Intervencionismo coronario percutáneo en mujeres con cardiopatía isquémica. Hospital Hermanos Ameijeiras

Daysi Luperon Loforte, Sergio Javier Enrique Vila, Suilbert Rodríguez Blanco, Susel Quesada Peña, Yiliam Blanco Pérez, Vivian Milagros Jarque Varela

Texto completo:

PDF

Resumen

Introducción: Existe poca evidencia sobre las características clínicas y resultados del intervencionismo coronario percutáneo en mujeres con diagnóstico de cardiopatía isquémica. Objetivo: Describir los resultados del intervencionismo coronario percutáneo en mujeres. Material y método: Se realizó un estudio observacional descriptivo transversal en mujeres atendidas en el departamento de hemodinámica del Hospital Clínico Quirúrgico “Hermanos Ameijeiras” entre enero de 2013 y diciembre de 2017. Resultados: La media de edad fue de 62.75 ± 13.98 años; 348 casos (76.5%) tenía hipertensión arterial como factor de riesgo. El diagnóstico fue angina estable en 244 casos (53.6%), 247 pacientes (54.3%) tenía enfermedad de un vaso, en 57.8% se trató la arteria descendente anterior y en 47% se trató una lesión tipo B1. El acceso más utilizado fue la vía radial (367 casos; 80.7 %). En 322 casos (50.9 %) no se colocó el stent directo y fue de tipo convencional en 398 (62.9 %). El resultado técnico fue exitoso en 439 pacientes (96.5 %). Solo se observaron 24 (5.3 %) complicaciones Conclusiones: En las pacientes estudiadas, la mayoría de la tercera edad y con angina estable, la enfermedad de un vaso y la lesión tipo B1 fueron las más representadas. La técnica del stent no directo fue la más utilizada para tratar las estenosis coronarias, así como el stent convencional. El resultado técnico de la intervención coronaria percutánea fue exitoso en casi la totalidad de las pacientes con una baja frecuencia de complicaciones.

Palabras clave

cardiopatía isquémica mujeres; infarto de miocardio; angina de pecho; intervencionismo coronario percutáneo.

Referencias

Heras M. Cardiopatía isquémica en la mujer: presentación clínica, pruebas diagnósticas y tratamiento de los síndromes coronarios agudos. Rev Esp Cardiol. [Internet]. 2006; 59(4):371-81. Disponible en: https://www.revespcardiol.org/es-content-articulo-13087060

Ferraz Torres M, Marín Fernández B, Belzunegui Otano T. Factores relacionados a las desigualdades de género observadas en el tratamiento de la cardiopatía isquémica en los servicios de urgencias. Revista científica e informativa de la Asociación Española de Enfermería en Cardiología [Internet]. 2016, 68: 54-59. Disponible en https://dialnet.unirioja.es/servlet/articulo?codigo=6282049

Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J [Internet]. 2014; 35(42):2950-9. Available from: https://academic.oup.com/eurheartj/article-abstract/35/42/2950/2293157

Serra MJ, Sala J, Balestrini C. Enfermedad coronaria en la mujer. ¿Dónde están las diferencias? Argentina: Instituto Modelo de cardiología; 2005. Disponible en: https://www.fac.org.ar/404.php

Gallego Curto E. Mujer y cardiopatía aguda: estudio descriptivo del perfil antropométrico y clínico en una región objetivo uno de la Unión Europea [Tesis]. Madrid: Universidad Complutense Madrid; 2018. Disponible en: https://eprints.ucm.es/46933/1/T39738.pdf

Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, et al. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J [Internet]. 2016; 37:24-34. Available from: https://academic.oup.com/eurheartj/article/37/1/24/2398374

Cuba. Ministerio de Salud Pública. Anuario Estadístico de Salud 2017. Dirección Nacional de Estadísticas. La Habana: MINSAP; 2018.

Kannel WB. The Framingham Study: historical insight on the impact of cardiovascular risk factors in men versus women. J Gend Specif Med [Internet]. 2002; 5(2):27-37. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11974672

Kyker KA, Limacher MC. Gender differences in the presentation and symptoms of coronary artery disease. Curr Womens Health Rep [Internet]. 2002; 2(2):115-9. Available from: https://pubmed.ncbi.nlm.nih.gov/12116600/

Sweitzer NK, Douglas PS. Cardiovascular disease in women. Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwaldʹs Heart Diseases. A textbook of cardiovascular medicine. Philadelphia: Elsevier Saunders; 2015.p. 1951-64.

