PRIMARY PERCUTANEOUS CORONARY INTERVENTION (PPCI) IN HOSPITAL WITHOUT REGIONAL CARDIAC SURGERY SUPPORT, DATA FROM SPLIT REGION
Autori:
Lovel Giunio, Ivica Vuković, Darko Duplančić, Dinko Mirić, Branimir Marković, Jakša Zanchi, Ivica Kristić
Sažetak
Svrha rada: Cilj je istraživanja istražiti izvedivost programa PCI u bolnici bez kardiokirurške potpore, i usporediti naše rezultate sa smjernicama i skupinom konzervativno liječenih bolesnika u razdoblju prije uvođenja primarne perkutane koronarne intervencije (pPCI). Metode: Podatci o svim bolesnicima s akutnim infarktom miokarda sa ST elevacijom (STEMI) liječenim pPCI prospektivno su bilježeni. Rezultati: Od početka programa pPCI od siječnja 2005. do listopada 2007. godine kada je u našoj ustanovi započeo s radom Odjel kardiokirurgije liječeno je 366 bolesnika. Unutarbolnička smrtnost iznosila je 6,3%, u usporedbi s 15% (87/583) u skupini konzervativno liječenih bolesnika u trogodišnjem razdoblju prije uvođenja pPCI. Prosječno vrijeme od početka boli do postavljanja balona iznosilo je 315 minuta, vrijeme od boli do prvoga medicinskog kontakta 102 minute, vrijeme od prvoga medicinskog kontakta do vrata bolnice 94 minute, vrijeme od vrata bolnice do laboratorija 84 minute, vrijeme od laboratorija do otvaranja krvne žile 45 minuta, a vrijeme od vrata do postavljanja balona 129 minuta. Zaključak: Analiza rezultata pokazuje da je uvođenje programa primarne PCI u bolnici bez kardiokirurške potpore u regiji sigurno i da pruža značajnu redukciju mortaliteta u bolesnika sa STEMI. U organizaciji službe za zbrinjavanje akutnog infarkta miokarda treba naglasiti agresivno rješavanje vremenskog zastoja u primjeni pPCI unutar bolnice.
Summary
Objectives: The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our »real-world« results to current guidelines and historical controls. Methods: Data of all STEMI patients treated by PCI were prospectively recorded. Results: From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. Conclusions: Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital time delays should be managed aggressively.
