Author/Editor		Sinkovič, Andreja
Title		Dileme in tveganja v diagnostiki in zdravljenju bolnikov z akutnimi koronarnimi sindromi pred in po perkutani koronarni intervenciji
Translated title		Dilemmas and risks in treatment of patients with acute coronary syndromes before and after percutaneous coronary
Type		članek
Source		In: Križman I, editor. Zbornik predavanj: interna medicina 2008: dileme in tveganja. Strokovni sestanek Združenja internistov SZD; 2008 sep 26-27; Ljubljana. Ljubljana: Združenje internistov SZD,
Publication year		2008
Volume		str. 119-22
Language		slo
Abstract		Ischemic ECG changes and chest pain, characteristics of acute coronary syndromes (ACS), signify the risk of myocardial infarction (MI) and thus of heart failure, arrhythmias and increased mortality. To prevent complications after acute MI early medical treatment and percutaneous coronary interventions (PCI) are necessary in particular in ST-elevation ACS, that represents an increased risk for a large Q-MI. Early recognition of ACS is necessary to start early treatment as the symptoms may be nonspecific in spite of significant ECG changes and vice versa. In all ACS patients combination of antiplatelet agents and standard or low-molecular-weight heparins are recommended to prevent the risk of rethrombosis and reinfections, but can be associated with increased risk of bleeding and acute renal failure, that additionally increase the risk of mortality. Early reperfusion therapy is with primary percutaneous coronary intervention (PCI) is most effective, but it is associated with increased risk of bleeding and acute renal failure due to concommitant use of antiplatelet agents and heparins. Iv. thrombolysis is an alternative to primary PCI in the first 3 hours of an ACS with ST-elevation, when primary PCI is not available or longer transports to catheter laboratory are necessary in particular in patients with large MI. Less frequent use of iv. thrombolysis is the consequence of increased risk of brain hemorrhage in particular in the elderly, women, after prior stroke, arterial hypertension, INR>4, use of alteplase. Conclusions. Combined medical treatment and PCI in patients with ACS effectively reduces the extend of MI and decreases the risk of heart failure, arrhytmias and mortality after acute MI. However, the risk of complications such as bleedings and acute renal failure is increased and they decrease the efficacy of early treatment.
Summary		Ishemija v EKG in bolečine v prsih, značilne za akutne korornarne sindrome (AKS), pomenita tveganje za razvoj miokardnega infarkta (MI) in s tem tveganje za srčno popuščanje, aritmije in smrt. Preprečevanje MI in zapletov predstavlja čim zgodnejše zdravljenje z zdravili in s perkutano koronarno intervencijo (PCI), še posebno pri AKS z dvigom veznice ST, ki pomeni neposredno tveganje za velik Q-MI.Zgodnji pričetek zdravljenja zahteva zgodnje prepoznavanje vseh oblik AKS, kjer so možni ob sicer jasnih spremembah v EKG tudi nespecifični simptomi in obratno. Vse oblike AKS zdravimo s kombinacijo antiagregacijskih sredstev in s standardnim ali nizko-molekularnim heparinom, da preprečimo tveganje za ponovno trombozo in s tem reinfarkt, kar pa je lahko združeno s tveganjem za krvavitve in/ali pojav ledvične odpovedi. Zgodnje reperfuzijsko zdravljenje s primarno perkutano koronarno intervencijo (PCI) je najučinkovitejše, vendar je združeno s tveganjem za akutno ledvično odpoved in krvavitve, posebno zaradi sočasno kombinacije antiagregacijskih sredstev in heparina. I. v. tromboliza je enakovredno primarni PCI le v prvih 3 urah AKS z dvigom ST, če primarna PCI ni na razpolago in/ali je potreben daljši transport do katetrskega laboratorija, predvsem pri obsežnem MI. Opuščanje i. v. trombolize je posledica povečanega tveganja za možganske krvavitve, zlasti pri starejših, suhih ženskah, po predhodni možganski kapi, arterijski hipertenziji, INR>4, uporabi alteplaze. Zaključek. Kombinacija PCI in zdravljenja z zdravili pri vseh oblikah AKS učinkovito zmanjša velikost MI in s tem tveganje za srčno popuščanje, aritmije in smrt. Najpogostejši in najnevarnejši zapleti so krvavitve in ledvična odpoved, saj zmanjšajo učinkovitost zdravljenja.
Descriptors		RISK FACTORS