2013, vol. 19, br. 3-4, str. 64-70
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Uticaj prehospitalnog davanja klopidogrela kod bolesnika sa akutnim infarktom miokarda i elevacijom ST segmenta lečenih primarnom perkutanom koronarnom intervencijom na pojavu kardijalnih i cerebrovaskularnih neželjenih događaja
Influence of prehospital administration of clopidogrel in patients with acute myocardial infarction with ST segment elevation treated with primary percutaneous intervention on the occurrence of cardiac and cerebrovascular adverse events
aVojnomedicinska akademija, Klinika za kardiologiju, Beograd, Srbija bKlinički centar Srbije, Klinika za kardiologiju, Beograd, Srbija cGradski zavod za hitnu medicinsku pomoć, Beograd dKlinicki centar Crne Gore, Podgorica, Crna Gora eZavod za zaštitu železničara Srbije, Beograd
e-adresa: stefanovic.jelena1@gmail.com
Sažetak
Uvod. Akutni infarkt miokarda je oblik koronarne bolesti srca koji nastaje zbog potpune okluzije koronarne arterije. Dvostruka antiagregaciona terapija, koja se sastoji od aspirina i klopidogrela, čini kamen temeljac farmakoterapije, nakon primarne perkutane koronarne intervencije (pPCI) kod bolesnika sa akutnim infarktom miokarda i elevacijom ST segmenta (STEMI), sa ciljem smanjenja učestalosti ponovnih ishemijskih događaja. Cilj rada. Ispitati uticaj prehospitalnog davanja udarne doze klopidogrela, na pojavu glavnih neželjenih kardijalnih i cerebrovaskularnih događaja (MACCE - Major adverse cardiac and cerebrovascular events) kod bolesnika lečenih pPCI. Metod. Studija je sprovedena kao prospektivna u Klinici za kardiovaskularne bolesti Kliničkog centra Srbije, u periodu od novembra 2008. godine do marta 2010. godine. Studijom je obuhvaćeno 73 bolesnika sa dijagnozom STEMI. Bolesnici, uključeni u studiju, podeljeni su u dve grupe. Prvu grupu činili su bolesnici (N=32) koji su nakon postavljanja dijagnoze STEMI dobili udarnu dozu (600 mg) klopidogrela, a potom transportovani u salu za kateterizaciju, gde je urađena pPCI (grupa I). Drugu grupu činili su bolesnici (N=41) koji su dobili klopidogrel neposredno pre primene pPCI u sali za kateterizaciju. U obe grupe bolesnika pratili smo pojavu glavnih neželjenih kardijalnih i cerebrovaskularnih događaja u bolnici i tokom prvih 30 dana od intervencije. Rezultati. U periodu praćenja od 30 dana, ukupno je bilo 9 bolesnika sa neželjenim srčanim i cerebrovaskularnim događajima (MACCE). Neželjene događaje imala su 3 (9,37%) bolesnika u grupi I i 6 (14,64%) u grupi II. Reinfarkt miokarda imala su 4 bolesnika. U grupi I - jedan (3,13%) bolesnik, u grupi II - tri (7,32%) bolesnika. Jedan od tretiranih bolesnika (2,44%) iz grupe II umro je u periodu praćenja. Ponovnu revaskularizaciju ciljne lezije (TLR - target lesion revascularization) imala su dva bolesnika. U grupi I - jedan (3,13%) bolesnik, u grupi II takođe jedan (2,44%) bolesnik. Ponovnu intervenciju na drugoj leziji u ciljnom krvnom sudu (TVR - target vessel revascularization) imala su 4 bolesnika, u grupi I - jedan (3,13%) bolesnik, u grupi II - tri (7,32%) bolesnika. Malo krvarenje imalo je 8 bolesnika, u grupi I - dva (6,25%) i u grupi II šest (14,63%) bolesnika. U našoj studiji nije bilo pojave moždanog infarkta u periodu praćenja bolesnika. Zaključak. U ovoj studiji nije nađen značajan uticaj prehospitalnog davanja klopidogrela na pojavu glavnih kardijalnih i cerebrovaskularnih neželjenih događaja u periodu od 30 dana posle primarne perkutane intervencije kod bolesnika sa akutnim infarktom miokarda i elevacijom ST segmenta.
Abstract
Introduction: Acute myocardial infarction is a form of heart disease, caused by complete occlusion of coronary artery. Dual antiplatelet therapy consisting of aspirin and clopidogrel makes the cornerstone of pharmacotherapy after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction with ST segment elevation (STEMI), with the aim of reducing the incidence of recurrent ischemic events. Objective: The aim of this study was to investigate the effect of pre-hospital benefits of clopidogrel, the occurrence of major adverse cardiac and cerebrovascular events (MACCE) in pPCI treated patients. Method: The study was conducted as a prospective study from November 2008 to March 2010 in the Clinic of Cardiology, Clinical Center of Serbia. The study involved 73 patients with STEMI. The patients included in the study were divided into two groups: the first group included patients (N=32) that were given a dose of 600 mg of clopidogrel after STEMI diagnosis, and then transported to the cardiac catheterization room and underwent pPCI. The second group consisted of the patients (N = 41) that received clopidogrel after admission to cardiac catheterization room, immediately before primary PCI. In both groups of patients was followed occurrence of MACCE during the first 30 days after the intervention. Results: In the follow-up period of 30 days, 9 patients had major adverse cardiac and cerebrovascular events (MACCE). Adverse events had 3 patients (9.37%) in group I and 6 patients (14.64%) in group II. Myocardial reinfarction had 4 patients. In group I 1 patient (3.13%), in group II 3 patients (7.32%). One of the treated patients (2.44%) from group II died during follow-up. Target lesion revascularization (TLR) had 2 patients: one (3.13%) in the group I, and one (2.44%) in the group II. Target vessel revascularization (TVR) needed 4 patients. In group I 1 patient (3.13%), in group II 3 patients (7.32%). A minor bleeding had 8 patients, 2 patients (6.25%) in group I and 6 patients (14.63%) in group II. In our study, there was no occurrence of cerebral infarction during the follow-up period. Conclusion: In this study, no significant effect was found of pre-hospital giving loading dose of clopidogrel on the occurrence of major adverse cardiac and cerebrovascular events within 30 days after primary percutaneous intervention in patients with acute myocardial infarction and ST-segment elevation.
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