Akutna okluzija koronarne arterije kao pretkazatelj ishoda bolesnika s akutnim infarktom miokarda

doctoral thesis

• Title (english): Acute coronary occlusion as a predictor of outcome in patients with acute myocardial infarction
• Author: Tomislav Krčmar
• Mentor: Nikola Bulj (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2019-10-24, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Akutni infarkt miokarda vodeći je uzrok smrtnosti u razvijenim zemljama unatoč
napretku u liječenju. Koristeći angiografski nalaz koronarnih arterija reklasificirali smo
ispitanike na one s angiografski dokazanom okluzijom koronarne arterije i na one bez okluzije.
Na taj način pokušali smo se približiti točnijoj patofiziološkoj podjeli infarkta miokarda. Ispitali
smo je li nalaz okluzije koronarne arterije neovisni pretkazatelj preživljenja.
U opservacijskom prospektivnom istraživanju sakupljeni su podatci o ispitanicima s
AIM u razdoblju od 1. 6. 2011. do 1. 1. 2017. godine. Praćenje ishoda bolesnika trajalo je do 1.
1. 2019. godine. Podatci su dobiveni iz postojećih elektronskih baza podataka u bolničkom
sustavu i iz baze podataka umrlih Hrvatskog zavoda za javno zdravstvo.
Na uzorku od 2483 ispitanika okluzija koronarne arterije potvrđena je kao neovisni
pretkazatelj smrtnosti u praćenju od 30 dana (p=0,000). U dugoročnom praćenju nije bila
neovisni pretkazatelj smrtnosti (HR 0,919, 95% CI 0,760–1,110, p=0,379). Dobiveni neovisni
pretkazatelji opće smrtnosti su: dob, anemija, VT kod dolaska ili tijekom PCI, glikemija, EFLV,
mitralna regurgitacija, aortna stenoza.
Bolesnici s NOIM bili su stariji, s više komorbiditeta, i ukupno su dugoročno imali
slabiji ishod. Bolesnici s OIM imali su viši mortalitet u kratkoročnom tridesetodnevnom
praćenju dok su dugoročno imali bolju prognozu koja nije imala statističku značajnost.

Abstract (english)

Acute myocardial infarction remains the leading cause of death in the developed world,
despite advances in the treatment. We used the coronary angiography to reclassify subjects into
those with the angiographically occluded coronary artery and those without occlusion. Our goal
was to better define the underlying pathophysiology of acute myocardial infarction. The aim of
the study was to evaluate prognostic impact of acute occlusion of coronary artery on outcome.
We performed observational, prospective study from January 2011-January 2017 in
University Hospital Sestre milosrdnice. Follow up period lasted until 1.1.2019. The study
population was 2483 patients. Mortality rates in thirty-day follow up were higher among
patients with occlusive myocardial infarction (7,3% vs. 3,6%, p=0000). In the long term follow
up patients with the non-occlusive myocardial infarction had higher mortality rates without
statistically significance (19% vs. 21,5%, p=0,374). We identified independent risk factors for
long term mortality: age, peripheral artery disease, anemia, ventricular tachycardia at admission
or during PCI, glucosae levels at admission, left ventricular ejection fraction, mitral
regurgitation and aortic stenosis.
Patients with the occlusive myocardial infarction had higher mortality rates in thirty-day
follow up. After long term follow up had better prognosis but difference didn’t meet statistical
significance.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:147084
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 110 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:35:43