scholarly journals A szívinfarktus miatt kezelt betegek ellátása Magyarországon. A Nemzeti Szívinfarktus Regiszter 2015. évi adatainak elemzése

2017 ◽  
Vol 158 (3) ◽  
pp. 90-93 ◽  
Author(s):  
András Jánosi ◽  
Péter Ofner ◽  
Fahmi Al-Maktari ◽  
Erik Hajkó ◽  
Krisztina Hati ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Invasive Procedure ◽  
Coronary Intervention ◽  
Coronary Arteriography ◽  
Registry Data ◽  
Myocardial Infarctions ◽  
Prehospital Thrombolysis ◽  
International Registry ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract: The authors summarize the most relevant data of myocardial infarction patients according to the National Myocardial Infarction Registry data base. In 2015 12,681 patients had 12,941 acute myocardial infarctions. Less than half of patients (44.4%) were treated with ST elevation myocardial infarction. National Ambulance Service was the first medical contact of more than half (51.4%) of patients with ST elevation infarction. Prehospital thrombolysis was occasionally done (0.23%), but 91.6% of the patients were treated in hospital with invasive facilities. The median of the ischaemic time (time between onset of symptoms and arrival at the invasive laboratory) was 223 minutes. Most of the patients (94%) with positive coronary arteriography were treated with percutaneous coronary intervention. The 30 day mortality of the whole group was 12.8% vs. 8.6% of patients treated with an invasive procedure. Conclusion: comparing the national and international registry data we conclude that we should analyse and decrease the prehospital delay time to improve the patient care in Hungary. Orv. Hetil., 2017, 158(3), 90–93.

Abstract 84: Thirty-day Mortality of Patients with ST-Elevation Myocardial Infarction (STEMI) According to Hospital Reperfusion Strategy: The Importance of Examining Outcomes of Both Treated and Not Treated Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Laurie J Lambert ◽  
Yongling Xiao ◽  
Simon Kouz ◽  
Stéphane Rinfret ◽  
Eli Segal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Final Diagnosis ◽  
Reperfusion Therapy ◽  
Myocardial Infarctions ◽  
Treatment Delays ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Reperfusion Strategy

BACKGROUND: In Quebec (Canada), patients with STEMI present to 1 of 4 types of hospitals: 1) primary percutaneous coronary intervention (PPCI) centers; 2) non-PPCI centers that systematically transfer patients for PPCI; 3) ‘mixed centers’ that transfer some patients for PPCI and treat others with fibrinolysis; and 4) centers that exclusively treat with fibrinolysis. In all centers, substantial proportions of STEMI patients do not receive any reperfusion therapy for a variety of reasons. Overall STEMI outcomes may vary by type of reperfusion strategy and who is selected to receive it. METHODS: All acute care centers that annually treated ≥ 30 acute myocardial infarctions participated in 2 field evaluations (n=80 in 2006-7; n=81 in 2008-9). All patients had a final diagnosis of myocardial infarction, characteristic symptoms and STEMI confirmed by centralized ECG interpretation. Clinical factors and comorbidities were compared across type of center for all patients, and by reperfusion therapy status. Odds ratios (OR) of 30-day mortality were estimated separately for treated, untreated and all STEMI patients. RESULTS: Of the 3731 STEMI patients, 29.7% presented to PPCI-capable centers, 33.0% to exclusive PPCI transfer centers, 26.7% to mixed centers (66% transferred for PPCI, 34% received fibrinolysis) and 10.6% to exclusive fibrinolysis centers. The proportion of untreated patients increased with decreasing PPCI access: 16.7% in PPCI centers, 21.4% in transfer PPCI centers, 24.9% in mixed centers and 29.8 % in fibrinolysis centers. Mixed center patients transferred for PPCI had the longest treatment delays (only 17% within guidelines). For treated patients, there were no significant differences in adjusted OR across type of center (see Table). However, for untreated patients, risk of death was significantly higher in transfer PPCI and mixed centers compared to PPCI centers. Risk was significantly higher in mixed centers for all STEMI patients combined. CONCLUSION: These findings suggest that in centers that transfer for PPCI, treatment selection bias may mask important disparities in STEMI outcomes, especially in centers with long transfer delays. When evaluating hospital outcomes for STEMI, it is important to examine not only those who are treated but also patients who do not receive reperfusion therapy.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

Risk factors of coronary microvascular obstruction (Preprint)

2020 ◽  
Author(s):  
Yong Li ◽  
Shuzheng Lyu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Neutrophil Percentage ◽  
Percutaneous Coronary ◽  
St Elevation

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention

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