Primary coronary intervention in ST-elevation myocardial infarction

Osszefoglalo. Bevezetes: Heveny myocardialis infarctusban a szivizommentes sikere, a beteg eletkilatasa nagymertekben fugg a panasz kezdete es az elzarodott koszoruer rekanalizalasa kozott eltelt ischaemias időtől. Jelenleg az er nyitasa optimalis esetben minden betegnel koszoruer-intervencioval tortenik. Celkitűzes: Annak vizsgalata, hogy ot ev alatt mennyit valtoztak az ischaemias idő osszetevői, es miben valtozott az elzarodott er nyitasanak modszere ST-elevacios myocardialis infarctus (STEMI) miatt vegzett primer coronariaintervencioban. Modszer: 2014. 01. 01. es 2018. 12. 31. kozott 1663, STEMI miatt koszoruer-intervencioval kezelt betegnel (1173 ferfi es 490 nő) vizsgaltuk evenkenti bontasban a panasztol a koszoruer nyitasaig eltelt idő osszetevőit es a 30 napos halalozast. Eredmenyek: Ot ev alatt a panasztol az első egeszsegugyi kontaktusig median 2:53 vs. 2:10 ora (p = 0,0132), ettől az intervencios centrumba tortent felvetelig median 1:17 vs. 1:03 ora (p = 0,009), a felveteltől a ballon nyitasaig median 0:31 vs. 0:29 ora (p = ns) telt el. A panasztol a ballon nyitasaig eltelt idő (median 5:29 vs. 4:07 ora, p = 0,0001) rovidult, dontően 2014 es 2015 kozott. A gyogyszerkibocsato stent beultetese 15%-rol 96%-ra nőtt. A vizsgalt evekben a legzes/keringes tamogatas aranya 8,2-10,6-13,9-7,6-8,4, a 30 napos halalozase 4,1-6,8-11,1-7,4-5,7% volt; a ket ertek korrelaciot mutat (p = 0,827). Kovetkeztetes: Ot ev alatt a panasztol az első egeszsegugyi kontaktusig es a korhazi beszallitasig eltelt idő rovidult, de az Europai Kardiologiai Tarsasag ajanlasahoz kepest hosszu; a korhazi felveteltől a ballon nyitasaig eltelt idő megfelelő. A negy oran beluli reperfuzio a betegek kozel feleben valosult meg. Az intervencios centrumba valo gyorsabb bekerules javithatna az eredmenyen. Orv Hetil. 2021; 162(13): 497-503. Introduction In acute myocardial infarction, the heart muscle salvage, the patient's life expectancy is highly dependent on the elapsed ischaemic time from the onset of complaint to target vessel recanalisation. Nowadays, target vessel recanalisation is performed with coronary intervention in all patients in optimal case. Objective To examine how the components of ischemic time and the opening procedure of the occluded coronary have changed over five years in primary intervention done in acute ST-elevation myocardial infarction (STEMI). Method Authors studied data of 1663 (1173 male and 480 female) STEMI patients in annual breakdowns treated with coronary intervention between 01. 01. 2014 and 31. 12. 2018, time from complaint to coronary artery opening, details of intervention and 30 days mortality rate. Results During the five years, time intervals were as follows: from onset of complaint to first medical contact: median 2:53 vs. 2:10 hours (p = 0.0132), from this to admission in the interventional centre: median 1:17 vs. 1:03 hours (p = 0.009), from hospital admission to balloon opening: median 0:31 vs. 0:29 hours (p = ns). In total, the complaint to balloon opening time (median 5:29 vs. 4:07 hours, p = 0.0001) diminished, decisively from 2014 to 2015. Ratio of drug-eluting stent implantation increased from 15% to 96%. In the investigated years, the need of respiratory and/or circulatory device support ratio was 8.2-10.6-13.9-7.6-8.4, 30-day mortality rate between 4.1-6.8-11.1-7.4-5.7%; these two values showed a correlation (p = 0.827). Conclusion The time from complaint to first medical contact and transfer to hospital against the significant decrease is still longer than the recommendation of the European Society of Cardiology. The time from hospital admission to balloon opening is adequate. Reperfusion within four hours was achieved in half of the patients in total. Faster hospitalization may improve results. Orv Hetil. 2021; 162(13): 497-503.