KORELACIJA KLINIČKIH I DEMOGRAFSKIH FAKTORA SA POJAVOM MIOKARDNOG INFARKTA I SRČANOG ZASTOJA KOD STARIJIH BOLESNIKA NAKON VELIKE ELEKTIVNE VASKULARNE HIRURGIJE
Sažetak
Stratifikacija rizika je deo preoperativne pripreme bolesnika, koja uključuje niz dijagnostičkih i terapijskih postupaka sa glavnim ciljem smanjenja perioperativnih, odnosno postoperativnih morbiditeta i mortaliteta. Cilj studije je identifikacija širokog spektra preoperativnih kliničkih i demografskih parametara, koji su značajno povezani sa pojavom infarkta miokarda i srčanog zastoja (MICA), tokom šest meseci nakon vaskularne hirurgije. Tokom 2017., 2018. i 2019. godine studija je obuhvatila 144 bolesnika (96 muškaraca – 66,6% i 48 žena – 33,3%) starosti preko 65 godina (prosečno 70). MICA je u prvih šest meseci povezana sa višom NYHA klasom (p < 0,001), prethodnom bolešću koronarnih arterija (p < 0,001), kardiomiopatijom (p < 0,05), prethodnim infarktom miokarda (p < 0,05), upotrebom antagonista kalcijumovih kanala (p < 0,05), upotrebom antitrombocitnih lekova (p < 0,001), višom ASA klasom (p < 0,01), višom koncentracijom uree (p < 0,01), nižom frakcijom srčanog izbačaja (p < 0,001) i dužim boravkom u jedinici intenzivnog lečenja (p < 0,001). Multivarijantnom analizom binarne logističke regresije identifikovana je prethodna bolest koronarnih arterija, kao prediktor pojave MICA (p < 0,01). Multivarijantna analiza Koks regresije utvrdila je šest nezavisnih prediktora preživljavanja bez pojave MICA (χ2 = 71,515, p < 0,001). Prethodna bolest koronarnih arterija najznačajniji je faktor preoperativnog rizika za pojavu MICA. Varijable povezane sa srčanom insuficijencijom i visoka koncentracija uree nezavisni su prediktori pojave MICA.
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