Utjecaj rane primjene statina na klinički ishod u bolesnika s akutnim infarktom miokarda

master's thesis

• Title (english): Effect of early statin administration on clinical outcome in patients with the acute myocardial infarction
• Author: Petra Mjehović
• Mentor: Davor Miličić (mentor)
• Committee member: Jure Samardžić (predsjednik povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Committee member: Davor Miličić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Clinical Pharmacology and Toxicology

Abstract

Kardiovaskularne bolesti su vodeći uzrok smrtnosti u razvijenim zemljama, među kojima bolest koronarnih arterija ima najveću prevalenciju i povezana je s visokim mortalitetom i morbiditetom, a posebno je značajna klinička prezentacija u obliku akutnog koronarnog sindroma (AKS). Medikamentna terapija u AKS-u je dobro definirana, ali optimalan vremenski interval primjene nekih od lijekova nije dovoljno istražen. Cilj istraživanja jest prikupiti podatake o unutarbolničkoj smrtnosti nakon preboljenog AKS-a kod bolesnika iz KBC-a Zagreb, Klinike za bolesti srca i krvnih žila, uključenih u ISACS-CT registar u razdoblju od početka 2013. godine pa do kraja 2015. godine te utvrditi principe odabira medikamentne terapije te na koji način vrijeme primjene lijeka, u prvom redu statina, utječe na klinički ishod. S obzirom na međusobno različite rezultate dobivene kliničkim studijama, postoje nejasnoće oko optimalnog vremenskog intervala primjene. Provedena je retrospektivna opservacijska studija na ukupno 1194 bolesnika s dijagnozom AKS-a (563 pacijenata s akutnim infarktom miokarda s ST-elevacijom i 630 pacijenata s akutnim infarktom miokarda bez ST-elevacije i nestabilnom anginom pektoris; 370 žene i 823 muškaraca). Istraživanje je pokazalo da primjena statina unutar prva 24 sata nakon AKS-a značajno smanjuje unutarbolničku smrtnost. Statini su u prva 24 sata nakon AKS-a primijenjeni kod ukupno 94,1% bolesnika. Između podskupina bolesnika koji su liječeni statinima u prva 24 h nakon AKS-a i onih koji nisu, nije bilo značajne razlike u dobi, spolu, indeksu tjelesne težine, hipertenziji, šećernoj bolesti, pušenju, vrijednostima kreatinina, sistoličkoj funkciji lijeve klijetke i zatajivanju srca. Unutarbolnička smrtnost je bila značajno niža u podskupini bolesnika kod kojih su primjenjeni statini u prva 24 h nakon AKS-a (1104 bolesnika. OR 0,014, 95% interval pouzdanosti CI 0,000 - 0,795, p=0,038). Ukupna unutarbolnička smrtnost iznosila je 4%, dok je smrtnost u podskupini bolesnika kod kojih nisu primijenjeni statini unutar prva 24 h iznosila 21,7%, a u podskupini bolesnika kod kojih su primijenjeni statini unutar prva 24 h 1,8%.

Abstract (english)

Cardiovascular diseases are the leading cause of death in developed countries, among which coronary artery disease (especially acute coronary syndrome) has the highest prevalence and is associated with high morbidity and mortality rate. Pharmacological treatment options for acute coronary syndrome (ACS) are well established, but little is known about the optimal timing of administration of some of the drugs. The aim of the study was to gather data on early outcomes of ACS in patients from Clinical hospital center Zagreb, Department of Cardiology, through the ISACS-TC registry during the period from the start of 2013 till the end of 2015 and to establish the way in which timing of administration of a certain medication, especially statins, affects the clinical outcome. Regarding that clinical trials have proven different results, optimal timing of administration remains unclear. A retrospective observational study was conducted. Study population included 1194 ACS patients (563 patients with acute ST segment elevation myocardial infarction, 630 patients with non-ST segment elevation myocardial infarction + patients with unstable angina; 370 females, 823 males). The results have shown that initiation of statin therapy within the first 24 h following ACS significantly reduces in-hospital mortality. In the first 24 hours following ACS, statins were administered in 94,1% of patients. Among the early treatment positive and negative groups, patients did not differ according to age, gender, body mass index, presence of hypertension or diabetes, smoking status, creatinine levels left ventricular ejection fraction (LVEF), and the history of heart failure for each of the studied groups. The odds ratio [OR] for in-hospital death was significantly lower in the early statin group (1104 patients, OR 0,014, 95% confidence interval [CI] 0,000 - 0,795, p = 0,038). Overall in-hospital mortality rate was 4%. In patients without statins treatment within the first 24 h the mortality rate was 21,7% and only 1,8% in patients with statins treatment within the first 24 h.

• Keywords: statini; akutni koronarni sindrom; unutarbolnička smrtnost
• Keywords (english): statins; acute coronary syndrome; in-hospital mortality
• Language: croatian
• URN:NBN: urn:nbn:hr:105:084408
• Study programme: Title: Medicine; 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: 2018-03-21 09:58:07