ST Segment Yükselmeli Miyokard İnfarktüsü ile Başvuran Hastalarda Hastane İçi ve Uzun Dönem Mortalitenin Değerlendirilmesi: Üçüncü Basamak Kardiyoloji Merkezi Deneyimi
Year 2020,
Volume: 10 Issue: 4, 600 - 607, 15.12.2020
Amaç: İskemik kalp hastalığı tüm dünyada önde gelen bir ölüm sebebidir ve kardiyovasküler hastalığı olan hastalarda yaşam beklentisini uzatmak için sadece sağlık hizmeti sağlayıcılarının stratejileri değil, toplum özellikleri de önem arz etmektedir. Bu nedenle, ilgilenilen toplum özelliklerini yansıtan, ulusal, klinik çalışmalar gerçek yaşam sağlık hizmetleri hakkında önemli bilgiler vermektedir. Biz bu çalışma ile üçüncü basamak kardiyoloji merkezimize başvuran ST elevasyonlu miyokart enfarktüsü (STEMI) hastalarında hastane içi ve uzun dönem sonuçlarımızı değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Primer perkütan koroner girişim (PCI) ile tedavi edilen ve telefon ile yaptığımız sorgulamalara cevap veren veya takiplerinde vefat ettiği belgelenen toplam 178 STEMI hastası analizlere dâhil edildi. Bu hastalar yaşa göre üç gruba ayrıldı (Grup-1: <35 yaş, Grup-2: ≥35-60 yaş ve Grup-3: ≥ 60 yaş). Bu üç grup hastanın takiplerinde ki ölüm ve ölümcül olmayan kardiyovasküler istenmeyen olaylar mukayese edildi. Hayatta kalma eğrileri Kaplan-Meier yöntemi ile oluşturuldu.
Bulgular: Çalışmamızda medyan takip süresi 95 aydı. Hastane içi dönemde, 4 hastada yeniden miyokart enfarktüsü ve 4 hastada ölüm görüldü. Uzun süreli takipte ise 30 hastada yeniden miyokart enfarktüsü izlendi. Tekrar miyokart enfarktüsü sıklığında gruplar arasında farklılık görülmedi. Çalışmaya dâhil edilen hastalarda uzun süreli mortalite % 27,5 olarak bulundu (n = 49). Gruplar arasındaki mortalite oranlarının anlamlı derecede farklı olduğu tespit edildi (sırasıyla; Grup-1 için % 13,3, Grup-2 için % 16, 8, Grup-3 için % 53,5) (p <0.001).
Sonuç: STEMI ile başvuran ve primer PCI ile tedavi edilen hastalarda hastane içi ve uzun dönem sonuçlarının değerlendirildiği çalışmamızda 95 aylık takipte, tüm nedenlere bağlı mortalite % 27,5 olarak bulunmuştur.
1. Szummer K, Wallentin L, Lindhagen L, Alfredsson J, Erlinge D, Held C, et al.Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014. Eur Heart J 2017;38:3056-3065.
2. World Health Organization, Top 10 causes of death. http://www9.who.int/gho/mortality_burden_disease/causes_death/top_10/en/
3. Fervers B, Burgers JS, Haugh MC, Latreille J, Mlika-Cabanne N, Paquet L, et al. Adaptation of clinical guidelines: literature review and proposition for a framework and procedure. Int J Qual Health Care 2006;18:167-76.
4. Ui S, Chino M, Isshiki T. Rates of primary percutaneous coronary intervention worldwide. Circ J 2005 ;69:95-100.
5. The Lancet. 40 years of percutaneous coronary intervention: where next? Lancet 2017;390:715.
6. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), European Heart Journal 2018 ; 39,3021–3104.
7. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD), European Heart Journal 2020; 41,255–323.
8. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-100.
9. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, Stokkel MP, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006; 48 :2508-14.
10. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18, 499-502.
11. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37: 3232–3245.
12. Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, et al. FAST MI Investigators. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 2012; 308: 998–1006.
13. Kristensen SD, Laut KG, Fajadet J, Kaifoszova Z, Kala P, Di Mario, et al. European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J 2014;35:1957–1970.
14. Yao H, Ekou A, Hadéou A, N’Djessan JJ, Kouamé I, N’Guetta R. Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study. BMC Cardiovasc Disord 2019;19: 65.
15. Agarwal SK, Singla I, Hreybe H, Saba S. Clinical predictors of late death in survivors of acute myocardial infarction. Tex Heart Inst J 2009; 36 :24-30.
16. 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 2018; 39 : 119-177.
17. Zorbozan O, Cevik AA, Acar N, Ozakin N, Ozcelik H, Birdane A, et al. Predictors of mortality in ST-elevation MI patients: A prospective study. Medicine (Baltimore) 2018; 97: e0065.
18. Hannan EL, Zhong Y, Jacobs AK, Holmes DR, Walford G, Venditti FJ, et al. Effect of onset-to-door time and door to-balloon time on mortality in patients undergoing percutaneous coronary interventions for ST-segment elevation myocardial infarction. Am J Cardiol. 2010;106:143–7.
19. Budzianowski J, Pieszko K, Burchardt P, Rzeźniczak J, Hiczkiewicz J. The Role of Hematological Indices in Patients with Acute Coronary Syndrome. Dis Markers 2017;2017:3041565.
