Upotreba reperfuzione terapije u zemljama tranzicije bez potpuno primenljive farmakoinvazivne strategije
Sažetak
Uvod/Cilj. Preporuke za lečenje bolesnika sa akutnim infarktom miokarda sa elevacijom ST segmenta (STEMI), nalažu da se kod bolesnika koji ne mogu blagovremeno da odu na primarnu perkutanu intervenciju (p-PCI) primeni farmakoinvazivna (FI) strategija lečenja. Cilj rada bio je da se utvrde karakteristike bolesnika koji se uopšte ne leče reperfuzionom terapijom (RT), kao i da se analizira ishod lečenja pomoću RT, u zemlji u tranziciji u kojoj mreža za primenu FI terapije nije u potpunosti razvijena. Metode. Za istraživanje su korišćeni podaci bolničkog Nacionalnog registra za akutni koronarni sindrom Srbije (HORACS). Rezultati. Značajni prediktori za izostanak primene RT su prikazani u modelu (c 75,6%, SE 0,004, 95% CI 0,748–0,761) u koji su uključene godine starosti (≥ 65), srčana insuficijencija (Killip klasa II-IV), dijabetes melitus, i vreme do prvog medicinskog kontakta (PMK) (> 360 min). Kod bolesnika koji nisu bili lečeni RT, mortalitet je bio 15,7%, kod bolesnika lečenih fibrinolitičkom terapijom (FT) iznosio je 10,5%, a kod bolesnika lečenih p-PCI 6,2% (p < 0,000). U grupi bolesnika koji su do PMK stizali za 3 sata, mortalitet lečenih pomoću FT bio je veći od mortaliteta bolesnika lečenih p-PCI (FT 8,7% vs p-PCI 4,3%). Bolesnici lečeni pomoću FT bili su stariji, sa više komorbiditeta i sa učestalijim znacima srčane insuficijencije. Ipak, posle primenjenog propensity skora, sa ciljem da se izbegnu razlike između dve grupe bolesnika, mortalitet u FT grupi ostao je veći, ali bez statistički značajne razlike u odnosu na bolesnike lečene p-PCI (FT 8,8%. vs p-PCI 6,4%). Zaključak. Primena RT, uz postignuti idealan balans potrošnje i koristi, teško je izvodljiva u zemljama u tranziciji. Mogućnosti za blagovremenu primenu p-PCI, kao i FI terapije, posebno su ograničene kod visoko rizičnih, starijih bolesnika, kod bolesnika sa znacima srčane insuficijencije, komorbiditetima i dijabetesom melitusom.
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