Title ISHODI LIJEČENJA AKUTNOG INFARKTA MIOKARDA S ELEVACIJOM ST SEGMENTA ZA VRIJEME PANDEMIJE COVID - 19 U KLINIČKOM BOLNIČKOM CENTRU RIJEKA : RAD S ISTRAŽIVANJEM Title (english) OUTCOMES OF TREATMENT OF ACUTE MYOCARDIAL INFARCTION WITH ST - SEGMENT ELEVATION DURING THE COVID - 19 PANDEMIC AT CLINICAL HOSPITAL CENTER RIJEKA : RESEARCH Author Lea Saftić Mentor Vjekoslav Tomulić (mentor)Committee member Zlatko Čubranić (predsjednik povjerenstva)Committee member David Gobić (član povjerenstva)Committee member Tomislav Krčmar (član povjerenstva)Granter University of Rijeka Defense date and country 2024-09-02, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Uvod: Akutni infarkt miokarda (IM) je oštećenje miokarda uzrokovano potpunim začepljenjem ili kritičnom stenozom koronarne arterije s oslabljenim protokom. Klasificira se u dvije različite skupine a to su STEMI (eng.: ST Elevation Miocardial Infarction) koji uključuje elevaciju ST segmenta u EKG (Elektrokardiografija) zapisu i NSTEMI (eng.: Non ST Elevation Miocardal Infarction) kod kojeg ST elevacija u EKG zapisu nije prisutna. Bolesnika sa visokorizičnim IM potrebno je podvrgnuti hitnoj PCI (eng.: Percutaneous Coronary Intervention) unutar 2 sata od pojave simptoma. Pandemija COVID-a 19 (eng.: Coronavirus Disease 2019) donijela je brojne promjene u zdravstvu i pristupu hitnim intervencijama.
Cilj istraživanja: Ovo istraživanje ima za svrhu predstaviti tehniku liječenja pPCI (eng.: Primary Percutaneous Coronary Intervention), ali i prikazati utjecaj globalno nepovoljnih uvjeta tijekom razdoblja pandemije na ishode liječenja te nedostatke u liječenju kritičnih zdravstvenih stanja (poput STEMI-ja)
Ispitanici i metode: U istraživanje je uključeno 218 bolesnika hospitaliziranih zbog STEMI – ja u KBC-u (Klinički bolnički centar) Rijeka u razdoblju od 01.ožujka 2019. do 31.lipnja 2019. godine (predpandemijsko razdoblje) i od 01. ožujka 2020. do 31. lipnja 2020. godine (razdoblje COVID-19 pandemije). Podaci su se prikupljali iz IBIS - a (Integrirani bolnički informacijski sustav). Glavni kriterij kod odabira bolesnika bio je akutni infarkt miokarda s elevacijom ST segmenta.
Rezultati: Prosječna dob bolesnika bila je 66,9 ± 11,7 godina, a zastupljeniji je bio muški spol. Razlika u broju primljenih bolesnika sa STEMI - jem te izvedenih hitnih pPCI nije statistički značajna. Nije dokazano da je prisutnost faktora rizika (ranije preboljeli infarkt miokarda, prethodno učinjena PCI te prisustvo srčanih premosnica), negativno utjecala na ishod liječenja tijekom pandemije u usporedbi sa prijepandemijskim periodom. Vrijednosti TnT - a (Troponin T) prilikom prijema u bolnicu kod bolesnika primljenih zbog STEMI-ja 2019. godine iznosi 219,0 (10-2468) ng/L, dok vrijednosti TnT - a 2020. godine iznose 518,8 (5-6116) ng/L što čini statistički značajnu razliku. U usporedbi maksimalne razine TnT - a ne postoji značajna razlika. Trajanje hospitalizacije 2019. godine bilo je 5,0 ± 3,6 dana, a 2020. godine 4,2 ± 2,4 dana što čini statistički značajnu razliku. Prije pandemije 2019. godine prosječna vrijednost sistoličke funkcije lijevog ventrikula iznosi 44 ± 8,7 % dok pandemijske 2020. godine prosječna vrijednost sistoličke funkcije lijevog ventrikula iznosi 44 ± 8,8 % te ovdje ne postoji statistički značajna razlika. Trajanje boravka u jedinici intenzivnog liječenja nije se statistički značajno razlikovalo. Hospitalni mortalitet u prvoj skupini iznosio je 1,9 % a u drugoj 5,2 % što nije statistički značajno.