Foussas S. Acute coronary syndromes and comorbidities. Hellenic J Cardiol [Internet]. 2015; 56(3):275-6. Available from: https://hellenicjcardiol.org/archive/full_text/2015/4/2015_4_351.pdf

Kosova E, Ricciardi M. Cardiac Catheterization. JAMA [Internet]. 2017; 317(22):2344. Available from: https://jamanetwork.com/journals/jama/article-abstract/2631532

Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the european society of cardiology. Eur Heart J [Internet]. 2005; 26(8):804-47. Available from: https://academic.oup.com/eurheartj/article/26/8/804/2888081

Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med [Internet]. 1987; 316(12):701-6. Available from: https://www.jvascsurg.org/article/0741-5214(87)90320-X/pdf

Stefanini GG, Holmes DR Jr. Drug-eluting coronary-artery stents. N Engl J Med [Internet]. 2013; 368(3):254-65. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra1210816

Dzavik V, Carere RG, Teo KK, Knudtson ML, Marquis JF, Buller CE. An open design, multicentre, randomized trial of percutaneous transluminal coronary angioplasty versus stenting, with a heparin-coated stent, of totally occluded coronary arteries: rationale, trial design and baseline patient characteristics. Total occlusion study of Canada (TOSCA) Investigators. Can J Cardiol [Internet]. 1998; 14(6):825-32. Available from: https://europepmc.org/article/med/9676168

Jean-Philippe Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronay syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal [Internet] 2020 00, 1_79 ESC GUIDELINES. Available from: doi: 10.1093/eurheartj/ehaa575

Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease: Implications for patients selection. Circulation [Internet]. 1990; 82: 1193-1202. Available from:

Smolina K, Ball L, Humphries KH, Khan N, Morgan SG. Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence: Problem for Young Women. Circ Cardiovasc Qual Outcomes [Internet]. 2015; 8(6):586-92. Available from: https://www.ahajournals.org/doi/full/10.1161/circoutcomes.115.001987

Kytö V, Sipilä J, Rautava P. Gender and in-hospital mortality of ST-segment elevation myocardial infarction (from a multihospital nationwide registry study of 31,689 patients). Am J Cardiol [Internet]. 2015; 115(3):303-6. Available from: https://www.sciencedirect.com/science/article/pii/S0002914914020694

Costabel JP, Burgos LM, Cigalini IM ,García S, Duczynsk MP, Giordanino EF, et al . Infarto de miocardio con supradesnivel del segmento ST en mujeres en Argentina. Subanálisis del registro CONAREC XVII. Rev Argent Cardiol [Internet]. 2017; 85:435-43. Available from: https://www.sac.org.ar/wp-content/uploads/2018/03/v85n5a05.pdf

McKechnie RS, Smith D, Montoye C, Kline-Rogers E, O'Donnell MJ, De Franco AC, et al. Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation [Internet]. 2004; 110(3):271-7. Available from: https://www.ahajournals.org/doi/abs/10.1161/01.CIR.0000134964.01697.C7

Brieger D, Hyun K, Chew D, Amerena J, Farouque O, MacIsaac A, et al. The relationship between the proportion of admitted high risk ACS patients and hospital delivery of evidence based care. Int J Cardiol [Internet]. 2016; 222:86-92. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0167527316314140

Worrall L, McEvedy S, Wilson A, Rahman MA. Gender Differences in presentation, coronary intervention, and outcomes of 28 985 acute coronary syndrome patients in Victoria, Australia. Womens Health Issues [Internet]. 2016; 26(1):14-20. Available from: https://doi.org/10.1016/j.whi.2015.09.002

Marcovic D, Radanovic A, Mihovilovic A, Bozic J, Lukin A, Simunic M. Effects of a percutaneous coronary intervention or conservative treatment strategy on treatment outcomes in elderly female patients with acute coronary syndrome. Signa Vitae [Internet]. 2016;

(1):96-100. Available from: https://hrcak.srce.hr/170194

El Color de la Piel según el Censo de Población y Viviendas de 2012. Centro de Estudios de Población y Desarrollo. Oficina Nacional de Estadística e Información. República de Cuba. La Habana; 2016.

