Abstract
Bu
derlemede, ESC (European Society of Cardiology) 2017 ST segment yükselmeli miyokart
enfarktüsü (STYME) kılavuzunda değişen ve yeni eklenen öneriler ele
alınacaktır. Bu kılavuzda ST segment yükselmeli miyokart enfarktüsü tanımı
genişletilerek hasta kapsamı arttırılmıştır. Acil tedavide oksijen tedavisinin
ve opioidlerin önemi azalırken reperfüzyon süresinin kısaltılmasına yönelik
‘tanıdan tel geçişine’ kavramı geliştirilmiştir. Koroner anjyografi süresi 2-24
saate indirilirken, 48 saatten sonra perkütan koroner girişim (PKG) iskemi
yokluğunda önerilmemiştir. Radial girişim ve ilaç kaplı stent kullanımı ön
plana çıkarken rutin trombüs aspirasyonu artık önerilmemektedir. Komplet
revaskülarizasyon artık hastaneden çıkmadan önerilmektedir. Stent trombozunu
artırdığından bivalirudin endikasyonu azalırken, enoxaparin heparine alternatif
olarak PKG de daha güçlü önerilmektedir. Potent P2Y12 inhibitörlerinin
kullanımı klopidogrele üstün gözükmektedir. Kangrelor oral alamayanlarda iv
olarak ilk kez kullanıma girmiştir. Maksimum doz statine rağmen, >70 mg/dl
LDL olanlarda ek ilaçların kullanımı önerilmektedir. İkili antiplatelet tedavi
bir yıl önerilirken, 36 aya uzatılabileceğinden bahsedilmiştir. Kalite kontrolü
değerlerinin standardizasyonu için kriterler belirlenmiştir.
References
- 1. Steg PG, James SK, Atar D, Badano LP, BlömstromLundqvist C, Borger MA, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619. 2.Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017 Aug 26, [Epub ahead of print]. doi: 10.1093/eurheartj/ehx393. 3.Valgimigli M,Bueno H,Byrne RA,Collet JP,Costa F,Jeppson A et al. 2017 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developped in collaboration with EACTS. Eur Heart Journal 2017 Aug26, doi :10.1093/eurheartj/ehx419
Abstract
In this review, we
will discuss new and revised concepts in the ESC (European Society of
Cardiology) 2017 ST-segment elevation myocardial infarction (STEMI) guideline.
The definition of STEMI has been expanded to increase the patient coverage. The
concept of 'diagnosis to wire crossing’ has been developed for the shortening
of the duration of reperfusion while the importance of oxygen therapy and
opioids are diminished in emergency treatment. The time to coronary angiography
was reduced to 2-24 hours, and percutaneous coronary intervention (PCI) was not
recommended after 48 hours in the absence of ischemia. While radial
intervention and the use of drug-eluting stents are at the forefront, routine
thrombus aspiration is no longer recommended. Complete revascularization is
recommended before leaving the hospital. Bivalirudin is less recommended as it
has increased stent thrombosis Enoxaparine is used as an alternative to heparin
in PCI. The use of potent P2Y12 inhibitors seems superior to clopidogrel. Cangrelor
has been used for the first time in patients not taking oral administration. The
use of additional medications is recommended in patients with LDL> 70 mg /
dL despite the use of maximum dose of statin. It has been mentioned that while dual
antiplatelet therapy is recommended for one year, it can be extended to 36
months. Criteria have been set for standardization of quality indicators.
References
- 1. Steg PG, James SK, Atar D, Badano LP, BlömstromLundqvist C, Borger MA, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619. 2.Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017 Aug 26, [Epub ahead of print]. doi: 10.1093/eurheartj/ehx393. 3.Valgimigli M,Bueno H,Byrne RA,Collet JP,Costa F,Jeppson A et al. 2017 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developped in collaboration with EACTS. Eur Heart Journal 2017 Aug26, doi :10.1093/eurheartj/ehx419
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Review |
| Authors | |
| Publication Date | December 18, 2017 |
| Submission Date | December 14, 2017 |
| Published in Issue | Year 2017 Volume: 19 Issue: 3 |
Cite
Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.