Da li je u redu kada kardiohirurški konzilijum promeni odluku o načinu revaskularizacije miokarda?
Sažetak
Uvod/Cilj. Odlučivanje od strane kardiohirurškog konzilijuma je uspostavljen način donošenja odgovarajućih odluka koje se tiču zbrinjavanja bolesnika sa oboljenjem koronarnih arterija. U kliničkoj praksi nisu retkost promene u odlukama različitih kardiohirurških konzilijuma. Međutim, kliničke implikacije u vezi sa promenama odluka kardiohirurških konzilijuma nisu jasne. Cilj rada je bio da se utvrde kliničke implikacije promene u odluci kardiohirurškog konzilijuma kod bolesnika kojima je prvo preporučena hirurška revaskularizacija miokarda, ali je ta odluka posledično promenjena u perkutanu koronarnu intervenciju (PKI). Metode. Retrospektivno su analizirani podaci za 1 501 bolesnika koji su bili primljeni u jedan centar visokog obima tercijarne nege za koronarni arterijski bajpas grafting (KABG). Kod svih bolesnika odluke su bile donete od strane kardiohirurškog konzilijuma pre prijema. Posle prijema, odluke su ponovo procenjivane od strane drugog kardiohiruškog konzilijuma. Odluka o načinu revaskularizacije promenjena je kod 73 (4,86%) bolesnika. Urađeno je usklađivanje skora podudarnja sa bolesnicima iz iste populacije koji su podvrgnuti KABG. Bolesnici u obe grupe praćeni su zbog velikih neželjenih kardiovaskularnih događaja (VNKVD) i ukupnog mortaliteta tokom 12 meseci. Rezultati. Grupe PKI i KABG bile su uravnotežene u odnosu na demografske i kliničke karakteristike. Svi bolesnici su imali dvosudovnu ili trosudovnu koronarnu bolest, sa sličnom učestalošću stenoze glavnog stabla (26% u PKI i 30,10% u KABG grupi). EuroSCORE II je bio sličan između grupa (2,48 ± 2,38 vs. 2,36 ± 2,92). Tokom perioda praćenja primećeno je ukupno 5 (6,80%) VNKVD u PKI grupi i 12 (5,80%) VNKVD u KABG grupi (log rank 0,096, p = 0,757). Ukupno 6 (8,20%) bolesnika umrlo je u grupi PKI, a 15 (7,30%) je umrlo u KABG grupi (log rank 0,067, p = 0,796). Zaključak. Naši podaci ukazuju na to da bolesnici kojima je prvi put savetovan KABG, ali je odluka posledično promenjena na PKI imaju sličnu prognozu kao i bolesnici sa KABG, 12 meseci nakon indeksne procedure.
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