RAZLIKE U MORTALITETU BOLESNIKA HOSPITALIZIRANIH ZBOG AKUTNOG INFARKTA MIOKARDA U KBC-u ZAGREB OVISNO O NAČINU LIJEČENJA

Maja Strozzi, Joško Bulum, Aleksander Ernst, Eduard Margetić, Ivan Škorak, Krešimir Putarek, Ivan Gornik

Sažetak. U Koronarnoj jedinici i Jedinici intenzivne skrbi Kliničkoga bolničkog centra Zagreb, tijekom 2005. godine hospitalizirana su 403 bolesnika s akutnim infarktom miokarda (AMI). Većina (288) bolesnika prezentirala se infarktom sa ST-elevacijom (STEMI), a 115 bolesnika s akutnim   infarktom bez ST-elevacije (NSTEMI). Hospitalni mortalitet STEMI bolesnika bio je 13,9% prema 9,6% u NSTEMI grupi. Kod 202 bolesnika u STEMI grupi učinjena je urgentna perkutana koronarna intervencija (PCI), a 86 bolesnika primilo je konzervativnu terapiju. Hospitalni mortalitet bolesnika liječenih primarnom PCI bio je 5,9 % prema 29,1% u grupi liječenoj konzervativno. Glavni razlog za konzervativnu terapiju bio je kasni dolazak bolesnika u bolnicu (>12 sati od početka simptoma). Kod samo 11 bolesnika visokog rizika s NSTEMI učinjena je primarna PCI, dok je 99 NSTEMI bolesnika liječeno konzervativno (hospitalni mortalitet 10,1%). Ukupno je učinjeno 218 urgentnih PCI u obje grupe bolesnika, s niskim hospitalnim mortalitetom od 6,0% u usporedbi s višim mortalitetom u konzervativno liječenim grupama. Mortalitet u PCI grupi bio je povezan s neuspješnom intervencijom i kasnom reperfuzijom. Ukupno vrijeme ishemije (6 sati i 5 minuta), kao i vrijeme od dolaska u bolnicu do reperfuzije (1 sat i 25 minuta) dulje je nego u sličnim serijama bolesnika i potrebno ih je poboljšati. Vrijeme transporta (1 sat i 40 minuta) bilo je prihvatljivo. U zaključku, kod velikog broja bolesnika (70,1%) sa STEMI i NSTEMI učinjena je primarna PCI u našoj ustanovi s primarnim uspjehom od 91,8% i niskim perioperativnim mortalitetom. Ova grupa imala je u usporedbi s konzervativno liječenim bolesnicima superiorni ishod u odnosu na hospitalni mortalitet. Još uvijek preveliki broj bolesnika hospitaliziranih zbog AMI dolazi prekasno za bilo koji oblik reperfuzije.

Summary. In Coronary Care Unit and Intensive Care Unit, Zagreb University Hospital Centre, 403 patients were hospitalized for acute myocardial infarction (AMI) in the year 2005. Majority (288) patients presented with ST-segment elevation myocardial infarction (STEMI) and 115 patients with acute myocardial infarction without ST-segment elevation (NSTEMI). In-hospital mortality of STEMI patients was 13.9% vs. 9.6% of NSTEMI group of patients. In STEMI group 202 patients underwent urgent percutaneous coronary intervention (PCI), and 86 patients in STEMI group received conservative therapy. In-hospital mortality of patients treated with primary PCI was 5.9%vs. 29.1%in the group treated conservatively. The main reason for conservative therapy was late presentation to the hospital (>12 hours from the beginning of symptoms). Only 11 high-risk patients in NSTEMI group underwent primary PCI and 99 NSTEMI patients received conservative therapy (in-hospital mortality 10.1%). We performed totally 218 urgent PCI interventions in both groups with low in-hospital mortality of 6.1 % in comparison with high mortality in conservatively treated groups of patients. The mortality in PCI group was strongly connected with unsuccessful intervention and late reperfusion. Total ischemic time (6 hours and 5 minutes), and time from hospital presentation to reperfusion -»door to balloon time« (1 hour and 25 minutes) are longer that in similar patients series, and need to be improved. Transportation time (1 hour and 40 minutes) is acceptable. In conclusion, high percentage (70.1%) of STEMI and NSTEMI patients underwent primary PCI in our institution with low perioperative mortality. This group of patients had superior in-hospital mortality when compared with conservatively treated group of patients. There is still unacceptably high percentage of patients with AMI, who came into the hospital too late for any reperfusion therapy.