Læknablaðið - 15.02.2008, Síða 15

FRÆÐIGREINAR
BRÁÐAR KRANSÆÐAR
innan 60-120 mínútna frá því einkenni hefjast er
bráð kransæðaþræðing besti kosturinn (20). Að
öðrum kosti er segaleysandi meðferð hið rökrétta
bráðaúrræði.
Sú rannsókn sem hér er kynnt hefur ýmsar tak-
markanir. Hún er afturskyggn og ekki nægilega
fjölmenn eða umfangsmikil til að kanna hvaða
afleiðingar tafir eða seinkuð viðbrögð hafa á afdrif
sjúklinga. Upplýsingarnar eru takmarkaðar við
það sem skráð var í sjúkra- og aðgerðarskýrslur
og gagnaöflun úr sjúkraskrám var ekki sannreynd
með annarri athugun. Aðeins hjá fáum sjúklingum
voru tiltækar upplýsingar um tímann sem leið
frá upphafi einkenna til upphafs meðferðar sem
að sjálfsögðu ræður miklu um afdrif. Ekki voru
heldur upplýsingar um flutningstíma eða hvaðan
sjúklingar komu og því ekki unnt að bera saman
sjúklinga eftir því hvort þeir komu um langan veg
eða skamman.
Ályktun
Reynslan fyrsta árið af stöðugri vakt á Landspítala
til að meðhöndla bráða kransæðastíflu með ST-
hækkun með tafarlausri kransæðaþræðingu og
kransæðavíkkun er mjög góð. Meðaltími frá inn-
lögn til þræðingar er langt innan við alþjóðleg
viðmiðunarmörk og fer í örfáum tilfellum yfir 90
mínútur. Meðallegutími er einnig stuttur og dán-
artíðni lág.
Heimildir
1. O'Neill W, Timmis GC, Bourdillon PD, et al. A prospective
randomized clinical trial of intracoronary streptokinase
versus coronary angioplasty for acute myocardial infarction.
N Engl J Med 1986; 314: 812-8.
2. Grines CL, Browne KF, Marco J, et al. A comparison of
immediate angioplasty with thrombolytic therapy for acute
myocardial infarction. N Engi J Med 1993; 328: 673-9.
3. Zijlstra F, De Boer JM, Hoomtje JCA, Reiffers S, Reiber JHC,
Suryapranata H. A comparison of immediate coronary
angioplasty with intravenous streptokinase in acute
myocardial infarction. N Engl J Med 1993; 328: 680-4.
4. Berger PB, Ellis SG, Holmes DR, et al. Relationship between
delay in performing direct coronary angioplasty and
early clinical outcome in patients with acute myocardial
infarction: results form the Global Use of Strategies to Open
Occluded Arteries in Acute Coronary Syndromes (Gusto-
Ilb) trial. Circulation 1999; 100:14-20.
5. Ryan TJ, Antman EM, Brooks NH, et al. ACC/AHA
guidelines for the management of patients with acute
myocardial infarction. A report of the American College
of Cardiology/American Heart Association Task Force on
Practice Guidelines (Committee on Management of Acute
Myocardial Infarction). J Am Coll Cardiol 1999; 34: 890-911.
6. Van de Werf F, Ardissino D, Betriu A, et al. Management of
acute myocardial infarction in patients presenting with ST-
segment elevation. Task force of the ESC. Eur Heart J 2003;
24: 28-66.
7. Christopher PC, Gibson CM, Lambrew CT, et al. Relationship
of symptom-onset-to-balloon time with mortality in patients
undergoing angioplasty for myocardial infarction. JAMA
2000; 283: 2941-7.
8. De Luca G, Suryapranata H, Ottervanger JP, Antman
EM. Time delay to treatment and mortality in primary
angioplasty for acute myocardial infarction: every minute of
delay counts. Circulation 2004; 109:1223-5.
9. McNamara RL, Wang Y, Herrin J, et al. Effect of door-to-
balloon time on mortality in patients with ST-segment
elevation myocardial infarction. J Am Coll Cardiol 2006; 108:
2828-30.
10. Jacobs AK, Antman EM, Ellrodt G, et al. Recommendation
to develop strategies to increase the number of ST-segment-
elevation myocardial infarction patients with timely access
to primary percutaneous coronary intervention. Circulation
2006; 113: 2152-63.
11. Guðnason Þ, Þorgeirsson G, Eyjólfsson K, Jónmundsson
EH. Tafarlaus kransæðavíkkun. Nýjung í meðferð bráðrar
kransæðastíflu á íslandi. Læknablaðið 1996; 82:269-75.
12. Danielsen R, Eyjólfsson K, Sigurðsson AF, Jónmimdsson
EJ. Árangur kransæðavíkkunaraðgerða á íslandi 1987-1998.
Læknablaðið 2000; 86: 241-9.
13. Danielsen R, Eyjólfsson K. Frumárangur kransæðavíkkana
hjá sjúklingum með sykursýki á íslandi. Læknablaðið 2004;
90: 227-32.
14. Pinto DS, Kirtane AJ, Nallamothu BK, et al. Hospital delays
in reperfusion for ST-elevation myocardial infarction.
Implications when selecting a reperfusion strategy.
Circulation 2006; 114: 2019-25.
15. Krumholz HM, Anderson JL, Brooks NH, et al. ACC/
AHA clinical performance measures for adults with ST-
elevation and non-ST-elevation myocardial infarction: a
report of the American College of Cardiology/American
Heart Association Task force on performance measures
(Writing committee to develop performance measures on
ST-elevation and non-ST-eievation myocardial infarction).
Circulation 2006; 113: 732-61.
16. Keeley EC, Boura J, Grines C. Primary angioplasty versus
intravenous thrombolytic therapy for acute myocardial
infarction: a quantitative review of 23 randomised trials.
Lancet 2003; 361:13-20.
17. Huynh T, O'Laughlin J, Joseph L, et al. Delays to reperfusion
therapy in acute ST-segment elevation myocardial infarction:
results from the AMI-Quebeck Study. CMAJ 2006; 175:1527-
32.
18. Anderson HR, Nielsen TT, Rasmussen K, et al; for the
DANAMI-2 Investigators. A comparison of coronary
angioplasty with fibrinolytic therapy in acute myocardial
infarction. N Engl J Med 2003; 349: 733-42.
19. Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley
EH, Krumholz HM:for the NRMI Investigators. Times
to treatment in transfer patients undergoing primary
percutaneous coronary intervention in the United States:
National Registry of Myocardial Infarction (NRMI)-3/4
analysis. Circulation 2005; 111: 761-7.
20. Nallamothu BK, Bradley EH, Krumholz HM. Time to
treatment in primary percutaneous coronary intervention.
N Engl J Med 2007; 357:1631-8.
21. Brindis RG; The challenges and pitfalls of door-to-balloon
time as performance metric. ww.cardiosource.com/editorial,
posted 14/6/2006.
22. Faxon D, Lenfant C: Time is everyting: Motivating patients
to call 9-1-1 at onset of acute myocardial infarction.
Circulation 2001; 104:1210-1.
23. Fibrinolytic Therapy Trialists (FTT) Collaborative Group:
Indications for fibrinolytic therapy in suspected acute
myocardial infarction: Collaborative overview of early
mortality and major morbidity results from all randomised
trials of more than 1000 patients. Lancet 1994; 343:311-22.
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