y Eugene Braunwald, Tratado De Cardiología, Texto De Medicina Cardiovascular, Síndromes Coronarios Agudos Sin Elevación Del ST, 10 ed. Volumen 1, El sevier. 2016; 53: 1155-1181.
2. Allan A. World Health Organization. Global status report on non communicable diseases 2011. [Fecha de consulta: 25 de abril de 2016]. Disponible en: http://www.who.int/nmh/publications/ncd_report2010/es/.
3. Mack M, Gopal A, Ambarish Gopal, Epidemiology, Traditional and Novel Risk Factors in Coronary Artery Disease, Cardiol Clin 32 (2014) 323–332
4. Stamler J, Stamler R, Neaton JD. Low riskfactor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 2012; 1999:282.
5. Roberts R, Steward AF. Genes and coronary artery disease: where are we? J Am Coll Cardiol 2012; 18:1715–21.
6. John M. Canty y Dirk J. Duncker, Tratado De Cardiología, Texto De Medicina Cardiovascular, Flujo Sanguineo Coronario E Isquemia Miocardica, 10 ed. Volumen 1, El sevier, 2016; 49: 1029-1055.
7. Beyer AM, Gutterman DD: Regulation of the human coronary microcirculation, J Mol Cell Cardiol. 2012; 52:814.
8. Zhang C, Rogers PA, Merkus D, et al: Regulation of coronary microvascular resistance in health and disease. In Tuma RF, Duran WN, Ley K, editors: Microcirculation, Boston, 2008, Elsevier, p 521.
9. Deussen A, Ohanyan V, Jannasch A. Mechanisms of metabolic coronary flow regulation, J Mol Cell Cardiol. 2012; 52:794.
10. Liu Y, Gutterman DD: Vascular Control In Humans: Focus On The Coronary Microcirculation, Basic Res Cardiol. 2009; 104:211.
11. Peter Libby, Ira Tabas, Gabrielle Fredman, Edward A. Fisher, Inflammation and its Resolution as Determinants of Acute Coronary Syndromes, Circ Res. 2014; 114:1867-1879.
12. Peter Libby, Tratado De Cardiología, Texto De Medicina Cardiovascular, biología vascular de la ateroesclerosis, 10 ed. Volumen 1, El sevier, 41:873-886, 2016.
13. Gimbrone MA, García-Cardena G. Vascular endothelium, hemodynamics, and the pathobiology of atherosclerosis, Cardiovasc Pathol. 2013: 22:9.
14. Fog Bentzon J, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014; 114:1852–1866.
15. Ley K, Miller YI, Hedrick CC. Monocyte and macrophage dynamics during atherogenesis. Arterioscler Thromb Vasc Biol. 2011; 31:1506–1516.
16. Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med. 2013; 368:2004–2013.
17. Sarwar N, Butterworth AS, Freitag DF. IL6R Genetics Consortium Emerging Risk Factors Collaboration, Interleukin-6 receptor pathway in coronary heart disease: a collaborative metaanalysis of 82 studies. Lancet 2012; 379:1205.
18. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al, Third universal definition of myocardial infarction. Eur Heart J. 2012; 33:2551–67.
19. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-STElevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; 123(18):e426–579.
20. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation. 2013; 127:2452–7.
21. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-STElevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 May 10; 123 (18):e426–579.
22. Morrow DA, Cannon CP, Rifai N, Frey MJ, Vicari R, Lakkis N, et al, Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001; 286:2405–12.
23. Reichlin T, Twerenbold R, Reiter M, Steuer S, Bassetti S, Balmelli C, et al. Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis. Am J Med. 2012; 125:1205–13, e 1201.
24. Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of imaging technologies in the diagnosis of acute cardiac ischemia in the emergency department: a meta-analysis. Ann Emerg Med. 2001; 37(5):471–7.
25. Kontos MC, Kurdziel K, McQueen R, Arrowood JA, Jesse RL, Ornato JP, et al. Comparison of 2-dimensional echocardiography and myocardial perfusion imaging for diagnosing myocardial infarction in emergency department patients. Am. Heart J. 2002; 143 (4):659–67.
26. De Araújo P, Ferreira J, Aguiar C, Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur. Heart J. 2005; 26(9):865–72.
