3layout original Article dr Anita suryo
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ehx393 ESC 2017 Ibanez
- Điều hướng trang này:
- Coeficcient 1.172 -19.547 0.409 1.073 0.928 0.676 3.519 1.232 -1.151 -0.382 0.011 0.00 Hazard Ratio
- P Value 0.177 0.999 0.136 0.00* 0.280 0.389 0.001* 0.301 0.012* 0.018* 0.340 0.981 95% CI
| Mortality (-)
47% 8% 45% 12.7% 78.8% 66.1% 79.9% 78.9% 1.2% 0.9% 15.7% 82.2% Mortality (+) 84% 4% 12% 12% 88% 84% 88% 96% 4.2% 4.2% 25% 66.7% P value 0.002* 1.00 0.398 0.105 0.609 0.038* 0.148 Note. LM = left main; LAD = left anterior descending; LCx = left circumflex; RCA = right coronary artery; TIMI = thrombosis in myocardial infarction study group Table 4.4 Bivariate selection of baseline characteristics contributing to mortality Variables Family History of CHD History of CABG Rhythm presentation KILLIP Class Random Blood Glucose HbA1c Category Complete vs Non complete revascularization Culprit TIMI Flow GRACE Heart Rate Coeficcient 1.172 -19.547 0.409 1.073 0.928 0.676 3.519 1.232 -1.151 -0.382 0.011 0.00 Hazard Ratio 3.229 0.00 1.505 2.924 2.529 1.969 4.680 3.429 0.316 0.682 1.011 1.00 Note. TIMI = thrombosis in myocardial infarction study group; CHD = coronary heart disease; CABG = coronary artery bypass grafting; 95 CI = 95% confidence interval P Value 0.177 0.999 0.136 0.00* 0.280 0.389 0.001* 0.301 0.012* 0.018* 0.340 0.981 95% CI 0.590-17.678 0.00-0.00 0.879-2.577 1.644-5.201 0.469-13.625 0.422-9.196 2.414-6.822 0.332-35.405 0.129-0.775 0.497-0.938 0.988-1.035 0.968-1.033 Most common complications developed during hospitaliza- tions and correlated to the mortality were shock, acute heart failure, pneumonia, stroke, acute renal failure, cardiac arrest, and arrhythmia (VT/VF, AF/SVT, TAVB/junctional/Second degree AV Block). 29,30 Our study found 3 variables that were significantly different during the treatment groups (table 3.4), those were cardiogenic shock (P 0.011), cardiac arrest (P 0.00), and VT/VF rhythm (P 0.00). In which duration of stay were not significantly correlated to complications and primary clinical outcome (P 0.105). However treatment cost were significantly different among treatment groups (P 0.003). Patients treated with medical treatment only require substantially higher cost of IDR 57.100.000 ± 55.690.000. Our study also analyzed the effect of complications toward primary clinical outcome of mortality. 4 variables are significantly correlated to mortality, those were cardiogenic shock (P 0.00), acute heart failure (P 0.00), cardiac arrest (P 0.00), and VT/VF rhythm (P 0.00). Baseline characteristics that were correlated with primary clinical outcome were family history of CHD (P 0.05), KILLIP Class (P 0.00), random blood glucose (P 0.007), HbA1C (P 0.002) (table 4.4). Lourdes Vincent et al. concluded that KILLIP Class were significantly A. S. Santoso, et al. Heart Sci J 2022; 3(2): 10-17 16 Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Pedoman tata laksana sindrom koroner akut. Edisi ke-4. Jakarta: PERKI; 2418. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio AL, Crea F, Goudevenos JA, Halvorsen S, Hindricks G. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal. 2018 Jan 7;39(2):119-77. Bohula E, Morrow D. ST-elevation myocardial infarction: manage- ment. Dalam: Zipes DP, Libby P, Bonow RO, editors. Braunwald’s Heart Disease: a Textbook of Cardiovascular Medicine. Edisi ke-11. Philadelphia, PA: Elsevier; 2018 Guo, Q., Huang, J., Shen, Y. et al. The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospec- tive cohort study. BMC Cardiovasc Disord 24, 247 (2424). https://- doi.org/10.1186/s12872-024-01479-0 Chotechuang Y, Phrommintikul A, Kuanprasert S, et al. Cardiovas- cular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial. Heart Asia 2419;11:e011241. doi:10.1136/hearta- sia-2419-011241. Huo Y. Current status and development of percutaneous coronary intervention in China. J Zhejiang Univ Sci B. 2410;11(8):631–3. JW Wu, H Hu, D Li, LK Ma. In-hospital outcomes of delayed stenting in hemodynamically stable patients with ST-segment elevation myocardial infarction: the CCC (Care for Cardiovascular Disease in China) project. Cardiovasc Diagn Ther 2419;9(5):462-471 | http://dx.doi.org/10.31037/cdt.2419.08.10. Kofoed, K. F., Kelbæk, H., Hansen, P. R., et al. Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. 2418; In Circulation (Vol. 138, Issue 24, pp. 2741–2750). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/circulationa- ha.118.037152 Ki, Y.-J., Kang, J., Yang, H.-M., Woo Park, K., et al. Immediate Compared With Delayed Percutaneous Coronary Intervention for Patients With ST-Segment–Elevation Myocardial Infarction 1. 2. 3. 4. 5. 6. 7. 8. 9. correlated with higher in hospital mortality. They were also more likely to have anterior lesions and tend to develop in hospital complications. 30 Our study also found that patients with LAD lesion exerted higher mortality rate compared to other culprit lesions (table 4.3). However from multivariate analysis we were able to conclude that treatment groups were the single most significant predictor contributing to mortality with adjusted HR of 4.506 (P 0.00). Adjusted HR for treatment group was substantially higher compared to other significant factors related to mortality eg. KILLIP Class and culprit lesion (table 4.5). Although our study provided clear evidence of positive outcome in early PPCI strategy, there were several limitations that could not be addressed in this study. Grouping of study subjects were based solely on broad category of early, late, and optimal medical therapy rather than using time series. Therefore, we were not able to pinpoint the effect of hourly delay in the primary clinical outcome, and concurrently the most optimal time to perform PPCI. We also limited our observation only during hospital stay, thus we did not measure the long-term effect early vs delayed PPCI vs non revascularized patients in terms of major adverse cardiac events (MACE). However, despite this limitations we were still able to conclude that early PPCI is the most appropriate strategy for STEMI patients to reduce in-hospital mortality and immediate lethal cardiovascular complications. tải về 251.28 Kb. Chia sẻ với bạn bè của bạn:
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