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ID naloge: 105 Letnik: 2001 Predmet: interna medicina
Pomen klinicne ocene bolnika bolnikovz nestabilno angino pektoris med stenokardijo za napoved poteka bolezni
Avtor: Katica Bajuk, Polona Studen
Mentor: prof.dr. Marko Noc, assist.dr. Tom Ploj, dr.med
IZHODIŠCE. Nestabilna angina pektoris (NAP) in njej zelo podobno stanje, miokardni infarkt brez dviga veznice ST (NSTEMI), sta akutni obliki koronarne srcne bolezni. Ocena tveganja za zaplete bolezni ima pomembno vlogo pri odlocanju za nacin zdravljenja. Tveganje se doloca predvsem na osnovi znacilnih sprememb v elektrokardiogramu in biokemicnih oznacevalcev poškodbe srcne mišice (troponin T in I, encimi srcnomišicne nekroze). Nekatere raziskave so v oceno tveganja vkljucile tudi klinicne znacilnosti teh bolnikov, nobena pa ni upoštevala stanja med stenokardijo.
NAMEN. Namen naloge je bil ovrednotiti pomen klinicnih spremenljivk med stenokardijo za napoved zapletov bolezni.
HIPOTEZA. Klinicna slika bolnika z NAP/NSTEMI med stenokardijo napoveduje zaplete bolezni do odpusta iz bolnišnice.
METODE. Retrospektivno smo 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. Klinicno sliko smo opisali s štirimi spremenljivkami: starost bolnika, trajanje stenokardije ter sistolicni krvni tlak in srcna 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 logisticno regresijo.
REZULTATI. V raziskavo smo vkljucili 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 sistolicnim krvnim tlakom (p = 0,01) in s srcno frekvenco (p < 0,001) med stenokardijo. Z akutnim miokardnim infarktom in nujnim revaskularizacijskim posegom ni bila povezana nobena klinicna spremenljivka.
ZAKLJUCKI. Nizek sistolicni krvni tlak in visoka srcna frekvenca med stenokardijo napovedujeta vecjo verjetnost smrti pred odpustom iz bolnišnice. Pri odlocanju za invazivnejši nacin zdravljenja teh bolnikov je zato poleg uveljavljenih meril smiselno upoštevati tudi sistolicni krvni tlak in srcno frekvenco med stenokardijo.
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[Abstract / English version]
Significance of the clinical estimationof patient with unstable angina pectoris during stenocardia for the prognosis of the disease.
Author: Katica Bajuk, Polona Studen
Mentor: prof.dr. Marko Noc, assist.dr. Tom Ploj, dr.med
BACKGROUND. Unstable angina pectoris (UAP) and non-ST elevation myocardial infarction (NSTEMI) reflect a critical moment of coronary artery disease. The choice of appropriate therapy depends on the estimated risk of adverse outcome. The risk stratification is made mainly on the basis of typical changes in electrocardiogram and values of biochemical markers of heart muscle damage (troponine T and I, enzymes of heart muscle necrosis). Only a limited number of studies included clinical characteristics in the estimation of the risk of these patients but none of the studies considered clinical presentation during stenocardia.
AIM. The aim of our research-paper was to evaluate the prognostic value of clinical characteristics during stenocardia.
HYPOTHESIS. The clinical presentation of a patient with UAP/NSTEMI during stenocardia predicts the adverse outcome of the disease during in-hospital treatment.
METHODS. A retrospective analysis of patients with admission diagnosis UAP/NSTEMI admitted to Centre of intensive internal medicine during the period between January 1996 and December 1999 was preformed. To describe the clinical presentation of the patient the following parameters were selected: age, duration of stenocardia, systolic blood pressure and heart rate during stenocardia. The connection of these characteristics with adverse outcome of the illness (death, acute myocardial infarction, urgent revascularisation procedure) until discharge from the hospital was analysed using analysis of variance and multiple logisitic regression.
RESULTS. One hundred ninety-two patients, aged 40_96, were included. Seven (3.6 %) patients died, 16 (8.3 %) had a myocardial infarction, and 82 (42.7 %) underwent the urgent revascularisation. Death of the patients before discharge from the hospital was significantly correlated with systolic blood pressure (p = 0.01) and heart rate (p < 0.001) during stenocardia. All selected clinical parameters failed to show any statistically relevant correlation with myocardial infarction or urgent revascularisation procedure.
CONCLUSIONS. Low systolic blood pressure and high heart rate during stenocardia predict higher probability of death before discharge from the hospital. The decision for a more invasive therapy should, in addition to established criteria, consider systolic blood pressure and heart rate during stenocardia.
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