Marcheco Teruel B, Parra EJ, Fuentes Smith E, Salas A, Buttenschøn HN, et al. Cuba: exploring the history of admixture and the genetic basis of pigmentation using autosomal and uniparental markers. PLoS Genet [Internet] 2014; 10(7):e1004488. Available from: https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1004488

Coronado BE, Griffith JL, Beshansky JR, Selker HP. Hospital mortality in women and men with acute cardiac ischemia: a prospective multicenter study. J Am Coll Cardiol [Internet]. 1997; 29(7):1490-6. Available from: DOI: 10.1016/S0735-1097(97)00077-6

Sauza Sosa JC, Cuéllar Álvarez J, Villegas Herrera KM, Sierra Galán LM. Aspectos clínicos actuales del monitoreo ambulatorio de presión arterial. Arch. Cardiol [Internet]. Méx. [Internet]. 2016 Sep.; 86 (3):255-259. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1405-99402016000300255&lng=es. Available from: https://doi.org/10.1016/j.acmx.2015.12.004.

Caja Guayerbas L. Papel del endotelio en la enfermedad cardiovascular [tesis] Universidad Complutense; 2018. Disponible en: http://147.96.70.122/Web/TFG/TFG/Memoria/LAURA%20CAJA%20GUAYERBAS.pdf

Foussas S. Acute coronary syndromes and diabetes mellitus. Hellenic J Cardiol [Internet]. Sep-Oct 2016;57(5):375-377. Available from: Available from: https://pubmed.ncbi.nlm.nih.gov/28302514/ doi: 10.1016/j.hjc.2016.12.012. Epub 2017 Mar 14.

Heller GV. Evaluation of the patient with diabetes mellitus and suspected coronary artery disease. Am J Med [Internet]. 2005; 118(2):9-14. Available from: https://doi.org/10.1016/j.amjmed.2005.01.045

Gina Lundberg, Mary Norine Walsh, Laxmi S Mehta. Sex-Specific Differences in Risk Factors for Development of Heart Failure in Women. [Internet] 2019 Jan;15(1):1-8. Available from: doi: 10.1016/j.hfc.2018.08.001. Epub 2018 Oct 24.

AL Dannenberg, RJ Garrison, WB Kannel Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892. “Incidence of hypertension in the Framingham Study.”, American Journal of Public Health [Internet] 1988; 78(1):676-679. Available from: https://doi.org/10.2105/AJPH.78.6.676

Willett WC, Green A, Stampfer MJ, Speizer FE, Colditz GA, Rosner B, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med [Internet]. 1987; 317(21):1303-9. Available from: https://www.nejm.org/doi/full/10.1056/NEJM198711193172102

Peters A.E., Singhateh Y, Mackay D, Huxley R, Woodward M. Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis [Internet]. 2016;248:123-131. Available from: https://doi.org/10.1016/j.atherosclerosis.2016.03.016

Lewis B, Assmann G, Tikkanen M, Mancini M, Pometta SY. Prevention of coronary heart disease. Scientific Background and New Clinical Guidelines. Recommendations of the European Atherosclerosis Society prepared by the International Task Force for the prevention of Coronary Heart Disease. Assmann G. editor. Lipid metabolism disorders and coronary heart disease. 6th ed. Munich: MMV Medizin Verlag; 2013.p. 74-81.

Vaina S, Milkas A, Crysohoou C, Stefanadis C. Coronary artery disease in women: From the yentl syndrome to contemporary treatment. World J Cardiol [Internet]. 2015; 7(1):10-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306201/

Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, et al. Acute myocardial infarction in women: A scientific statement from the American Heart Association. Circulation. [Internet]. 2016; 133(9):916 47. Available from: https://www.ahajournals.org/doi/abs/10.1161/cir.0000000000000351

Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman PA, et al. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016. Heart Lung Circ [Internet]. 2016; 25(9):895-951. Available from: https://europepmc.org/article/med/28867028

Younan H, Ragab T, El-Khashab K, Farag N. Impact of gender difference on PCI outcome in Egyptian diabetic patients: Prospective two center registry study. Egyptian Heart J [Internet]. 2015; 67:55–61. Available from: https://doi.org/10.1016/j.ehj.2014.09.001

Barreda Pérez AM, López Ferrero L, Rodríguez Nande L, González Espinosa AB, Antuña Aguilar T, Borges Machado L. Caracterización de las mujeres con intervencionismo coronario percutáneo. Rev Cubana Cardiol Cir Cardiovas [Internet]. 2018; 24(2). Disponible en: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/776/html_125

