KOMPARACIJA PREDIKTIVNE TAČNOSTI SKOROVA RIZIKA U POGLEDU KRATKOROČNE I DUGOROČNE PROGNOZE BOLESNIKA SA AKUTNIM INFARKTOM MIOKARDA LEČENIH PRIMARNOM PERKUTANOM KORONARNOM INTERVENCIJOM
Sažetak
Uvod: Primarna perkutana koronarna intervencija (pPKI) predstavlja terapiju izbora kod pacijenata sa akutnim infarktom miokarda. U cilju predikcije prognoze bolesnika sa infarktom miokarda sa elevacijom ST segmenta (STEMI) razvijeni su skorovi rizika koji imaju mogućnost procene individualnog rizika pojedinca.
Cilj rada: Poređenje prediktivne tačnosti tri validirana skora rizika u pogledu intrahospitalnog, kratkoročnog (30-dnevnog) i dugoročnog (jednogodišnjeg) mortaliteta kod bolesnika sa dijagnozom STEMI lečenih pPKI u Sali za kateterizaciju srca Kliničkog centra Srbije.
Materijal i metode: Retrospektivna studija obuhvatila je 311 konsekutivnih bolesnika sa dijagnozom STEMI, lečenih pPKI, tokom 2017. godine. Isključeni su bolesnici sa kardiogenim šokom pri prijemu. Analizirani su podaci iz elektronske baze podataka. Za svakog bolesnika određena je vrednost tri skora (CADILLAC, ZWOLLE i TIMI). Dijagnostička tačnost skorova procenjena je na osnovu površine (AUC) ispod ROC (Receiver Operating Characteristic) krivih. Kratkoročni i dugoročni ishod bolesnika je procenjen na osnovu telefonskog i kliničkog kontakta.
Rezultati: Ispitivana populacija iznosila je 311 bolesnika, prosečne starosti 61±11 godina od čega je osoba muškog pola bilo 237 (76,2%). Kumulativni mortalitet intrahospitalno, na 30 dana i godinu dana nakon pPKI iznosio je 1,9%, 3,2%, 6,1%. Sva tri ispitivana skora (CADILLAC, ZWOLLE i TIMI) su pokazala veoma dobru tačnost u pogledu predikcije, kako intrahospitalnog (AUC 0,962; 0,986; 0,964; p=ns) tako i mortaliteta nakon 30 dana (AUC 0,920; 0,956; 0,861, p=ns) dok je nakon 1 godine predikcija sa CADILLAC i ZWOLLE skorom bila bolja u odnosu na TIMIskor (AUC 0,921; 0,905; 0,786; p vs. TIMI 0,009 i 0,056). Nezavisni prediktori jednogodišnjeg mortaliteta u populaciji bili su starost, trosudovna koronarna bolest i niže prijemne vrednosti hemoglobina.
Zaključak: CADILLAC i ZWOLLE omogućavaju veoma dobru predikciju intrahospitalne, kratkoročne, a takođe i dugoročne prognoze bolesnika nakon pPKI, za razliku od TIMI skora, koji ima komparabilnu prediktivnu tačnost sa prethodnim, ali samo unutar 30 dana od pPKI.
Ključne reči: akutni infarkt miokarda, STEMI, primarna PKI, stratifikacija rizika
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