Hirurška revaskularizacija miokarda u akutnom koronarnom sindromu

Abstract

Akutni koronarni sindrom (ACS) je dramatična manifestacija ishemijske, koronarne, bolesti srca u čijoj osnovi se nalazi naglo nastalo smanjenje ili prekid dotoka krvi određenim delovima srčanog mišića. U osnovi lečenja ACS je dvojna antitrombocitna terapija. S obzirom na činjenicu da oko 10% pacijenata sa ACS zahteva hirurško lečenje tokom inicijalne hospitalizacije, ovakva terapija predstavlja opasnost zbog moguće pojave povećanog postoperativnog krvarenja i povećane potrebe za transfuzijama krvi, koje dovode do povećane učestalosti postoperativnih komplikacija i potencijalno uslovljavaju povećan mortalitet. Ciljevi istraživanja su bili da se ispita da li je učestalost komplikacija hirurškog lečenja veća kod bolesnika koji su hitno operisani unutar pet dana od davanja poslednje doze klopidogrela, od učestalosti komplikacija kod pacijenata koji su operisani u istoj hospitalizaciji kada je rađena koronarografija, ali nakon više od pet dana od poslednje doze klopidogrela, zatim da se utvrdi da li oni više krvare, da li je količina transfuzija derivata krvi veća kod tih bolesnika kao i da se utvrdi da li je trajanje ukupne hospitalizacije i trajanje boravka u intenzivnoj nezi veće kod bolesnika koji su operisani unutar pet dana od davanja poslednje doze klopidogrela. Materijal i metod: Ovo istraživanje je osmišljeno kao kohortna studija. Obuhvaćeno je 180 bolesnika operisanih u periodu od aprila 2008 godine do decembra 2016 godine. Ispitivanu populaciju su činili bolesnici sa ACS, odnosno oni koji su zbog ACS primljeni na kliniku i koji su, nakon urađene koronarografije operisani u istoj hospitalizaciji od strane jednog hirurškog tima. U prvoj (studijskoj grupi), bilo je 94 pacijenta (oni koji su operisani od prvog do četvrtog dana nakon dobijanja poslednje doze klopidogrela, odnosno nakon koronarografije), dok je u drugoj grupi bilo 86 pacijenata (oni kojima je poslednja doza klopidogrela data pre više od 4 dana). Statistička analiza je uradjena korišćenjem statističkog programa SPSS (SPSS for Windows, release 24.0, SPSS, Chicago, IL)...

Introduction: Acute coronary syndrome (ACS) is a dramatic manifestation of ischemic heart disease. The cause of ACS is a sudden reduction, or interruption of the blood supply to certain parts of the heart muscle. Antithrombotic therapy is the base of the ACS treatment (i.e. double antithrombotic therapy: aspirin + clopidogrel or ticagrelor). The fact is that approximately 10% of patients with ACS require surgical treatment during initial hospitalization, but in those patients such therapy poses a risk for postoperative bleeding and increased need for blood transfusions leading to increased incidence of postoperative complications and potentially conditioning increased mortality. The aims of the study: was to examine whether the incidence of complications of surgical treatment was higher in the group of patients who were urgently operated within five days of giving the last dose of clopidogrel, than in patients who were operated in the same hospitalization when coronarography was performed, but after more than five days after clopidogrel discontinuation, then to determine whether patients had more bleeding, as well as whether the amount of transfusions of erythrocytes, platelets and other blood derivatives is higher and to determine whether the duration of total hospitalization as well as the duration of stay in intensive care is greater in patients who are operated within five days after clopidogrel discontinuation. Material and Method: This research is designed as a cohort study. 180 patients were operated in the period from April 2008 to December 2016. The population surveyed were patients with ACS (those who, due to ACS, were admitted to the clinic) and who were, after the performed coronarography, operated during the same hospitalization by the same surgical team. In the first (study group), there were 94 patients (those who were operated from the first to the fourth day after receiving the last dose of clopidogrel), while in the second group there were 86 patients (those who received the last dose of clopidogrel more than 4 days). The statistical analysis was done using the statistical program SPSS (SPSS for Windows, release 24.0, SPSS, Chicago, IL).