Zaključak: Dobivenim rezultatima dokazano je kako osim u trajanju hospitalizacije i u razini visoko osjetljivog TnT - a iz venske krvi prilikom prijema bolesnika nema statistički značajne razlike između bolesnika sa preboljenim STEMI - jem prije pandemije (2019. godine) i tijekom pandemije COVID - om 19.
Abstract (english) Introduction: Acute myocardial infarction (MI) is myocardial damage caused by complete occlusion or critical stenosis with impaired blood flow of a coronary artery. It is classified into two distinct groups: STEMI (ST Elevation Myocardial Infarction), characterised by ST -segment elevation on the ECG (Electrocardiography), and NSTEMI (Non - ST Elevation Myocardial Infarction), where ST - segment elevation is absent. High-risk MI patients should undergo urgent PCI (Percutaneous Coronary Intervention) within 2 hours of symptom onset. The COVID - 19 pandemic brought significant changes to healthcare and emergency intervention approaches.
Aim of the Study: This study aims to present the treatment technique of pPCI (Primary Percutaneous Coronary Intervention) and to demonstrate the impact of globally adverse conditions during the pandemic on treatment outcomes and the shortcomings in treating critical health conditions such as STEMI.
Participants and Methods: The study included 218 patients hospitalised for STEMI at the Clinical Hospital Center (CHC) Rijeka from March 1, 2019, to June 31, 2019 (pre-pandemic period), and from March 1, 2020, to June 31, 2020 (COVID - 19 pandemic period). Data were collected from the IBIS (Integrated Hospital Information System). The primary criterion for selecting patients was acute myocardial infarction with ST-segment elevation.
Results: The average age of patients was 66.9 ± 11.7 years, with a higher prevalence of males. The difference in the number of admitted STEMI patients and emergency pPCI performed was insignificant. The presence of risk factors (previous myocardial infarction, prior PCI, and the presence of coronary bypass grafts) did not negatively impact treatment outcomes during the pandemic compared to the pre-pandemic period. The TnT (Troponin T) levels at hospital admission for STEMI patients in 2019 were 219.0 (10-2468) ng/L, while in 2020, they were 518.8 (5-6116) ng/L, which constitutes a statistically significant difference. There was no significant difference in the maximum TnT levels. The duration of hospitalisation in 2019 was 5.0 ± 3.6 days, compared to 4.2 ± 2.4 days in 2020, which is statistically significant. The average systolic left ventricular function was 44 ± 8.7% in 2019 and 44 ± 8.8% in 2020, with no statistically significant difference. The length of stay in the intensive care unit did not differ significantly. The in-hospital mortality rate was 1.9% in the first group and 5.2% in the second group, which was not statistically significant.
Conclusion: The results indicate that, except for the duration of hospitalisation and the level of high-sensitivity TnT from venous blood at admission, there is no statistically significant difference between STEMI patients before the pandemic (2019) and during the COVID - 19 pandemic.
Keywords
Akutni infarkt miokarda s elevacijom ST - segmenta
COVID - 19 pandemija
primarna perkutana koronarna intervencija.
Keywords (english)
Acute ST - segment elevation myocardial infarction
COVID - 19 pandemic
primary percutaneous coronary intervention.
Language croatian URN:NBN urn:nbn:hr:184:830602 Study programme Title: Professional study of nursing (Biomedicine and Healthcare; clinical medical sciences) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-08-21 13:43:44
