KLINIČKI REZULTATI PERKUTANOG LEČENJA STENOZE NA GLAVNOM STABLU LEVE KORONARNE ARTERIJE U AKUTNOM INFARKTU MIOKARDA

  • Dijana Bojović Medicinski fakultet Univerziteta u Beogradu
  • Zlatko Mehmedbegović
Ključne reči: akutni infarkt miokarda; perkutana koronarna intervencija; glavno stablo leve koronarne arterije

Sažetak


UvodAkutni infarkt miokarda izazvan lezijom na glavnom stablu leve koronarne arterije je redak ali katastrofalan događaj, često povezan sa iznenadnim smrtnim ishodom i/ili kardiogenim šokom. Optimalna strategija za revaskularizaciju ovih pacijenata je i dalje predmet debate, pogotovo u urgentnim situacijama gde je neophodno brzo osigurati optimalni angiografski rezultat kako bismo poboljšali prognozu bolesnika.

Cilj rada: Cilj ovog rada je da istraži karakteristike pacijenata, proceduralne i kliničke varijable kao prediktore ishoda nakon perkutane koronarne intervencije kod bolesnika sa akutnom lezijom na glavnom stablu leve koronarne arterije.

Materijal i metode: Retrospektivno je analizirano 40 pacijenata sa akutnim infarktom miokarda usled lezije na glavnom stablu, kojima je rađena perkutana koronarna intervencija, u periodu od 01.01.2019. do 21.12.2022. godine.

Rezultati: Prosek godina ispitivane populacije, koju je činilo 40 pacijenata, je bio 70,83±11,415. Kardiogeni šok je bio prisutan kod njih 20 (50%). Tokom procedure su preminula 2 pacijenta (5%), a tokom hospitalizacije njih 16 (40%). Od 22 pacijenta koji su uspešno otpušteni sa bolničkog lečenja, pet pacijenata je preminulo tokom perioda praćenja. Ukupni mortalitet je bio 23 (57,5%). Faktori povezani sa povećanim mortalitetom uključuju ženski pol (p=0,008), kardiogeni šok (p=0,025) i primena inotropne potpore u toku hospitalizacije (p=0,000).

ZaključakAkutni infarkt miokarda izazvan lezijom na glavnom stablu leve koronarne arterije je praćen visokom učestalošću kardiogenog šoka i stopom hospitalnog i udaljenog mortaliteta. Uprkos visokoj stopi proceduralne uspešnosti perkutane procedure, mortalitet ovih bolesnika je i dalje visok.

 

Ključne reči: akutni infarkt miokarda; perkutana koronarna intervencija; glavno stablo leve koronarne arterije

 

Reference


References


1. Vis MM, Beijk MA, Grundeken MJ, Baan J Jr, Koch KT, Wykrzykowska JJ, et al. A systematic review and meta-analysis on primary percutaneous coronary intervention of an unprotected left main coronary artery culprit lesion in the setting of acute myocardial infarction. JACC   Cardiovasc Interv. 2013;6(4):317–24.


2. Ibdah RK, Alrabadi N, Rawashdeh SI, Al-Ksassbeh A, Habib A, Hijazi E. A 44 years-old male patient surviving total occlusion of the left main coronary artery (STEMI) accompanied with cardiogenic shock. Ann Med Surg (Lond). 2020;60:610–3.


3. Mahmarian JJ, Pratt CM, Boyce TM, Verani MS. The variable extent of jeopardized myocardium in patients with single vessel coronary artery disease: quantification by thallium-201 single photon emission computed tomography. J Am Coll Cardiol. 1991;17(2):355–62.


4. Pappalardo A, Mamas MA, Imola F, Ramazzotti V, Manzoli A, Prati F, et al. Percutaneous coronary intervention of unprotected left main coronary artery disease as culprit lesion in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2011;4(6):618–26.


5. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Glob Heart. 2018;13(4):305–38.


6. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999;341(9):625–34.


