Suboptimal reperfusion after primary percutaneous coronary intervention

master's thesis

• Title (croatian): Suboptimalna reperfuzija nakon primarne perkutane koronarne intervencije
• Author: Monika Praljak
• Mentor: Matias Trbušić (mentor)
• Committee member: Matias Trbušić (predsjednik povjerenstva)
• Committee member: Diana Delić-Brkljačić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Reperfusion therapy with primary percutaneous coronary intervention (PPCI) has become the gold standard for treating patients with STEMI. Despite timely reperfusion of the affected coronary artery and restoration of blood flow, suboptimal reperfusion in myocardial tissue is seen in several patients. Damage of myocardial tissue after PPCI is thought to be caused by microvascular obstruction (MVO), no-reflow phenomenon, reperfusion injury and others. To optimize myocardial salvage during PPCI, many mechanical and pharmacological agents have been developed to address these issues. The most common mechanical strategies used during PPCI are: direct stenting, mesh - covered stents, self-expanding stents, thrombectomy, distal protection devices, deferred stenting and ischemic conditioning. Pharmacological agents such as cyclosporine A, metoprolol, abciximab, nitrates, glycogen modulators, nitroprusside, and adenosine can be used as adjunctive therapy to achieve better patient outcomes. With door to balloon (D2B) times decreasing with still high mortality among STEMI patients, other issues need to be addressed such as patient - related delays, and increasing cardioprotection. Combining mechanical and pharmacological strategies still remain at an investigational stage and needs further research. In the future, evidence based medicine will change clinical guidelines on how to treat acute coronary events, which will most likely decrease long-term side effects and mortality rates.

Abstract (croatian)

Reperfuzijska terapija s primarnom perkutanom koronarnom intervencijom (PPKI) postala je zlatni standard za liječenje bolesnika sa STEMI. Unatoč pravovremenoj reperfuziji zahvaćene koronarne arterije i obnavljanju protoka krvi, suboptimalni protok krvi u miokardijalnom tkivu vidljiv je u brojnim bolesnicima. Oštećenje miokardijalnog tkiva nakon PPKI-a je uzrokovano mikrovaskularnom opstrukcijom (MVO), ne-reflow fenomenom, reperfuzijskim ozljedama i drugim. Kako bi se optimiziralo spašavanje miokarda tijekom PPKI-a, razvijena su mnoga mehanička i farmakološka sredstva za rješavanje ovih izazova. Najčešće mehaničke strategije koje se koriste tijekom PPKI-a su: direktni stenting, mrežasti stentovi, samoekspandirajući stentovi, trombektomija, distalni zaštitni uređaji, odgođeno stentiranje i ishemijsko kondicioniranje. Farmakološka sredstva kao što su ciklosporin A, metoprolol, abciximab, nitrati, modulatori glikogena, nitroprusid, adenozin mogu se upotrijebiti kao pomoćna terapija kako bi se postigli bolji ishodi kod bolesnika. U novije vrijeme se brže stiže do cath-laba, ali još uvijek je visoka smrtnost među pacijentima STEMI-a, zato treba riješiti druga pitanja kao što su kašnjenja vezana uz pacijenta i povećanje kardioprotekcije. Kombinacija mehaničkih i farmakoloških strategija i dalje ostaje u istražnoj fazi i potrebna su daljnja istraživanja. U budućnosti će „medicina na temelju dokaza“ promijeniti kliničke smjernice o liječenju akutnih koronarnih događaja, što će najvjerojatnije smanjiti dugoročne nuspojave i smrtnosti.

• Keywords: suboptimal reperfusion; STEMI
• Keywords (english): suboptimalna reperfuzija; STEMI
• Language: english
• URN:NBN: urn:nbn:hr:105:025224
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-04-19 11:35:41