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Titolo:
Interventional management of acute myocardial infarction
Autore:
Straumann, E; Naegeli, B; Frielingsdorf, J; Gerber, A; Mury, R; Schuiki, E; Bertel, O;
Indirizzi:
Triemli Spital, Med Klin, Dept Innere Med, Kardiol Abt, CH-8063 Zurich, Switzerland Triemli Spital Zurich Switzerland CH-8063 t, CH-8063 Zurich, Switzerland
Titolo Testata:
SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT
fascicolo: 51-52, volume: 130, anno: 2000,
pagine: 1970 - 1978
SICI:
0036-7672(200012)130:51-52<1970:IMOAMI>2.0.ZU;2-0
Fonte:
ISI
Lingua:
GER
Soggetto:
TRANSLUMINAL CORONARY ANGIOPLASTY; TISSUE-PLASMINOGEN-ACTIVATOR; IIB/IIIA RECEPTOR BLOCKADE; THROMBOLYTIC THERAPY; CARDIOGENIC-SHOCK; TRIAL; COUNTERPULSATION; SURVIVAL; OUTCOMES; REGISTRY;
Keywords:
myocardial infarction; hospital transfer; coronary angioplasty; treatment delays;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
36
Recensione:
Indirizzi per estratti:
Indirizzo: Straumann, E Triemli Spital, Med Klin, Dept Innere Med, Kardiol Abt, Birmensdorferstr 497, CH-8063 Zurich, Switzerland Triemli Spital Birmensdorferstr 497 Zurich Switzerland CH-8063
Citazione:
E. Straumann et al., "Interventional management of acute myocardial infarction", SCHW MED WO, 130(51-52), 2000, pp. 1970-1978

Abstract

Background: Randomised trials have shown that primary percutaneous angioplasty (PTCA) may offer advantages over thrombolysis in treating acute myocardial infarction (vessel patency is achieved more often, mortality and reinfarction rate are lower, cerebrovascular accidents are less frequent). Data from several foreign registries have been less clear. Up to now no registrydata have been available for Switzerland. Data from registries are very important in planning optimal treatment under "real world" conditions. Method: All patients receiving acute PTCA during the first 24 hours of acute myocardial infarction were prospectively included in a registry at a single centre. We assessed times until revascularisation, as well as clinical,angiographic and outcome data. Results: 503 patients (age 59 +/- 12 years, 15% women) were included from 1. 1. 1995 to 30. 6. 2000. Primary PTCA was performed in 334 patients, and rescue PTCA in 169. Diabetes mellitus was present in 36% of the total. Multivessel disease was present in 61%, anterior infarction in 36%, and 16% were in cardio genic shock before intervention. The pre-hospital delay was 2:12 h (median). In-hospital decision delay (hospital admission until contact to cardiologist) in patients with primary PTCA was 31 minutes (median). Thetime from vessel puncture to recanalisation was 19 minutes (median). 273 patients were transferred for coronary angiography and intervention by otherhospitals (218 by ground ambulance, 55 per helicopter transfer). The totaltransfer time (calculated from time of decision to arrival in the catherisation laboratory) was 57 minutes (median). PTCA was successful angiographically in 97% and TIMI 3 flow was obtained in 93% of all patients. Hospital mortality was low in view of the high proportion of patients in cardiogenic shock prior to PTCA (mortality in shock patients was 33%). Mortality in patients without pre-existing cardiogenic shock was 2%. Conclusion: Patients with acute myocardial infarction, especially high-risk patients, can be treated successfully by acute PTCA around the clock in Switzerland, in accordance with the strict international recommendations fortime delays. The treatment results are similar to those in randomised trials. Transfer of patients from referral hospital is safe, with acceptable delays. Optimisation of the decision process and transport logistics may further improve outcome by reducing the total ischaemia time.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 03:17:54