Jarrah MI, Hammoudeh AJ, Al-Natour DB, Khader YS, Tabbalat RA, AlhaddadI A, et al. Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention. Saudi Med J [Internet]. 2017; 38(2):149-55. Available from: doi:10.15537/smj.2017.2.16301

Kovacic JC, Mehran R, Karajgikar R, Baber U, Suleman J, Kim MC, et al. Female gender and mortality after percutaneous coronary intervention: Results from a large registry. Catheterization and Cardiovascular Interventions [Internet]. 2012; 80:514-21. Available from: https://doi.org/10.1002/ccd.23338

Epps KC, Holper EM, Selzer F, Vlachos HA, Gualano SK, Abbott JD, et al. Sex differences in outcomes following percutaneous coronary intervention according to age. Circ Cardiovasc Qual Outcomes [Internet]. 2016; 9(2 Suppl 1):S16-25. Available from: https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.115.002482

Parra PF, Buitrago N, Carvajal R, Wagner K, Viáfara J, Calle A, et al. Diferencias angiográficas y epidemiológicas entre hombres y mujeres que desarrollan síndrome coronario agudo. Rev Colomb Cardiol [Internet]. 2017; 24(5):436-41. Disponible en: https://doi.org/10.1016/j.rccar.2017.04.010

Kuhn L, Page K, Rahman MA, Worrall-Carter L. Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: a retrospective database study. Aust Crit Care [Internet]. 2015; 28(4):196-202. Available from: https://doi.org/10.1016/j.aucc.2015.01.004

Valero MJ, Velásquez J, Diez F, Devesa C, Juárez M, Sousa I, et al. Sex differences in acute myocardial infarction: Is it only the age? Int J Cardiol [Internet]. 2017; 231:36-41. https://doi.org/10.1016/j.ijcard.2016.11.010

De Carlo M, Morici N, Savonitto S, Grassia V, Sbarzaglia P, Tamburrini P, et al. Sex-related outcomes in elderly patients presenting with Non-ST-segment elevation acute coronary syndrome: insights from the italian elderly a CS study. JAAC Cardiovasc Interv. [Internet]. 2015;8(6):791-796. Available from: DOI: 10.1016/j.jcin.2014.12.240

Ramos R, Ramos V, Giestas R, Bortot F, Fraga MV, Moulin D, et al. Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction. Rev Bras Cardiol Invasiva [Internet]. 2015; 23(2):96-101. Available from: https://doi.org/10.1016/j.rbciev.2015.12.006

Venetsanos D, Sederholm S, Alfredsson J, Janzon M, Cequier A, Chettibi M, et al. Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis. BMJ Open [Internet]. 2017; 7(9):e015241. Available from: http://dx.doi.org/10.1136/bmjopen-2016-015241

Macín SM, del Sueldo M, Perna ER, Tajer CD, Cerezo GH, Struminger M, et al. Características clínicas y evolución hospitalaria de mujeres con infarto agudo de miocardio en el Registro Nacional de Infarto SAC-FAC. Rev Fed Arg Cardiol [Internet]. 2018, 47(3):125-9. Disponible en: https://www.fac.org.ar

Barthélémy O, Degrell P, Berman E, Kerneis M, Petroni T, Silvain J, et al. Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Arch Cardiovasc Dis [Internet]. 2015; 108(8-9):428-36. Available from: https://doi.org/10.1016/j.acvd.2015.03.002

Ghauharali S, Bax M, Haasdijk A, Schotborgh C, Oemrawsingh P, Bech J, et al. The impact of gender on long-term mortality in patients with multivessel disease after primary percutaneous coronary intervention. Neth Heart J [Internet]. 2015; 23(12):592-9. Available from: https://link.springer.com/article/10.1007/s12471-015-0754-x

Pilgrim T, Heg D, Tal K, Erne P, Radovanovic D, Windecker S, et al. Age and Gender-related disparities in primary percutaneous coronary interventions for acute ST-segment elevation myocardial infarction. PLoS One [Internet]. 2015; 10(9):e0137047. Available from: https://doi.org/10.1371/journal.pone.0137047

Khan E, Brieger D, Amerena J, Atherton JJ, Chew DP, Farshid A, et al. Differences in management and outcomes for men and women with ST-elevation myocardial infarction. Med J Aust [Internet]. 2018; 209(3):118-23. Available from: https://doi.org/10.5694/mja17.01109

