Značaj ranih malignih aritmija kod bolesnika sa infarktom miokarda sa ST elevacijom lečenih primarnom perkutanom koronarnom intervencijom i njihova povezanost sa biomarkerima
Sažetak
Uvod/Cilj. Bolesnici koji su lečeni primarnom perkutanom koronarnom intervencijom (pPKI) posle infarkta miokarda sa ST elevacijom (ST-elevation myocardial infarction – STEMI) i koji su preživeli ventrikularnu tahikardiju (VT) i ventrikularnu fibrilaciju (VF) u prvih 48 sati imali su, u većini istraživanja, sličnu dugoročnu prognozu ishoda u poređenju sa bolesnicima koji nisu imali VT i VF tokom prvih 48 sati nakon STEMI. Cilj rada bio je da se kod bolesnika sa STEMI utvrdi povezanost markera infarkta miokarda: MB frakcije kreatin kinaze (creatine kinase-MB fraction – CK-MB), markera srčane insuficijencije – natriuretičkog peptida tipa B (B-type natriuretic peptide – BNP) i sistemskog inflamacijskog faktora – C-reaktivnog proteina (CRP) sa ranim početkom VT i VF, u odnosu na mortalitet
bolesnika tokom prvih šest meseci nakon STEMI. Metode. Ovom retrospektivnom studijom obuhvaćeno je 971 bolesnika sa STEMI, lečenih primenom pPKI tokom deset godina. VF i trajna VT (tVT) su detektovane i van bolnice i tokom prvih 48 sati hospitalizacije. Rezultati. Tokom prvih 48 sati od prijema, 108 (11,1%) bolesnika imalo je aritmiju opasnu po život, od kojih je 75 (69,4%) imalo VF, a 33 (30,6%) tVT, a lečeni su direct current – DC šokom i amjodaronom intravenski. Intrahospitalni mortalitet bio je značajno viši kod bolesnika sa VF/tVT u prvih 48 sati u poređenju sa bolesnicima bez VF/tVT (14,8% vs. 5,7%, p = 0,001). Nivo BNP pokazao je veću tačnost u predviđanju šestomesečnog mortaliteta u odnosu na vrednost maksimalnog nivoa CRP u krvi kod bolesnika bez VF/tVT nakon 48 sati. Međutim, kod bolesnika sa ranim početkom malignih aritmija, BNP je pokazao niži nivo tačnosti u predviđanju šestomesečnog mortaliteta, kao i vrednosti CRP, koje su imale skoro isti nivo tačnosti. Glikemija na prijemu je imala mnogo nižu prognostičku vrednost u obe grupe bolesnika u poređenju sa BNP i CRP [0,705 (0,628–0,781), p < 0,001 i 0,662 (0,521–0,803), p = 0,046, redom]. Ni u jednoj grupi, maksimalni nivoi CK-MB nisu imali značaj u predviđanju šestomesečnog mortaliteta izazvanog bilo kojim od uzroka. Zaključak. Naša studija ukazuje na to da bolesnici sa STEMI, sa ranim početkom VF i tVT, lečeni primenom pPKI i sa visokim nivoom BNP, imaju statistički značajno višu stopu mortaliteta u odnosu na bolesnike sa nižim nivoom BNP.
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