ST Yükselmeli Miyokart İnfarktüslü Hastaların Başvuru Anındaki Ölüm Riskine Başvuru Saatinin Etkisi

Abstract

Giriş: Önceki çalışmalarda hastane başvuru zamanının (hafta içine göre hafta sonu, mesai saatlerine göre mesai dışı saatler) ST yükselmeli miyokart infarktüsü (STEMİ) ölüm oranına farklı oranda etkilemektedir. Fakat bu çalışmalarda başvuru anındaki hasta ölüm riski incelenmemiştir.

Hastalar ve Yöntem: Ocak 2006 ile Mart 2009 tarihleri arasında reperfüzyona uygun STEMİ 228 hasta çalışmaya dâhil edildi. Hastalar başvuru saatine göre gece (24.00 ile 05.59 saatleri arası), sabah (06.00 ile 11.59 saatleri arası), öğlen (12.00 ile 17.59 saatleri arası) ve akşam (18.00 ile 23.59 saatleri arası) olarak gruplara ayrıldı. Başvuru saatiyle başvuru anındaki hastane ölüm riski TIMI risk indeksi [Kalp hızı x (yaş/10)2 /Sistolik kan basıncı] kullanılarak hesaplandı.

Bulgular: Başvuru zamanına göre, hastalar yaş, kalp hızı, sistolik kan basıncı, Killip sınıf > 1 ya da infarkt süresi açısından farklılık göstermiyorlardı. Hastane içi ölüm ön görücüsü TRI, gruplar arasında farklılık göstermemekteydi (p: 0.69)

Sonuç: STEMİ hastaları için ölüm riski başvuru saatine göre belirgin farklılık göstermemektedir. Sağlık hizmeti sağlayıcılar, mesai içi ve dışı saatlerde sağlık sisteminin etkili çalışmasını sağlamaya devam etmelidirler ve kanıta dayalı tedavilere zamanında ulaşmada iyileşmeyi amaçlamalıdırlar.

Keywords

• STEMİ,TIMI risk indeksi,prognoz

The Impact of the Time of Admission on Baseline Mortality Risk in Patients with ST Elevation Myocardial Infarction

Abstract

Introduction: Prior studies have reported a differential mortality effect of the time of admission (weekdays vs. weekends, regular hours vs. off hours) in patients with ST elevation myocardial infarction (STEMI). However, these studies did not evaluate the relationship between the admission hours and mortality risk at admission.

Patients and Methods: A total of 228 patients presenting with reperfusion eligible acute STEMI between January 2006 and March 2009 were enrolled in this study. With respect to admission hours, patients were divided into 4 groups: night (between 24.00 and 05.59 hours), morning (between 06.00 and 11.59 hours), afternoon (between 12.00 and 17.59 hours) and evening (between 18.00 and 23.59 hours)]. The relationship between admission hours and in hospital mortality risk were examined using the TIMI risk index (TRI) [heart rate x (age/10)2 /systolic blood pressure].

Results: Patients in different groups of admission hours were not significantly different in terms of age, heart rate, systolic blood pressure, Killip class > 1 or time to infarction. TRI, a predictor of in-hospital mortality, was also not significantly different between these groups defined using 6-hour time intervals (p: 0.69).

Conclusion: Time of admission did not significantly affect the mortality risk at presentation in patients with STEMI. Healthcare providers should continue to work to enhance the healthcare system during regular and off-hours and to reduce existing disparities in cardiac care through multifaceted initiatives aiming to improve the timely delivery of evidence-based therapies.

Keywords

• STEMI,TIMI risk index (TRI),prognosis

References

1. 1. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-619.
2. 2. American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013:61:e78-140.
3. 3. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 2001;345:663-8.
4. 4. Magid DJ, Wang Y, Herrin J, McNamara RL, Bradley EH, Curtis JP, et al. Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction. JAMA 2005;294:803-12.
5. 5. Kostis WJ, Demissie K, Marcella SW, Shao YH, Wilson AC, Moreyra AE; Myocardial Infarction Data Acquisition System (MIDAS 10) Study Group.Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med 2007;356:1099-109.
6. 6. Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967;20:457-64.
7. 7. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation 1995;91:1659-68
8. 8. Hasdai D, Behar S, Wallentin L, Danchin N, Gitt AK, Boersma E, et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J 2002;23:1190-201.

9. 9. Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, et al. Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2002;23:1177-89.
10. 10. Morrow DA, Antman EM, Giugliano RP, Cairns R, Charlesworth A, Murphy SA, et al. A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: an InTIME II substudy. Lancet 2001;358:1571-5.
11. 11. Wiviott SD, Morrow DA, Frederick PD, Giugliano RP, Gibson CM, McCabe CH, et al. Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction -3 and -4: a simple index that predicts mortality in ST-segment elevation myocardial infarction. J Am Coll Cardiol 2004;44:783-9.
12. 12. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421.
13. 13. Fournier S, Eeckhout E, Mangiacapra F, Trana C, Lauriers N, Beggah AT, et al. Circadian variations of ischemic burden among patients with myocardial infarction undergoing primary percutaneous coronary intervention. Am Heart J 2012;163:208-13.
14. 14. Suarez-Barrientos A, Lopez-Romero P, Vivas D, Castro-Ferreira F, Nunez-Gil I, Franco E, et al. Circadian variations of infarct size in acute myocardial infarction. Heart 2011;97:970-6.
15. 15. Reiter R, Swingen C, Moore L, Henry TD, Traverse JH. Circadian dependence of infarct size and left ventricular function after ST elevation myocardial infarction. Circ Res 2012;110:105-10.
16. 16. Slonka G, Gasior M, Lekston A, Gierlotka M, Hawranek M, Tajstra M, et al. Comparison of results of percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction during routine working hours or off-hours. Kardiol Pol 2007:65:1171-7.
17. 17. Garot P, Juliard JM, Benamer H, Steg PG. Are the results of primary percutaneous transluminal coronary angioplasty for acute myocardial infarction different during the “off” hours? Am J Cardiol 1997;79:1527-9.