ST yükselmeli miyokard infarktüslü vakalarda trombolitik ve primer perkütan koroner girişim ile tedavi edilen vakalarda reperfüzyon aritmisi sıklığının karşılaştırılması
Küçük Resim Yok
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ST yükselmeli miyokard infarktüsünde tedavinin en önemli aşaması miyokardiyal kanlanmanın mümkün olan en kısa sürede tekrar sağlanmasıdır. Miyokardiyal reperfüzyonu sağlamada günümüzde kullanılan iki ana tedavi yöntemi trombolitik ilaçlar ve perkutan koroner girişimlerdir.Çalışmamızda ucuz ve kolay elde edilebilen bir veri olarak reperfüzyon aritmilerinin, uygulanan tedavi sonrası koroner damar açıklığının invaziv olmayan bir göstergesi olup olmadığı araştırıldı. Çalışmaya akut ST yükselmeli miyokard infarktüsü tanısıyla takip edilen 151 hasta dahil edildi. Hastaların 54'üne primer perkutan koroner girişim ve 97'sine trombolitik tedavi uygulandı ve ilk 48 saat süresince kaydedilen reperfüzyon aritmilerinin sıklığı karşılaştırıldı. Reperfüzyon aritmisi görülmesinin elektrokardiyografide ST segment gerilemesi, infarkt yerleşim bölgesi ile ilişkisi analiz edildi. Ayrıca hastaların anjiografik olarak dokümante edilmiş koroner damar açıklıkları, infarkt ilişkili arteri ve kollateral damar varlığıyla reperfüzyon aritmisi görülmesinin ilişkisi analiz edildi. Çalışmamızın sonucunda iki grup arasında reperfüzyon aritmisi sıklığında istatistiksel olarak anlamlı farklılık saptanmadı (p=0,355). Perkutan koroner girişim uygulanan hastalarda anjiografik olarak daha yüksek oranda damar açıklığı tespit edilmesine rağmen, reperfüzyon aritmisi görülen ve görülmeyen hasta oranları istatistiksel olarak anlamlı farklılık göstermedi (p>0,05).Bu çalışma ST yükselmeli miyokard infarktüsünde gözlenen reperfüzyon aritmilerinin tek başına damar açıklığının bir göstergesi olmadığını ortaya koymuştur. Kaydedilen bazı aritmilerin devam eden damar tıkanıklığı sonucunda iskemiye bağlı aritmiler olabileceği ancak bunları reperfüzyon aritmilerinden ayırt etmenin pratik olarak şimdilik mümkün olmadığı sonucunu doğurmuştur.
The most important clinical step of ST segment elevation myocardial infarction is the urgent restoration of myocardial blood supply. Thrombolytic agents and percutaneous coronary interventions are the two fundamental therapeutic modalities currently used for myocardial reperfusion.In the present study, data from reperfusion arrhythmias that is considered as a relatively inexpensive and easily applicable were investigated to figure out whether they are among the strong markers of coronary artery patency following reperfusion therapy. 151 patients with acute ST segment elevation myocardial infarction are included in this study. Following implementation of 54 patients with percutaneous coronary intervention and treatment of 97 patients with thrombolytic therapy, frequency of reperfusion arrhythmias noted for first 48 hours are compared. The relationship of reperfusion arrhythmias presence with ST segment resolution and infarct localization are analyzed. Moreover, angiographically documented coronary artery patency, infarct related arteries and occurrence of collateral vessels in these patients are also analyzed for relationship of reperfusion arrhythmias presence. There was no statistically significant difference between two groups considering frequency of reperfusion arrhythmias (p=0,355). Among patients undergoing percutaneous coronary intervention, there was higher rates of coronary artery patency. However, there was no statically difference between the patients with reperfusion arrhythmias and the patients without reperfusion arrhythmias (p>0,05).This study revealed that presence of reperfusion arrhythmias in ST segment elevation myocardial infarction is not a marker for coronary artery patency on its own. These arrhythmias could be due to ongoing myocardial ischemia as a result of coronary occlusion yet it is impossible to distinguish between reperfusion arrhythmias on practice.
The most important clinical step of ST segment elevation myocardial infarction is the urgent restoration of myocardial blood supply. Thrombolytic agents and percutaneous coronary interventions are the two fundamental therapeutic modalities currently used for myocardial reperfusion.In the present study, data from reperfusion arrhythmias that is considered as a relatively inexpensive and easily applicable were investigated to figure out whether they are among the strong markers of coronary artery patency following reperfusion therapy. 151 patients with acute ST segment elevation myocardial infarction are included in this study. Following implementation of 54 patients with percutaneous coronary intervention and treatment of 97 patients with thrombolytic therapy, frequency of reperfusion arrhythmias noted for first 48 hours are compared. The relationship of reperfusion arrhythmias presence with ST segment resolution and infarct localization are analyzed. Moreover, angiographically documented coronary artery patency, infarct related arteries and occurrence of collateral vessels in these patients are also analyzed for relationship of reperfusion arrhythmias presence. There was no statistically significant difference between two groups considering frequency of reperfusion arrhythmias (p=0,355). Among patients undergoing percutaneous coronary intervention, there was higher rates of coronary artery patency. However, there was no statically difference between the patients with reperfusion arrhythmias and the patients without reperfusion arrhythmias (p>0,05).This study revealed that presence of reperfusion arrhythmias in ST segment elevation myocardial infarction is not a marker for coronary artery patency on its own. These arrhythmias could be due to ongoing myocardial ischemia as a result of coronary occlusion yet it is impossible to distinguish between reperfusion arrhythmias on practice.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Kardiyoloji, Cardiology
