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Title:Vpliv ledvične funkcije na preživetje bolnikov po trombozi v žilni opornici v koronarnih arterijah
Authors:ID Kanič, Vojko (Author)
ID Hojs, Radovan (Mentor) More about this mentor... New window
Files:.pdf DOK_Kanic_Vojko_2015.pdf (2,38 MB)
MD5: EE75375AD647589A4FE4265611BB7650
 
Language:Slovenian
Work type:Doctoral dissertation
Organization:MF - Faculty of Medicine
Abstract:Namen raziskave Namen raziskave je bil opredeliti, ali kronična ledvična bolezen (KLB) po vgraditvi žilne opornice vpliva na dolgoročen izzid zdravljenja po kasnejši trombozi v žilni opornici (TŽO). Teoretična podlaga za raziskavo Bolniki s KLB imajo slabše rezultate zdravljenja po perkutani koronarni intervenci. Med samo perkutano koronarno intervenco lahko s kontrastom dodatno poslabšamo KLB. Ni nobenih podatkov, ali KLB po implantaciji žilne opornice vpliva na slabši izzid zdravljenja po kasnejši TŽO. Če bi bilo to res, bi lahko že ob implantaciji žilne opornice opredelili skupino bolnikov z večjim tveganjem za slabši izhod ob TŽO, ki bi jih lahko bolje spremljali in pazljiveje zdravili. Metode dela Pregledali smo podatke 4824 zaporednih bolnikov, ki so v našem centru imeli opravljeno perkutano koronarno intervenco od Marca 2004 do Aprila 2010. Izluščili smo 100 bolnikov, ki so utrpeli TŽO in jih spremljali do 31.12.2012. Povprečno smo jih spremljali 48,03±29,32 meseca (najmanj 30 in največ 98 mesecev). Opazovali smo samo bolnike z definitivno TŽO, opredeljeno po ARC (Academic Research Consortium) kriterijih. Spremljali smo podatke o smrti, miokardnih infarktih, ponovnih perkutanih ali kirurških revaskularizacijah. Podatke smo dobili iz bolnišničnega sistema, pregledi ali po telefonu. Primerjali smo skupino z in brez KLB po.implantaciji žilne opornice (KLBpoIŽO). KLB smo opredelili kot hitrost glomerulne filtracije < 60 ml/min/1,73 m2. Rezultati Bolniki s KLBpoIŽO so v opazovanem obdobju pomembno bolj umirali po TŽO, kot bolniki brez KLBpoIŽO (64,5% proti 17,4%; p <0,0001)(hi-kvadrat test). Sestavljeni končni koronarni dogodki (smrt, miokardni infarkt, ponovna revaskulariozacija) so bili prav tako pomembno pogostejši v skupini s KLBpoIŽO (83,9% proti 58,8%; p <0,021) (hi-kvadrat test). Pogostnost ponovnih miokardnih infarktov po TŽO je bila podobna v skupini z in brez KLBpoIŽO (32,3% proti 31,9%), pa tudi perkutanih in kirurških revaskularizacij je bilo podobno (41,9% proti 46,4%). Smrt po TŽO sta napovedovali KLBpoIŽO (prilagojeno razmerje ogroženosti = adjusted HR 5,30; 95% interval zaupanja = CI 2,30 do 1,22; p < 0,0001) in starost več kot 75 let (adjusted HR 2,99: 95 % CI 1,27 do 7,05; p = 0,012). Sestavljen končni koronarni dogodek po TŽO sta napovedovala KLBpoIŽO (adjusted HR 1,77: 95% CI 1,01 do 3,19; p = 0,049) in sladkorna bolezen (adjusted HR 1,78: 95% CI 1,02 do 3,01; p = 0,041). Zaključek Bolniki s KLBpoIŽO, starejši od 75 let umirajo pogosteje po TŽO. Bolniki s KLBpoIŽO, ki imajo ob tem še sladkorno bolezen, pa utrpjio po TŽO bistveno več sestavljenh končnih koronarnih dogodkov. Z določitvijo KLBpoIŽO lahko že ob implantaciji žilne opornice opredelimo skupino bolnikov, ki bo ob TŽO imela pomembno večje tveganje za slab izhod. Na te bolnike moramo biti pozorni že ob implantaciji žilne opornice. TŽO lahko poskusimo preprečiti pri njih s podaljšanim dvojnim protitrombocitnim zdravljenjem, z novimi zdravili ali kombinacijo obojega. Individualno prilagojeno dvojno protitrombocitno zdravljenje glede na bolnikovo KLB in tveganje za krvavitev bi lahko bila najvarneje. Trenutno ni nobenih podatkov o varnosti takšnih pristopov. Do takrat moramo te bolnike po implantaciji žilne opornice skrbno spremljati, jim razložiti nevarnosti TŽO in krvavitev, da bodo čimbolj upoštevali navodila zdravljenja.
