Amaç Primer perkutan koroner girişim (pPKG), ST elevasyonlu miyokard infarktüsünde (STEMI) ölüm başta olmak üzere klinik sonuçları fibrinolitik tedaviye kıyasla daha iyi olması üzerine, önerilen ve gittikçe daha yaygın kullanılan tedavi yöntemidir. Amacımız hastanemizde bir yıl içinde yapmış olduğumuz pPKG işlemlerinin ve hastane içi klinik sonuçlarının istatistiksel analizini yapmaktır. Gereç ve Yöntem Ocak 2018 ile Aralık 2018 arasında pPKG ile tedavi edilmiş STEMI hastaları retrospektif olarak hastane kayıtlarından belirlendi, anjiyografi görüntüleri izlendi, hastane içi mortalite ve iskemik-kanama-prosedürel komplikasyon oranları analiz edildi. Bulgular Acil pPKG tedavisi amacıyla kateter laboratuvarına alınmış olan 982 hasta belirlendi. İşlem başarısı oranı %96.9 idi. Ortalama (Ort.) yaş kadın hastalarda (69±11) erkeklere (59±12) göre daha fazlaydı. Ortalama kapı-balon zamanı (KBZ) 60.0±18 dk. olup, hastaların %94.5'inde <90dk. KBZ hedefine ulaşıldı. Ponksiyon yeri ile ilişkili komplikasyon oranına bakıldığında radyal ponksiyon femoral ponksiyona göre daha güvenli bulundu (%1.4 v.s. % 3.5, p=0.037). Kardiyojenik şokta olan hastaların mortalite oranı %76.0' dı. STEMI hastane içi mortalite oranı %8.6 saptandı. Mortal seyreden grupta yaş ort. 'sı daha yüksekti (69±14 v.s. 60±12, p<0.001) ve kadın cinsiyette ölüm oranı (%15.0 v.s. % 6.8, p<0.001) erkeklerdeki ölüm oranına göre anlamlı olarak daha fazla saptandı. Sonuç Verilerimiz neticesinde, STEMI hastalarında mortalite özellikle kardiyojenik şok tablosundaki hastalar ile, ileri yaş ve kadınlarda daha yüksek saptanmıştır. STEMI hastalarında pPKG kliniğimizde yüksek başarı oranı ile uygulanmaktadır. Anahtar Kelimeler Primer perkutan koroner girişim; miyokard infarktüsü; koroner arter hastalığı Öz Objective Primary percutaneous coronary intervention (pPCI) in the treatment of STEMI is the recommended and increasingly widely used treatment modality, since the clinical outcomes are better than fibrinolytic therapy. The aim of this study is to evaluate of pPCI procedures and in-hospital clinical outcomes in one year period. Materials and methods Between January 2018 and December 2018, patients with STEMI who underwent pPCI were reviewed from hospital records retrospectively. Ischemic-bleeding-procedural complications and in-hospital mortality rates were analyzed. Results 982 patients with STEMI who were admitted to emergency department for pPCI were identified. The success rate of the procedure was 96.9%. The mean age of the patients was higher in female patients (69 ± 11) than in men (59 ± 12). Average door-to-balloon time (DBT) was 60.0 ± 18 min. Target DBT (<90min) was achieved in 94.5% of the cases. Radial puncture was found safer than femoral puncture (1.4% vs. 3.5%, p = 0.037). Mortality rate of the patients with cardiogenic shock was 76.0%. In-hospital mortality rate of the STEMI patients was 8.6%. Patients who died were older than the survivors (69 ± 14 v.s. 60 ± 12, p <0.001). Mortality rate in females was higher than that in men (15.0% v.s. 6.8%, p <0.001)...
Objective The aim of this study was to evaluate the demographic characteristics, frequency of perforation, clinical characteristics, treatment strategies and outcomes of patients who developed coronary artery perforation (CAP) during a percutaneous coronary intervention (PCI). Materials and Methods Patients who CAP during a PCI between January 2015 and January 2020 were included in the study. In this five-year period, 25 out of 10,794 patients who underwent PCI developed CAP. Outcomes were classified as cardiac tamponade, requiring urgent revascularization by bypass or PCI, in-hospital mortality, and 30-day mortality. Results In our study, frequency of CAP during PCI was 0.23%. Seventeen patients (68%) were male. The mean age of the patients was 62,52 ± 9.60 years. Eight patients had diabetes, 17 patients had hypertension and 5 patients had a history of chronic kidney disease. According to the Ellis classification system; rates of Ellis types I, II, III, and III-CS were 8 (32%), 9 (36%), 7 (28%), and 1 (4%), respectively. In 12 patients, tamponade was observed, and 7 of these patients underwent pericardiocentesis immediately, while 4 patients underwent pericardiocentesis on their follow-up (>24 hours). In three patients, type I perforation was initially unnoticed and tamponade was observed during follow-up. Six patients died in the hospital. In remaining patients, no mortality was observed within 30 days. In our study, the rates of adverse events for Ellis types I, II and III/III-CS, were as follows: cardiac tamponade, 12%, 20%, and 16%, respectively; emergency surgery, 0%, 4%, and 0% respectively; and death, 12%, 4%, and 8%, respectively. Conclusion Although CAPs are very rare, they have quite a high mortality. Interventional cardiologists should be aware of the risk for Ellis type 1 perforations, especially, because they may not be noticed during the PCI. These data should be evaluated by studies conducted with larger numbers of patients. Keywords Coronary artery perforation; percutaneous coronary intervention; graft-coated stent Öz Amaç Bu çalışmanın amacı perkutan koroner girişim sırasında koroner arter perforasyonu gelişen hastaların demografik özelliklerini, sıklığını, klinik özelliklerini, tedavi stratejilerini ve sonuçlarını değerlendirmektir. Gereç ve Yöntemler 2015 ocak ve 2020 ocak ayları arasında perkütan koroner girişim yapılması sırasında koroner arter perforasyonu gelişen hastalar çalışmaya dahil edildi. Perkütan koroner girişim yapılan 10794 hastanın 25 tanesinde koroner arter perforasyonu gelişti. Kardiyak tamponad, acil perkütan veya baypas ile revaskülarizasyon gereksinimi, hastane içi ve 30 günlük mortalite sonlanım noktaları olarak belirlendi.
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