Guelker JE, Bansemir L, Ott R, Kuhr K, Koektuerk B, Turan RG, et al. Gender-based acute outcome in percutaneous coronary intervention of chronic total coronary occlusion. Neth Heart J [Internet]. 2017; 25(5):304-11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405030/

Numasawa Y, Kohsaka S, Miyata H, Noma S, Suzuki M, Ishikawa S, et al. Gender differences in in-hospital clinical outcomes after percutaneous coronary interventions: an insight from a japanese multicenter registry. PLoS One [Internet]. 2015; 10(1):e0116496. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116496

Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet [Internet]. 2011; 377(9775):1409-20. Available from: https://doi.org/10.1016/S0140-6736(11)60404-2

Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, et al. Gender difference in long-term clinical outcomes following percutaneous coronary intervention during 1984-2008. Atherosclerosis [Internet]. 2016; 247:105-10. Available from: https://doi.org/10.1016/j.atherosclerosis.2015.10.088

Jang JS, Park YA, Jin HY, Seo JS. P4661 Sex difference in mortality among patients with acute myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis. European Heart Journal [Internet]. 2017; 38(Suppl 1). Available from: https://academic.oup.com/eurheartj/article/38/suppl_1/ehx504.P4661/4090707

Wada H, Ogita M, Miyauchi K, Shitara J, Endo H, Doi S, et al. Impact of gender difference on long-term outcomes of percutaneous coronary intervention for coronary artery disease in patients under statin treatment. Heart Vessels [Internet]. 2017; 32(1):16-21. Available from: https://link.springer.com/content/pdf/10.1007/s00380-016-0835-9.pdf

Kunadian V, Qiu W, Lagerqvist B, Johnston N, Sinclair H, Tan Y, et al. Gender differences in outcomes and predictors of all-cause mortality after percutaneous coronary intervention (data from United Kingdom and sweden). Am J Cardiol [Internet]. 2017; 119(2):210-6. Available from: https://doi.org/10.1016/j.amjcard.2016.09.052

Kanic V, Vollrath M, Tapajner A, Sinkovic A. Sex-Related 30-day and long-term mortality in acute myocardial infarction patients treated with percutaneous coronary intervention. J Womens Health (Larchmt) [Internet]. 2017; 26(4):374-9. Available from: https://www.liebertpub.com/doi/abs/10.1089/jwh.2016.5957

Barranco D, Artucio C, Comité de Cardiopatía en la Mujer de la Sociedad Uruguaya de Cardiología, Comité de Hemodinamia de la Sociedad Uruguaya de Cardiología, Perna A, Mayol J. Angioplastia primaria en el infarto agudo de miocardio: diferencias según el género. Subestudio de la casuística uruguaya (2004-2012). Rev. Urug. Cardio [Internet]. 2017, 32(2):141-9. Disponible en: http://www.scielo.edu.uy/scielo.php?pid=S1688-04202017000200141&script=sci_arttext

Yang J, Zhang F, Qian J, Ge L, Zhou J, Ge J. Sex-based influence on clinical outcomes after drug-eluting stent implantation in real-world patients: insight from the FOCUS registry. Ann Med [Internet]. 2017; 49:185–95. Available from: https://doi.org/10.1080/07853890.2016.1235283

Heer T, Hochadel M, Schmidt K, Mehilli J, Zahn R, Kuck KH, et al. Sex differences in percutaneous coronary intervention-insights from the coronary angiography and PCI registry of the german society of cardiology. J Am Heart Assoc [Internet]. 2017; 6(3):e004972. Available from: https://doi.org/10.1161/JAHA.116.004972

Wolff R, Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Sparkes JD, et al. Gender differences in the prevalence and treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv [Internet]. 2016; 87(6):1063-70. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/ccd.26330

Idris H, French JK, Shugman IM, Hopkins AP, Juergens CP, Thomas L. Influence of Age and Gender on Clinical Outcomes Following Percutaneous Coronary Intervention for Acute Coronary Syndromes. Heart Lung Circ [Internet]. 2017; 26(6):554-65. Available from: https://doi.org/10.1016/j.hlc.2016.10.021

Enlaces refback

  • No hay ningún enlace refback.




Copyright (c) 2021 Daysi Luperon Loforte, Sergio Javier Enrique Vila, Suilbert Rodríguez Blanco, Susel Quesada Peña, Yiliam Blanco Pérez, Vivian Milagros Jarque Varela

Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.