Naslov
Routine urgent PCI after fibrinolysis versus primary PCI in STEMI patients.

Autori
Hadžibegović, Irzal ; Prvulović, Đeiti ; Vujeva, Božo ; Gabaldo, Krešimir ; Knežević Praveček, Marijana ; Dunđer, Ivica ; Cvitkušić Lukenda, Katica ; Samardžić, Pejo

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Book of abstracts / - , 2011

Skup
2nd Dubrovnik Cardiology Highlights

Mjesto i datum
Dubrovnik, Hrvatska, 29.09.2011. - 02.10.2011

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
PCI ; STEMI patients ; fibrinolysis

Sažetak
Background: Reperfusion with primary PCI (pPCI) has been established as a treatment of choice for patients with STEMI, if it is done timely within a well organized network. However, patients treated with pPCI more than 120 minutes after first medical contact were found to have higher both short and long term mortality rates. We conducted this cross sectional study to compare results of routine urgent PCI after fibrinolysis with primary PCI for STEMI patients in the only Croatian region without 24/7 pPCI service. Methods and patients: Data were analyzed from 128 STEMI patients in Western Slavonia region treated from 7/2010 to 7/2011 in a general hospital performing PCI only in working hours. Demographic and clinical characteristics, as well as treatment strategies and in-hospital outcomes were analyzed and compared. Patients who presented late (more than 12 hours), died within 3hours of admission or had absolute contraindications for reperfusion therapy were exluded from comparisons. Results: Demographic and clinical data showed different patient characteristic than in western European countries. There were more diabetic patients (22%), patients with treated or untreated arterial hypertension (73%), and dyslipidemia (84%). Proportion of male patients was 61%. In all, 28%of patients presented with Killip class equal or higher than II, and 4%had malignant arrhytmia that required defibrilation. There were 89 (69%) patients who received reperfusion therapy, whereas 39(31%) of patients were treated conservatively, predominantly because of late presentation, or rarely absolute contraindications. Reperfusion therapy was fibrinolysis in 53(60%) patients, where as 40% of pateints received pPCI. Reason for fibrinolysis was presentation out of the working hours. There were 34(26%) patients that were transported from 2non-PCI centers, out of which 80% were transported for urgent PCI after fibrinolysis, and only 20%received pPCI. In general, pain to first medical contact was 170 minutes, and pain to balloon/needle was237 minutes. After fibrinolysis, 49(93%) patients underwent angiography, from which 76%underwent urgent angiography within 24h of lytic administration, whereas other 24%were taken to cath-lab with in 72 hours. Referral to pPCI led to successfull PCI in 90%of patients, whereas 81%of patients after fibrinolysis had successfull PCI. There were no patients referred to CABG after inital pPCI strategy, whereas 10%of were referred to CABG after post-lytic angiography. pPCI patients had LAD involvement in 66%of cases, compared to 45%of LAD involvement in fibrinolysis group. There were no diferencies in clinical or demographic data between two treatment groups. Among patients who received fibrinolysis, TIMI 2 or 3 flow on urgent angio within 24 hours was found in 83%of cases. However only 62%of patients had indirect ECGor laboratory sings of successfull reperfusion after fibrinolysis. In-hospital mortality rate was 3% and 5% in pPCI and fibrinolysis group, respectively. There was only one patient with non-serious bleeding (arm haematoma) infibrinolysis group. One patient from pPCI group had non-fatal embolic stroke from apical aneurysm. Conclusion: In regions where pPCI can not be organized in a timely fashion, urgent PCI within 24 hours of fibrinolytic administration was proved to be as safe and effective as pPCI.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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