Kompletna perkutana revaskularizacija miokarda kod bolesnika sa STEMI komplikovanim kardiogenim šokom

  • Milovan Petrovic University of Novi Sad, Medical faculty
  • Milana Jarakovic
  • Milenko Cankovic
  • Ilija Srdanovic
  • Mila Kovacevic
  • Dragica Tesic
  • Vladimir Ivanovic
  • Aleksandar Redzek
  • Lazar Velicki
DOI: https://doi.org/10.2298/VSP180128183P
Ključne reči: infakrt miokarda, šok, kardiogeni, miokard, revaskularizacija, perkutana koronarna intervencija, mortalitet

Sažetak


Apstrakt

 

Uvod/Cilj. I pored značajnog napretka rane miokardne revaskularizacije i upotrebe mehaničke cirkulatorne podrške, kardiogeni šok i dalje predstavlja vodeći uzrok smrti kod akutnog infarkta miokarda. Aktuelne preporuke Evropskog udruženja kardiologa preporučuju ranu revaskularizaciju svih kritičnih stenoza ili visoko nestabilnih lezija kod stanja kardiogenog šoka, dok skorašnje studije preporučuju ranu revaskularizaciju samo infarktne koronarne arterije kod bolesnika sa akutnim infarktom miokarda sa ST segment elevacijom (STEMI) i kardiogenim šokom. Cilj studije bio je da analizira uticaj kompletne rane perkutane miokardijalne revaskularizacije u akutnom infarktu komplikovanim kardiogenim šokom na intrahospitalni mortalitet. Metode. Istraži­vanje je sprovedeno kao retrospektivna opservaciona analiza podataka dobijenih iz bolničkih registara za kardiogeni šok. Studijska grupa imala je 235 bolesnika lečenih u periodu od avgusta 2007. do oktobra 2016. godine zbog STEMI komplikovanim kardiogenim šokom. Formirane su tri grupe. Prva grupa sastojala se od bolesnika sa bolešću jednog krvnog suda podvrgnutih revaskularizaciji, arterije povezane sa infarktom. Drugu grupu činili su bolesnici sa multisudovnom bolešću, kod kojih je samo revasulizirana culprit lezija, a treću grupu činili su bolesnici sa multi-sudovnom bolešću i kompletnom revaskularizacijom miokarda. Dodatne subgrupe formirane su na osnovu implantaciju intraaortne balon pumpe (IABP). Intrahospitalni mortalitet analiziran je u svim grupama i subgrupama. Rezultati. Revaskulsrizacija samo culprit lezije kod bolesnika sa multisudovnom bolešću učinjena je kod 142 (60,4%) bolesnika, dok je kompletna revaskularizacija (revaskularizacija culprit i ostalih značajnih lezija) kod bolesnika sa multisudovnim lezijama učinjena kod 28 (11,9%) bolesnika. Šezdeset pet (27,7%) bolesnika sa jednosudovnom bolešću podvrgnuto je revaskularizaciji infarktne arterije. Najniži mortalitet bio je u grupi bolesnika sa multisudovnom koronarnom bolešću koji su podvrgnuti kompletnoj revaskularizaciji i implantaciji IABP (mortalitet 35,7%). Razlika u srednjoj vrednosti ejekcione frakcije leve komore (EF) između preživelih i umrlih bila je statistički značajna (p < 0,005). Prosečna vrednost EF kod preživelih bila je 44% (35%–50%), dok je kod umrlih iznosila 30% (25%–39,5%). Na osnovu korišćenih podataka, testiran je matematički prediktivni model. Reciever operating characteristics (ROC) kriva pokazala je da je naš model dobar pokazatelj fatalnog ishoda (p < 0,0005; AUROC = 0,766), uz senzitivnost od 80,3% i specifičnost 67%. Zaključak. STEMI komplikovan kardiogenim šokom još uvek je udružen sa visokom stopom mortaliteta. Samo kompletna revaskularizacija miokarda, kao i u kombinaciji sa IABP, značajno smanjuje mortalitet kod bolesnika sa akutnim STEMI komplikovanim kardiogenim šokom.

Reference

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Objavljeno
2021/02/11
Broj časopisa
Vol. 76 Br. 2 (2019): Vojnosanit pregl
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Originalni članak