| Abstract | Koronarna arterijska bolest obuhvaća stabilnu anginu pektoris i akutni koronarni sindrom. Akutni koronarni sindrom je klinički entitet uzrokovan akutnom ishemijom miokarda i obuhvaća nestabilnu anginu pectoris, infarkt miokarda bez elevacije ST-segmenta (NSTEMI – engl. non-ST-elevation myocardial infarction) te infarkt miokarda s elevacijom ST-segmenta (STEMI – engl. ST-elevation myocardial infarction). Glavni simptom koji upućuje na akutni koronarni sindrom je angina. Čest prateći simptom je i dispneja, a mogu se javiti i drugi simptomi kao što su mučnina, povraćanje, znojenje, sinkopa, poremećaji svijesti i neurološki simptomi. Najčešći uzrok koronarne bolesti srca je ateroskleroza koja dovodi do stvaranja aterosklerotskih plakova na stijenkama koronarnih arterija, rezultirajući stenozom arterije. Ukoliko dođe do rupture aterosklerotskog plaka, na mjestu rupture dolazi do tromboze i okluzije krvne žile, a mogu se pojaviti i distalne embolije. Koronarna bolest srca je vodeći uzrok smrti u svijetu i uzrokuje otprilike trećinu smrti u svijetu. Prema podacima iz 2017. godine, globalno zahvaća 126 milijuna ljudi, što čini 1.72% svjetske populacije i prevalencija je u stalnom porastu. Za stratifikaciju bolesnika s akutnim koronarnim sindromom koristi se GRACE bodovna ljestvica koja služi za kliničku procjenu rizika, procjenjujući 6-mjesečni rizik od smrti i smrti od infarkta miokarda kako bi se poboljšala trijaža i briga pacijenata koji boluju od svih oblika akutnog koronarnog sindroma. Srce se opskrbljuje krvlju pomoću dviju arterija, arteria coronaria dextra i arteria coronaria sinistra. Arteria coronaria sinistra se dijeli na r. interventricularis anterior i r. circumflexus. Ta bifurkacija i ogranci su često mjesto okluzije i zahtijevaju posebne tehnike liječenja. Revaskularizacija okludirane krvne žile se može postići trima metodama: fibrinolizom, CABG i PCI metodom. Najbolji rezultati se postižu liječenjem PCI ili CABG metodom. Uobičajena tehnika CABG se sastoji od termino-lateralnog anastomoziranja lijeve unutarnje torakalne arterije na prednju silaznu granu lijeve koronarne arterije i izvodi se uz pomoć uređaja za izvantjelesnu cirkulaciju. Primarna PCI definira se kao intervencija na koronarnoj arteriji, koja je uzrok akutnog infarkta, unutar 12 sati od početka boli ili drugih simptoma, bez ranije primjene trombolitičke ili druge terapije usmjerene na otapanje krvnog ugruška. U odluci, koju je metodu liječenja bolje primijeniti, koristi se SYNTAX score koji pomaže utvrđivanju dugoročne smrtnosti. Na temelju izračuna SYNTAX score-a pacijenti se dijele na one niskog, srednjeg ili visokog rizika za liječenje PCI metodom. Iako se CABG desetljećima koristio kao primarna metoda izbora za liječenje bolesti debla lijeve koronarne arterije, prema rezultatima dosadašnjih studija PCI se nije pokazao kao inferiorna metoda prema većini ishoda. |
| Abstract (english) | Acute coronary syndrome is a clinical entity caused by acute myocardial ischemia and includes unstable angina pectoris, non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). The main symptom indicating acute coronary syndrome is angina. A frequent accompanying symptom is dyspnea, and other symptoms such as nausea, vomiting, sweating, syncope, disturbances of consciousness and neurological symptoms may occur. The most common cause of coronary heart disease is atherosclerosis, which leads to the formation of atherosclerotic plaques on the walls of the coronary arteries, which leads to artery stenosis. If an atherosclerotic plaque ruptures, thrombosis and occlusion of the blood vessel occur at the site of the rupture, and distal emboli can also occur. Coronary heart disease is the leading cause of death in the world and accounts for approximately one third of all deaths worldwide. According to data from 2017, it affects 126 million people globally, which is 1.72% of the world's population, and the prevalence is constantly increasing. To stratify patients with acute coronary syndrome, the GRACE scoring scale is used for clinical risk assessment, estimating the 6-month risk of death and death from myocardial infarction to improve triage and care of patients suffering from all forms of acute coronary syndrome. The heart is supplied with blood by means of two arteries, arteria coronaria dextra and arteria coronaria sinistra. Arteria coronaria sinistra divides into r. interventricularis anterior and r. circumflexus, and this bifurcation and branches are often the site of occlusion and require special treatment techniques. Revascularization of an occluded blood vessel can be achieved by three methods: fibrinolysis, CABG and the PCI method. The best results are achieved with PCI or CABG treatment. The usual CABG technique consists of termino-lateral anastomosis of the left internal thoracic artery to the anterior descending branch of the left coronary artery and is performed with the help of extracorporeal circulation devices. Primary PCI is defined as an intervention on the coronary artery, that is the cause of an acute infarction, within 12 hours of the onset of pain or other symptoms, without earlier use of thrombolytic or other therapy aimed at dissolving the blood clot. In deciding which treatment method is better to apply, the SYNTAX score is used, which helps determine long-term mortality. Based on the calculation of the SYNTAX score, patients are divided into those of low, medium or high risk for PCI treatment. Although CABG has been used for decades as the primary method of choice for the treatment of left coronary artery disease according to the results of previous studies, PCI has not proven to be an inferior method according to most outcomes. |