27. Kozieradzka A, Kamiński KA, Maciorkowska D, Olszewska M, Dobrzycki S, Nowak K, et al. GRACE, TIMI, Zwolle and CADILLAC risk scores — Do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively? International Journal of Cardiology. 2011; 148:70–5.
28. Abu-Assi E, Raposeiras-Roubin S, Lear P, Cabanas-Grandio P, Girondo M, Rodriguez-Cordero M, et al. Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2012;1: 222–31.
29. Akkerhuis KM, Klootwijk PA, Lindeboom W, Umans VA, Meij S, Kint PP, Simoons ML. Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J. 2001; 22:1997–2006
30. Schwartz BG, Kloner RA. Drug interactions with phosphodiesterase-5 inhibitors used for the treatment of erectile dysfunction or pulmonary hypertension. Circulation. 2010;122:88–95
31. Jugdutt BI, Warnica JW. Intravenous nitroglycerin therapy to limit myocardial infarct size, expansion, and complications.Effect of timing, dosage, and infarct location. Circulation. 1988 Oct;78(4):906–19.
32. Chatterjee S, Chaudhuri D, Vedanthan R, Fuster V, Ibanez B, Bangalore S, Mukherjee D. Early intravenous beta-blockers in patients with acute coronary syndrome—a meta-analysis of randomized trials. Int J Cardiol. 2013; 168:915–21. 120.
33. Berger JS, Stebbins A, Granger CB, Ohman EM, Armstrong PW, Van de Werf F, et al. Initial aspirin dose and outcome among ST-elevation myocardial infarction patients treated with fibrinolytic therapy. Circulation. 2008;117 (2):192-9.
34. Bauer T, Bouman HJ, van Werkum JW, Ford NF, ten Berg JM, Taubert D. Impact of CYP2C19 variant genotypes on clinical efficacy of antiplatelet treatment with clopidogrel: systematic review and meta-analysis. BMJ. 2011; 343:d4588.
35. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009.
36. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045- 57. 100.
37. Harrington RA, Becker RC, Cannon CP, Gutterman D, Lincoff AM, Popma JJ. et al. Antithrombotic therapy for non-ST-segment elevation acute coronary syndromes: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133
38. Fox KA, Bassand JP, Mehta SR, Wallentin L, Theroux P, Piegas LS, et al. Influence of renal function on the efficacy and safety of fondaparinux relative to enoxaparin in non ST-segment elevation acute coronary syndromes. Ann Intern Med. 2007; 147(5):304-10. 144.
39. Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006; 355(21):2203-16.
40. Stone GW, Ware JH, Bertrand ME, Lincoff AM, Moses JW, Ohman EM, et al. Antithrombotic strategies in patients with acute coronary syndromes undergoing early invasive management: one-year results from the ACUITY trial. JAMA. 2007; 298(21):2497-506. 155.
41. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ, Jr., Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992; 327(10): 669-77.
42. GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto Miocardico. Lancet. 1994;343(8906):1115-22.
43. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993; 342 (8875):821-8.
44. Swedberg K, Held P, Kjekshus J, Rasmussen K, Ryden L, Wedel H. Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II). N Engl J Med. 1992; 327 (10):678-84.
45. Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003 Apr 3; 348 (14):1309-21.
46. Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364:11e21.
47. Moss AJ, Oakes D, Rubison M, McDermott M, Carleen E, Eberly S, et al. Effects of diltiazem on long-term outcome after acute myocardial infarction in patients with and without a history of systemic hypertension. The Multicenter Diltiazem Postinfarction Trial Research Group. Am J Cardiol. 1991; 68 (5):429-33.
48. Held PH, Yusuf S, Furberg CD. Calcium channel blockers in acute myocardial infarction and unstable angina: an overview. BMJ. 1989; 299 (6709):1187-92.
49. Lubsen J, Tijssen JG. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/ metoprolol Trial (HINT). Am J Cardiol. 1987; 60(2):18A-25A.
50. Wood D, De Backer G, Faergemann O, Graham I, Mancia G, Mancia G on behalf of the Task Force Prevention of coronary heart disease in clinical practice. Recommendation of the Second Joint task Force of European and Societies on coronary prevention. Eur Heart J. 1998; 19: 1434-503.
51. Smith SC, Jr., Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124 (22):2458-73.
2. Allan A. World Health Organization. Global status report on non communicable diseases 2011. [Fecha de consulta: 25 de abril de 2016]. Disponible en: http://www.who.int/nmh/publications/ncd_report2010/es/.