20. Ensrud K, Grimm RH Jr. The white blood cell count and risk for coronary heart disease. Am Heart J 1992 ;124:207-13
21. Yarnell JW, Baker IA, Sweetnam PM, Bainton D, O'Brien JR, Whitehead PJ, et al. Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies. Circulation 1991;83:836-44.
22. Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al; CAPRIE Investigators. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke 2004;35:1147-52.
23. Huczek Z, Kochman J, Filipiak KJ, Horszczaruk GJ, Grabowski M, Piatkowski R, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005 ;46:284-90.
Evaluation of Intra-hospital and Long-term Mortality in Patients Presenting with ST-segment Elevation Myocardial Infarction: A Tertiary Cardiology Center Experience
Year 2020,
Volume: 10 Issue: 4, 600 - 607, 15.12.2020
Objective: Ischemic heart disease remains the leading cause of death. Not only strategies of health care providers but also population characteristics are also important to extend life expectancy in patients with cardiovascular disease. Thus clinical studies including national cohort of patients provide important insights into the real-life health care. We aimed to assess intra-hospital and long-term outcomes in patients with ST-elevation myocardial infarction (STEMI).
Materials and Methods: A total of 178 STEMI patients treated with primary percutaneous coronary intervention (PCI), who were documented to be death or responded the telephone interview, were included into the analyses. These patients were divided into three groups according to age (Group-1: <35 years, Group-2: ≥35-60 years, and Group-3: ≥ 60 years). Mortality and nonfatal cardiovascular complications were compared in three groups.
Results: Median period of follow-up was 95 months. At the intra-hospital period, re-myocardial infarction was occurred in 4 patients while death was seen in 4. During the long term follow-up, re-myocardial infarction was occurred in 30 patients. Incidence of re-myocardial infarction did not differ among the groups. Long-term mortality among study patients was found to be 27.5 % (n=49). The mortality rates between the groups were significantly different (13.3% for group-1, 16.8% for group-2, 53.5% for group-3, respectively) (p <0.001)
Conclusion: In conclusion, the present study is an evaluation of intra-hospital and long-term outcomes in patients presented with STEMI and treated with primary PCI. Over the 95 months follow-up, all cause mortality was found to be 27.5% in those.
1. Szummer K, Wallentin L, Lindhagen L, Alfredsson J, Erlinge D, Held C, et al.Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014. Eur Heart J 2017;38:3056-3065.
2. World Health Organization, Top 10 causes of death. http://www9.who.int/gho/mortality_burden_disease/causes_death/top_10/en/
3. Fervers B, Burgers JS, Haugh MC, Latreille J, Mlika-Cabanne N, Paquet L, et al. Adaptation of clinical guidelines: literature review and proposition for a framework and procedure. Int J Qual Health Care 2006;18:167-76.
4. Ui S, Chino M, Isshiki T. Rates of primary percutaneous coronary intervention worldwide. Circ J 2005 ;69:95-100.
5. The Lancet. 40 years of percutaneous coronary intervention: where next? Lancet 2017;390:715.
6. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), European Heart Journal 2018 ; 39,3021–3104.
7. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD), European Heart Journal 2020; 41,255–323.
8. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-100.
9. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, Stokkel MP, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006; 48 :2508-14.
10. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18, 499-502.
11. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37: 3232–3245.
12. Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, et al. FAST MI Investigators. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 2012; 308: 998–1006.
13. Kristensen SD, Laut KG, Fajadet J, Kaifoszova Z, Kala P, Di Mario, et al. European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J 2014;35:1957–1970.
14. Yao H, Ekou A, Hadéou A, N’Djessan JJ, Kouamé I, N’Guetta R. Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study. BMC Cardiovasc Disord 2019;19: 65.
15. Agarwal SK, Singla I, Hreybe H, Saba S. Clinical predictors of late death in survivors of acute myocardial infarction. Tex Heart Inst J 2009; 36 :24-30.
16. 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 2018; 39 : 119-177.
17. Zorbozan O, Cevik AA, Acar N, Ozakin N, Ozcelik H, Birdane A, et al. Predictors of mortality in ST-elevation MI patients: A prospective study. Medicine (Baltimore) 2018; 97: e0065.
18. Hannan EL, Zhong Y, Jacobs AK, Holmes DR, Walford G, Venditti FJ, et al. Effect of onset-to-door time and door to-balloon time on mortality in patients undergoing percutaneous coronary interventions for ST-segment elevation myocardial infarction. Am J Cardiol. 2010;106:143–7.
19. Budzianowski J, Pieszko K, Burchardt P, Rzeźniczak J, Hiczkiewicz J. The Role of Hematological Indices in Patients with Acute Coronary Syndrome. Dis Markers 2017;2017:3041565.
20. Ensrud K, Grimm RH Jr. The white blood cell count and risk for coronary heart disease. Am Heart J 1992 ;124:207-13
21. Yarnell JW, Baker IA, Sweetnam PM, Bainton D, O'Brien JR, Whitehead PJ, et al. Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies. Circulation 1991;83:836-44.
22. Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al; CAPRIE Investigators. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke 2004;35:1147-52.
23. Huczek Z, Kochman J, Filipiak KJ, Horszczaruk GJ, Grabowski M, Piatkowski R, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005 ;46:284-90.
Savaş G, Kızılay M, Süzer M. Evaluation of Intra-hospital and Long-term Mortality in Patients Presenting with ST-segment Elevation Myocardial Infarction: A Tertiary Cardiology Center Experience. Sakarya Tıp Dergisi. December 2020;10(4):600-607. doi:10.31832/smj.778996