| Avtor/Urednik | Pust, Borut | |
| Naslov | Perkutana transluminalna koronarna angioplastika v luči EBM (evidence based medicine) | |
| Prevedeni naslov | Percutaneous transluminal coronary angioplasty as seen in the context of evidence based medicine | |
| Tip | članek | |
| Vir | Zdrav Vestn | |
| Vol. in št. | Letnik 68, št. 10 | |
| Leto izdaje | 1999 | |
| Obseg | str. 569-73 | |
| Jezik | slo | |
| Abstrakt | Background. The treatment of coronary heart disease is as a consequence of it's high prevalence in well-develo- ped nations one of the most investigated and most expensive fields of medicine. Due to scientifique evidence from many randomized prospective trials conducted in last twenty-years prolonged survival and improved quality of life are expected in coronary patients treated with aspirine and some other anti-ischemic, anti-thrombotic or anti-lipemic drugs. Myocardial revascularization procedures as compared to conservative treatment significantly improve survival in multivessel coronary disease, in single vessel disease no such evidence is available yet. A clear positive effect is demonstrated of myocardial revascularization on angina pectoris and hence on the quality of life in at least 90% of patients. The value of balloon angioplasty is increasing again when compared to alter native angioplasty methods. All of them including (at least partially) coronary stenting are disappointing in respect to prevention of restenosis first of all in long and complex stenoses, where very long and/or in series stents were implanted apart of any previous evidence of their long-term effectiveness. There is no doubt currently about positive effects of stenting in (threatened) sudden arterial occlusion. The long-term comparison of optimal coronary stenting to "stent-like effect" bringing aggressive ballon angioplasty will demonstrate, which method is more cost-effective. Urgent (direct) PTCA performed during first hours of acute myocardial infarction improves the prognosis especially in hemodynamically compromised patients. (Abstract truncated at 2000 characters.) | |
| Izvleček | Izhodišča. Zdravljenje koronarne bolezni srca je zaradi njene visoke prevalence v razvitem svetu eno od najbolj raziskovanih in najdražjih področij medicine. Veliko število randomiziranih prospektivnih študij v zadnjih dveh desetletjih zagotavlja pri mnogih koronarnih bolnikih podaljšanje preživetja in izboljšanje kakovosti življenja že ob uporabi aspirina, protiishemičnih, protilipemičnih in protitrombotičnih zdravil. Revaskularizacija miokarda v primerjavi s konzervativnim zdravljenjem pomembno izboljša preživetje pri več žilnih koronarnih bolnikih, pri enožilnih bolnikih iz logističnih razlogov takšnih dokazov še nimamo. Pozitiven je učinek vseh metod revaskularizacije na angino pektoris in s tem na kakovost življenja pri ca. 90% vseh tako zdravljenih. Perkutana balonska angioplastika vprimerjavi z alternativnimi perkutanimi metodami ponovno pridobiva na pomenu. Vse alternativne perkutane metode in delno tudi stenti (žilne opornice) so namreč razočarale na področju dolgoročnega preprečevanja restenoze, še posebej pri dolgih in kompleksnih zožitvah, pri katerih so brezpoznavanja dolgoročnih rezultatov uporabljali zelo dolge ali serijsko postavljene stente (žilne opornice). Učinkovitost stenta (žilne opornice) pri zdravljenju (grozeče) nenadne zapore arterije takoj po neuspešni PTKA je nedvomna. Le dolgoročne primerjave optimalne postavitve stenta (žilne opornice) z agresivno balonsko angioplastiko, ki daje "stentu podobne" rezultate, bodo pokazale, katera metoda je ekonomsko bolj učinkovita. Takojšnja (neposredna) PTKA v prvih urah miokardnega infarkta izboljša prognozo, še posebej pri hemodinamsko ogroženih bolnikih. (Izvleček prekinjen pri 2000 znakih.) | |
| Deskriptorji | ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY MYOCARDIAL REVASCULARIZATION STENTS TREATMENT OUTCOME |