3. Mack M, Gopal A, Ambarish Gopal, Epidemiology, Traditional and Novel Risk Factors in Coronary Artery Disease, Cardiol Clin 32 (2014) 323–332
4. Stamler J, Stamler R, Neaton JD. Low riskfactor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 2012; 1999:282.
5. Roberts R, Steward AF. Genes and coronary artery disease: where are we? J Am Coll Cardiol 2012; 18:1715–21.
6. John M. Canty y Dirk J. Duncker, Tratado De Cardiología, Texto De Medicina Cardiovascular, Flujo Sanguineo Coronario E Isquemia Miocardica, 10 ed. Volumen 1, El sevier, 2016; 49: 1029-1055.
7. Beyer AM, Gutterman DD: Regulation of the human coronary microcirculation, J Mol Cell Cardiol. 2012; 52:814.
8. Zhang C, Rogers PA, Merkus D, et al: Regulation of coronary microvascular resistance in health and disease. In Tuma RF, Duran WN, Ley K, editors: Microcirculation, Boston, 2008, Elsevier, p 521.
9. Deussen A, Ohanyan V, Jannasch A. Mechanisms of metabolic coronary flow regulation, J Mol Cell Cardiol. 2012; 52:794.
10. Liu Y, Gutterman DD: Vascular Control In Humans: Focus On The Coronary Microcirculation, Basic Res Cardiol. 2009; 104:211.
11. Peter Libby, Ira Tabas, Gabrielle Fredman, Edward A. Fisher, Inflammation and its Resolution as Determinants of Acute Coronary Syndromes, Circ Res. 2014; 114:1867-1879.
12. Peter Libby, Tratado De Cardiología, Texto De Medicina Cardiovascular, biología vascular de la ateroesclerosis, 10 ed. Volumen 1, El sevier, 41:873-886, 2016.
13. Gimbrone MA, García-Cardena G. Vascular endothelium, hemodynamics, and the pathobiology of atherosclerosis, Cardiovasc Pathol. 2013: 22:9.
14. Fog Bentzon J, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014; 114:1852–1866.
15. Ley K, Miller YI, Hedrick CC. Monocyte and macrophage dynamics during atherogenesis. Arterioscler Thromb Vasc Biol. 2011; 31:1506–1516.
16. Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med. 2013; 368:2004–2013.
17. Sarwar N, Butterworth AS, Freitag DF. IL6R Genetics Consortium Emerging Risk Factors Collaboration, Interleukin-6 receptor pathway in coronary heart disease: a collaborative metaanalysis of 82 studies. Lancet 2012; 379:1205.
18. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al, Third universal definition of myocardial infarction. Eur Heart J. 2012; 33:2551–67.
19. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-STElevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; 123(18):e426–579.
20. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation. 2013; 127:2452–7.
21. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-STElevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 May 10; 123 (18):e426–579.
22. Morrow DA, Cannon CP, Rifai N, Frey MJ, Vicari R, Lakkis N, et al, Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001; 286:2405–12.
23. Reichlin T, Twerenbold R, Reiter M, Steuer S, Bassetti S, Balmelli C, et al. Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis. Am J Med. 2012; 125:1205–13, e 1201.
24. Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of imaging technologies in the diagnosis of acute cardiac ischemia in the emergency department: a meta-analysis. Ann Emerg Med. 2001; 37(5):471–7.
25. Kontos MC, Kurdziel K, McQueen R, Arrowood JA, Jesse RL, Ornato JP, et al. Comparison of 2-dimensional echocardiography and myocardial perfusion imaging for diagnosing myocardial infarction in emergency department patients. Am. Heart J. 2002; 143 (4):659–67.
26. De Araújo P, Ferreira J, Aguiar C, Seabra-Gomes R. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS. Eur. Heart J. 2005; 26(9):865–72.
27. Kozieradzka A, Kamiński KA, Maciorkowska D, Olszewska M, Dobrzycki S, Nowak K, et al. GRACE, TIMI, Zwolle and CADILLAC risk scores — Do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively? International Journal of Cardiology. 2011; 148:70–5.
28. Abu-Assi E, Raposeiras-Roubin S, Lear P, Cabanas-Grandio P, Girondo M, Rodriguez-Cordero M, et al. Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2012;1: 222–31.
