Author/Editor		Bajuk, Katica; Studen, Polona
Title		Pomen klinične ocene bolnika z nestabilno angino pektoris med stenokardijo za napoved poteka bolezni
Translated title		The importance of clinical evaluation of a patient with unstable angina pectoris for prognosis of the disease
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 40, št. 4
Publication year		2001
Volume		str. 367-82
Language		slo
Abstract		Unstable angina pectoris (UAP) and non-ST elevation myocardial infarction (NSTEMI) signify a critical moment of coronary artery disease. The choice of appropriate therapy depends on the estimated risk of adverse outcome. Risk assessment is made primarily on the basis of typical changes in the electrocardiogram and values of biochemical markers of cardiac muscle damage (troponine T and I, enzymes of cardiac muscle necrosis). Only a limited number of studies included clinical characteristics in the risk estimates of such patients, but none of these studies considered clinical presentation during stenocardia. The aim of our research was to evaluate the prognostic value of clinical characteristics during stenocardia. The clinical presentation of a patient with UAP/NSTEMI during stenocardia predicts the adverse outcome of the disease during in-hospital treatment. A retrospective analysis was performed on patients with an admission diagnosis of UAP/NSTEMI who were admitted to the Center for Intensive Internal Medicine between January and December 1999. The following parameters were selected for describing the patients clinical presentation: age, duration of stenocardia, systolic blood pressure and heart rate during stenocardia. The connection of these characteristics with an adverse outcome of the illness (death, acute myocardial infarction, urgent revascularization procedure) up until discharge from the hospital was analyzed using analysis of variance and multiple logistic regression. One hundred ninety-two patients, aged 40-96, were included. Seven (3.6%)of the patients died, 16 (8.3%) suffered a myocardial infarction, and 82 (42.7%) underwent urgent revascularization. Death of the patients before discharge from the hospital was significantly correlated with their systolic blood pressure (p=0.01) and heart rate (p<0.001) during stenocardia. (Abstract truncated at 2000 characters).
Summary		Nestabilna angina pektoris (NAP) in njej zelo podobno stanje, miokardni infarkt brez dviga veznice ST (NSTEMI), sta akutni obliki koronarne srčne bolezni. Ocena tveganja za zaplete bolezni ima pomembno vlogo pri odločanju za način zdravljenja. Tveganje se določa predvsem na osnovi značilnih sprememb v elektrokardiogramu in biokemičnih označevalcev poškodbe srčne mišice. Nekatere raziskave so v oceno tveganja vključile klinične značilnosti teh bolnikov, nobena pa ni upoštevala stanja med stenokardijo. Namen naloge je bil ovrednotiti pomen kliničnih spremenljivk med stenokardijo za napoved zapletov bolezni. Postavili smo hipotezo, da klinična slika bolnika z NAP/NSTEMI med stenokardijo napoveduje zaplete bolezni do odpusta iz bolnišnice. Retrospektivno amo analizirali bolnike, ki so bili v obdobju med januarjem 1996 in decembrom 1999 sprejeti na Center za intenzivno interno medicino s sprejemno diagnozo NAP/NSTEMI. Klinično sliko smo opisali s štirimi spremenljivkami: starost bolnika, trajanje stenokardije ter sistolični krvni tlak in srčna frekvenca med stenokardijo. Povezanost teh spremenljivk z zapleti bolezni (smrt, akutni miokardni infarkt, nujni revaskularizacijski poseg) do odpusta iz bolnišnice smo preverjali z analizo variance in multiplo logistično regresijo. V raziskavo smo vključili 192 bolnikov, starih od 40 do 96 let. Med zdravljenjem v bolnišnici je 7 (3,6) bolnikov umrlo, 16 (8,3%) jih je doživelo akutni miokardni infarkt, pri 82 (42,7%) pa je bil potreben nujni revaskularizacijski poseg. Smrt bolnika pred odpustom iz bolnišnice je bila pomembno povezana s sistoličnim krvnim tlakom (p-0,01) in s srčno frekvenco (p<0,001) med stenokardijo. Z akutnim miokardnim infarktom in nujnim revaskularizacijskim posegom ni bila povezana nobena klinična spremenljivka.(Izvleček prekinjen pri 2000 znakih).
Descriptors		ANGINA, UNSTABLE MYOCARDIAL INFARCTION PROGNOSIS ELECTROCARDIOGRAPHY INTENSIVE CARE UNITS AGE FACTORS BLOOD PRESSURE HEART RATE MYOCARDIAL REVASCULARIZATION