7. Puricel S, Adorjan P, Oberhänsli M, Stauffer J-C, Moschovitis A, Vogel R, et al. Clinical outcomes after PCI for acute coronary syndrome in unprotected left main coronary artery disease: insights from the Swiss Acute Left Main Coronary Vessel Percutaneous Management (SALVage) study. EuroIntervention. 2011;7(6):697–704.


8. Montalescot G, Brieger D, Eagle KA, Anderson FA Jr, FitzGerald G, Lee MS, et al. Unprotected left main revascularization in patients with acute coronary syndromes. Eur Heart J. 2009;30(19):2308–17.


9. Marso SP, Steg G, Plokker T, Holmes D, Park SJ, Kosuga K, et al. Catheter-based reperfusion of unprotected left main stenosis during an acute myocardial infarction (the ULTIMA experience). Unprotected Left Main Trunk Intervention Multi-center Assessment. Am J Cardiol. 1999;83(11):1513–7.


10. Izumikawa T, Sakamoto S, Takeshita S, Takahashi A, Saito S. Outcomes of primary percutaneous coronary intervention for acute myocardial infarction with unprotected left main coronary artery occlusion. Catheter Cardiovasc Interv. 2012;79(7):1111–6.


11. Sakai K, Nakagawa Y, Kimura T, Ando K, Yokoi H, Iwabuchi M, et al. Primary angioplasty of unprotected left main coronary artery for acute anterolateral myocardial infarction. J Invasive Cardiol. 2004;16(11):621–5.


12. Parma A, Fiorilli R, DE Felice F, Chini F, Giorgi Rossi P, Borgia P, et al. Early and mid-term clinical outcome of emergency PCI in patients with STEMI due to unprotected left main coronary artery disease: Pci on lmca disease in Stemi: Early and mid-term outcomes. J Interv Cardiol. 2012;25(3):215–22. 


13. Hurtado J, Pinar Bermúdez E, Redondo B, Lacunza Ruiz J, Gimeno Blanes JR, García de Lara J, et al. Emergency percutaneous coronary intervention in unprotected left main coronary arteries. Predictors of mortality and impact of cardiogenic shock. Rev Esp Cardiol. 2009;62(10):1118–24.


14. Jensen LO, Kaltoft A, Thayssen P, Tilsted HH, Christiansen EH, Mikkelsen KV, et al. Outcome in high risk patients with unprotected left main coronary artery stenosis treated with percutaneous coronary intervention. Catheter Cardiovasc Interv. 2010;75(1):101–8.


15. Homorodean C, Iancu AC, Leucuţa D, Bãlãnescu Ş, Dregoesc IM, Spînu M, et al. New predictors of early and late outcomes after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and unprotected left main coronary artery culprit lesion. J Interv Cardiol. 2019;2019:8238972. 


16. Lee MS, Sillano D, Latib A, Chieffo A, Zoccai GB, Bhatia R, et al. Multicenter international registry of unprotected left main coronary artery percutaneous coronary intervention with drug-eluting stents in patients with myocardial infarction. Catheter Cardiovasc Interv. 2009;73(1):15–21. 


17. Elmayergi N, Nguyen T, Hiebert B, Philipp RK, Jassal DS, Tam JW, et al. A “no-option” left main PCI registry: outcomes and predictors of in hospital mortality-utility of the logistic EuroSCORE: Logistic EUROscore in No option Left Main PCI. Catheter Cardiovasc Interv. 2013;82(3):361–9. 


18. Thiele H, Zeymer U, Thelemann N, Neumann F-J, Hausleiter J, Abdel-Wahab M, et al. Intraaortic Balloon Pump in Cardiogenic Shock complicating acute myocardial infarction: Long-term 6-year outcome of the randomized IABP-SHOCK II trial. Circulation. 2019;139(3):395–403.



 


 

Objavljeno
2024/10/05
Rubrika
Originalni naučni članak