The Effecting Factors of Thrombolytic Therapy on Acut Myocardial Infarction Which Diagnosed In Emergency Department

Abstract

Objectives: Myocardial reperfusion and early treatment of complications are the most effective factors for survey after AMI. In this study, we evaluated the effecting factors of thrombolytic theraphy in patients diagnosed with AMI at emergency department. Materials and Methods: Between the dates of January 2002 and January 2003, 168 patients diagnosed with AMI at emergency department in the Hospital of Medicine Faculty, Cumhuriyet University, Sivas, were included. Data about ages, types of AMI, attending time to the hospital after started chest pain, properties of thrombolytic theraphy were collected. Result: Seventy-nine patients with acute myocardial infarction were given thrombolytic theraphy. 89 (52.98%) patients weren’t given thrombolytic theraphy owing to some reasons. These reasons; 47 (52,81%) of these patients with delayed application to the hospital, 22 (24,72%) with non ST elevation myocardial infarction, 15 (16,85%) with delayed diagnosis at emergency department, 5 (5,62%) with thrombolytic theraphy contraindications. Conclusion: nearly a half of AMI patients weren’t given thrombolytic theraphy due to delayed attendance. Transporting difficulties have a major role in delayed attendance. Delayed diagnosis and contraindications for antithrombotic treatment have a minor role in administration of antithrombotic treatment ©2006, Fırat Üniversitesi, Tıp Fakültesi

Keywords

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Acil Serviste Akut Miyokard Enfarktüsü Tanısı Almış Hastalarda Trombolitik Tedavi Uygulanmasını Etkileyen Faktörler

Abstract

Amaç: Miyokard enfarktüsünden sonraki sağ kalımı belirleyen başlıca faktörler koroner kan akımının hızlıca sağlanması ve komplikasyonların erken tedavisidir. Bu çalışmada, akut miyokard enfarktüsü (AMI) tanısı alan hastaların acil serviste trombolitik tedavi uygulamasını etkileyen faktörler incelendi. Gereç ve Yöntem: Ocak 2002-Ocak 2003 tarihleri arasında Cumhuriyet Üniversitesi Tıp Fakültesi Acil Servisi’nde AMI tanısı alan 168 hasta incelendi. Vakalar ile ilgili yaş, AMI tipleri, hastaneye başvuru zamanları ve trombolitik tedavi alan hastaların özelliklerine ait veriler toplandı. Bulgular: AMI tanısı alan bu hastaların 79’una (%47,02) trombolitik tedavi uygulanırken, 22 (%24.72) ST elevasyonu olmayan MI, 47 (%52.81) hastaneye geç başvuru, 15 (%16,85) tanı konulmadaki gecikme, 5 (%5,62) trombolitik tedavi kontrendikasyonu nedeniyle toplam 89 hastaya (%52.98) trombolitik tedavi uygulanamadı. Sonuç: Hastanemiz acil servisinde AMI tanısı alan hastaların yaklaşık yarısına geç başvuru nedeniyle trombolitik tedavi verilememektedir. Bu tedavi oranının düşüklüğünde hastaların hastaneye geç başvurmalarına neden olan ulaşım sorunu rol oynamaktadır. Tanı konulamama ve kontrendikasyonlar trombolitik tedaviyi az oranda etkilemektedir.©2006, Fırat Üniversitesi, Tıp Fakültesi

Keywords

• Acil servis, miyokart enfarktüsü, trombolitik tedavi

References

1. Fuster V, Alexander RW, O’Rourke R. The Heart. Kaynak E (Çeviren). 10. baskı, İstanbul: AND Danışmanlık, 2002. 2. Tunstall-Pedoe H, Kuulasmaa K, Mahonen M et al. Contributions of trends in survival and coronary events rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet 1999; 353:1547- 1557.
2. Capewell S, Beaglehole R, Seddom M et al. Explanation for the decline in coronary heart disease mortality rates in Auckland, New Zealland, between 1982 and 1993. Circulation 2000; 102:1511-1516.
3. American College of Cardiology/America Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedure: Guidelines for the early management of patient with acute myocardial infarction. J Am Coll Cardiol 1990;137:249- 252.
4. Candan İ, Oral D. Kardiyoloji. 1. baskı, Ankara: Ankara tıp yayınları, 2002:605-787
5. Ritzmann P, Frey R, Ruttimann S. Acute myocardial infarction: time delay from onset of pain to hospital presentation and thrombolysis. Schweiz Med Wochenschr 2000; 6;130:657-663.
6. Schou J. Delayed mobilization of the emergency physician in prehospital missions. Eur J Emerg Med 1999;6(4):337-340.
7. Schneider SM, Cobaugh DJ, Leahey NF. Gatekeepers: a missed opportunity for safe transport. Acad Emerg Med 1998;5:587-592.
8. Canto JG, Zalenski RJ, Ornato JP et al. National Registry of Myocardial Infarction 2 Investigators.Use of emergency medical departments in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation 2002;10:106:3018-3023.

9. Bardelli G, Maggi G, Maggi A et al. Successive ischemic events to a first acute myocardial infarct treated with fibrinolysis. An analysis of GISSI-2 patients considered reperfused by a clinical criterion. G Ital Cardiol 1995 ;25:463-472.
10. Baigent C, Collins R, Appleby P et al. 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither. The ISIS-2 (Second International Study of Infarct Survival) Collaborative Group.BMJ 1998; 316: 1337-1343.
11. Berger AK, Radford MJ, Krumholz HM. Factors associated with delay in reperfusion therapy in elderly patients with acute myocardial infarction: Analysis of the Cooperative Cardiovasculer Projet. Am Heart J 2000;139:985-992.
12. Yarzebski J, Goldberg RJ, Gore JM et al. Temporal trents and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction. The Worcester Heart Attack Study. Am Heart J 1994;128:255-263.
13. Cadwell MA, Froelicter ES, Drew BJ. Prehospital delay time in acute myocardial infarction: An exploratory study on relation to hospital outcomes and cost. Am Heart J 2000; 139:788-796.
14. Raitt MH, Maynard C, Wagner GS et al. Relation between symptom duration before trombolytic therapy and final myocardial infarct size. Circulation 1996; 93:48-53.
15. TÜMAR Çalışma Grubu: Çok merkezli çalışma. Akut miyokard infarktüsü sonrası hastane içi dönem prognozunda cinsiyetin önemi:Türk Akut Miyokard İnfarktüsü Çalışması.XVI. Ulusal Kardiyoloji Kongresi Bildiri Özetleri 11-14 Ekim 2000: SB 73
16. Kabul Tarihi: 27.03.2006