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

Abstract

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.

Keywords

• 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)

Abstract

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.

Keywords

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

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