29. Akkerhuis KM, Klootwijk PA, Lindeboom W, Umans VA, Meij S, Kint PP, Simoons ML. Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J. 2001; 22:1997–2006
30. Schwartz BG, Kloner RA. Drug interactions with phosphodiesterase-5 inhibitors used for the treatment of erectile dysfunction or pulmonary hypertension. Circulation. 2010;122:88–95
31. Jugdutt BI, Warnica JW. Intravenous nitroglycerin therapy to limit myocardial infarct size, expansion, and complications.Effect of timing, dosage, and infarct location. Circulation. 1988 Oct;78(4):906–19.
32. Chatterjee S, Chaudhuri D, Vedanthan R, Fuster V, Ibanez B, Bangalore S, Mukherjee D. Early intravenous beta-blockers in patients with acute coronary syndrome—a meta-analysis of randomized trials. Int J Cardiol. 2013; 168:915–21. 120.
33. Berger JS, Stebbins A, Granger CB, Ohman EM, Armstrong PW, Van de Werf F, et al. Initial aspirin dose and outcome among ST-elevation myocardial infarction patients treated with fibrinolytic therapy. Circulation. 2008;117 (2):192-9.
34. Bauer T, Bouman HJ, van Werkum JW, Ford NF, ten Berg JM, Taubert D. Impact of CYP2C19 variant genotypes on clinical efficacy of antiplatelet treatment with clopidogrel: systematic review and meta-analysis. BMJ. 2011; 343:d4588.
35. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009.
36. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045- 57. 100.
37. Harrington RA, Becker RC, Cannon CP, Gutterman D, Lincoff AM, Popma JJ. et al. Antithrombotic therapy for non-ST-segment elevation acute coronary syndromes: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133
38. Fox KA, Bassand JP, Mehta SR, Wallentin L, Theroux P, Piegas LS, et al. Influence of renal function on the efficacy and safety of fondaparinux relative to enoxaparin in non ST-segment elevation acute coronary syndromes. Ann Intern Med. 2007; 147(5):304-10. 144.
39. Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006; 355(21):2203-16.
40. Stone GW, Ware JH, Bertrand ME, Lincoff AM, Moses JW, Ohman EM, et al. Antithrombotic strategies in patients with acute coronary syndromes undergoing early invasive management: one-year results from the ACUITY trial. JAMA. 2007; 298(21):2497-506. 155.
41. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ, Jr., Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992; 327(10): 669-77.
42. GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto Miocardico. Lancet. 1994;343(8906):1115-22.
43. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993; 342 (8875):821-8.
44. Swedberg K, Held P, Kjekshus J, Rasmussen K, Ryden L, Wedel H. Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II). N Engl J Med. 1992; 327 (10):678-84.
45. Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003 Apr 3; 348 (14):1309-21.
46. Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364:11e21.
47. Moss AJ, Oakes D, Rubison M, McDermott M, Carleen E, Eberly S, et al. Effects of diltiazem on long-term outcome after acute myocardial infarction in patients with and without a history of systemic hypertension. The Multicenter Diltiazem Postinfarction Trial Research Group. Am J Cardiol. 1991; 68 (5):429-33.
48. Held PH, Yusuf S, Furberg CD. Calcium channel blockers in acute myocardial infarction and unstable angina: an overview. BMJ. 1989; 299 (6709):1187-92.
49. Lubsen J, Tijssen JG. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/ metoprolol Trial (HINT). Am J Cardiol. 1987; 60(2):18A-25A.
50. Wood D, De Backer G, Faergemann O, Graham I, Mancia G, Mancia G on behalf of the Task Force Prevention of coronary heart disease in clinical practice. Recommendation of the Second Joint task Force of European and Societies on coronary prevention. Eur Heart J. 1998; 19: 1434-503.
51. Smith SC, Jr., Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124 (22):2458-73.
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2016-08-10
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ENFOQUE ACTUAL DEL TRATAMIENTO FARMACOLÓGICO DEL SÍNDROME CORONARIO AGUDO SIN ELEVACIÓN DEL SEGMENTO ST. DE LA FISIOPATOLOGÍA AL MANEJO. (2016). Biociencias, 11(2), 67-77. https://doi.org/10.18041/2390-0512/bioc..2.2560
