SÍNDROME CORONARIO AGUDO: DIAGNÓSTICO PRECOZ Y MANEJO TERAPÉUTICO EN URGENCIAS
DOI:
https://doi.org/10.56238/levv17n57-046Palabras clave:
Síndrome Coronario Agudo, Diagnóstico Precoz, Medicina de Urgencias, Infarto de Miocardio, TratamientoResumen
Las enfermedades cardiovasculares continúan siendo la principal causa de morbimortalidad a nivel mundial, y el síndrome coronario agudo (SCA) constituye un desafío central en los servicios de urgencias y emergencias. Esta revisión narrativa sintetiza evidencias publicadas entre 2021 y 2025 sobre el diagnóstico precoz y el manejo del SCA en el contexto asistencial de emergencia. El diagnóstico contemporáneo se basa en la integración de la evaluación clínica, el electrocardiograma de 12 derivaciones y biomarcadores cardíacos de alta sensibilidad, especialmente la troponina. La adopción de algoritmos diagnósticos acelerados (0/1 h y 0/2 h) ha incrementado la eficiencia y la seguridad del flujo asistencial, permitiendo la exclusión fiable del infarto agudo de miocardio en pacientes de bajo riesgo cuando se aplica en concordancia con el juicio clínico. La estratificación del riesgo se optimiza mediante el uso de escalas validadas, destacándose el puntaje HEART en la predicción de mortalidad a corto plazo y el T-MACS en la identificación de pacientes con mayor riesgo de eventos cardiovasculares adversos mayores. En el SCA sin elevación persistente del segmento ST, el momento de la coronariografía se determina según el perfil de riesgo isquémico, recomendándose una estrategia invasiva inmediata en pacientes de muy alto riesgo y una estrategia precoz en aquellos de alto riesgo. El manejo terapéutico inicial incluye antiagregación plaquetaria y anticoagulación, equilibrando el beneficio isquémico y el riesgo hemorrágico. Persisten desafíos relacionados con la heterogeneidad de las presentaciones clínicas y las desigualdades asistenciales, especialmente en mujeres y adultos mayores. En conjunto, los avances recientes apuntan hacia un modelo de atención progresivamente orientado por la estratificación del riesgo, protocolos estandarizados e integración tecnológica.
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