Kliniğimize ST Yükselmeli Miyokart İnfarktüsü Nedeniyle Başvuran Hastalarda Tercih Edilen Tedavi Stratejilerinin Karşılaştırılması (Yaşam İçin Trombolitik Tedavi)

Yıl 2015, Cilt: 18 Sayı: 3, 121 - 125, 01.12.2015

Mahmut Özdemir Nesim Aladağ Ferit Onur Mutluer Musa Şahin

Öz

Giriş:
Bu çalışmada, kliniğimize ST-yükselmeli miyokart
infarktüsü (STEMI) ile başvuran hastalara uygulanan tedavi stratejileri
karşılaştırıldı.

Hastalar
ve Yöntem: STEMI tanısı ile başvuran 165
hastanın reperfüzyon stratejisi belirlendi. Hastaların kapı-balon ve kapı-iğne
süreleri kaydedildi.

Bulgular: Ortalama kapı-balon süresi sevk edilen hastalarda 240
dakika, doğrudan acil servise başvuran hastalarda 64.6 dakika bulundu (p=
0.000). Sevk edilen hastaların mekanik reperfüzyon süreleri AHA (American Heart
Association) kılavuzuna göre sadece %7 hastada uygunken, ESC (European Society
of Cardiology) kılavuzuna göre %26 hastada uygundu. Doğrudan acil servise
başvuran hastalarda bu oranlar sırasıyla %86 ve %97 idi. Kapı-iğne ortalama
süreleri, dış merkezlerde trombolitik tedavi (TT) verilen ve kliniğimize yönlendirilen
hastalarda 41.3 dakika, merkezimizde TT verilen hastalarda 35 dakika idi. İkisi
arasında anlamlı fark saptanmadı (p= 0.454).

Sonuç: STEMI tanısı ile dış merkezlerden
sevk edilen hastaların reperfüzyon süreleri kliniğimize doğrudan başvuran hastaların
reperfüzyon süreleriyle karşılaştırıldığında, ikinci grupta güncel kılavuzlara
düşük oranda uyulduğu gösterildi. Trombolitik tedavi kullanımında ise iki hasta
grubunda da kapı-iğne zamanının kabul edilebilir sınırlar içinde olduğu
görüldü. Bulgularımız, dış merkezlerden sevk edilen hastalarda, güncel
kılavuzlara göre hareket edildiği taktirde, trombolitik tedavinin etkili bir
reperfüzyon stratejisi olarak öne çıktığını göstermektedir.

Anahtar Kelimeler

ST-segment elevasyonu, miyokart infarktüsü, reperfüzyon, strateji, kapı-iğne zamanı, kapı-balon zamanı

Comparison of Treatment Strategies Preferred in Patients Admitted to Our Clinic with ST-Segment Elevation Myocardial Infarction (Thrombolytic Therapy for Life)

Öz

Introduction: The aim of
this study was to compare treatment strategies for patients admitted to our
clinic with ST-segment-elevation myocardial infarction.

Patients and Methods:
Reperfusion strategies were determined in 165 patients admitted with STEMI.
Door-to-balloon and door-to-needle times were recorded for the patients.

Results: The mean
door-to-balloon time was 240 minutes for refferred patients, and was 64.6
minutes for patients directly presenting to our emergency department (p=
0.000). Among patients referred from other centers, mechanical perfusion times
were appropriate in only 7% of the patients according to the AHA (American
Heart Association) guidelines, and in 26% of the patients according to the ESC
(European Society of Cardiology) guidelines. These rates were 86% and 97%,
respectively, among patients directly presenting to our emergency department.
The mean door-to-needle times were 41.3 minutes and 35 minutes in patients who
received thrombolytic treatment (TT) in other centers and in our center,
respectively. There was no significant difference in the mean door-to-needle
times between the two patient groups (p= 0.454).

Conclusion: Comparison of reperfusion times of
patients referred from other centers with the diagnosis of STEMI and of those
directly presenting to our hospital showed a low level of compliance with the
current guidelines in the latter group. Concerning TT use, the door-to-needle
times were within acceptable limits in the two patient groups. Our findings
show that TT can be an effective reperfusion strategy among patients referred
from other centers, provided that decisions are made in accordance with the
current guidelines.

Anahtar Kelimeler

ST-segment elevation, myocardial infarction, reperfusion, strategy, door-to-needle time, door-to-balloon time

Kaynakça

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