Keywords:perkutana koronarna intervenca, tromboza v žilni opornici, ledvična funkcija, smrt, miokardni infarkt, revaskularizacija
Place of publishing:Maribor
Year of publishing:2015
PID:20.500.12556/DKUM-54238 New window
COBISS.SI-ID:5579583 New window
NUK URN:URN:SI:UM:DK:J6SIHDDJ
Publication date in DKUM:27.01.2016
Views:2325
Downloads:192
Metadata:XML DC-XML DC-RDF
Categories:MF
:
KANIČ, Vojko, 2015, Vpliv ledvične funkcije na preživetje bolnikov po trombozi v žilni opornici v koronarnih arterijah [online]. Doctoral dissertation. Maribor. [Accessed 28 March 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=54238
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Secondary language

Language:English
Title:Influence of renal function at stent implantation on the outcome after stent thrombosis
Abstract:Objectives The aim of the study was to examine the possible influence of renal dysfunction after stent implantation on long term outcomes after stent thrombosis (ST). Bacminround Renal dysfunction is associated with an increased risk of worse outcome after percutaneous coronary intervention (PCI). Furhermore contrast used during PCI worsens renal dysfunction. There are no data if renal dysfunction immediately after stent implantation influences worse prognosis after ST. If so patients with a higher risk for worse outcome after ST can be identified already at the time of stent implantation. Methods Data from 4824 consecutive patients treated with PCI in our centre was recorded from March 2004 through April 2010. From these 100 patients with ST were identified and prospectively followed until December 2012 for 48.03±29.32 months. Only patients with definite ST were included in the study. The Academic Research Consortium definition of ST was used. Data on death, myocardial infarction and repeated percutaneous or operative revascularization after ST were ascertained from the hospital database, by phone or with clinical examinations. The outcomes after definite ST were compared in patients with and without renal dysfunction after stent implantation (RDafterSI). Renal dysfunction was defined as estimated glomerular filtration rate <60 ml/min/1.73m2. Results Patients with RDafterSI had a higher mortality rate after ST than patients without RDafterSI (64.5% vs. 17.4%; p <0.0001)(chi-square test) during observation period. Major adverse cardiac events (MACE - death, myocardila infarction, repeated revascularization) rate after ST was significant different considering patients with or without RDafterSI (83.9% vs. 58.8%; p <0.021)(chi-square test). The prevalence of myocardial infarction was similar in both groups (32.3% vs. 31.9%) as was the revascularization rate (41.9% vs. 46.4%). Death was independently predicted by RDafterSI (adjusted HR 5.30; 95 CI 2.30 to 12.22; p < 0.0001) and age >75 years (adjusted HR 2.99: 95 % CI 1.27 to 7.05; p = 0.012). MACE was predicted by RDafterSI (adjusted HR 1.77: 95% CI 1.01 to 3.19; p = 0.049) and diabetes (adjusted HR 1.78: 95% CI 1.02 to 3.01; p = 0.041). Conclusions Patients with RDafterSI who are older than 75 years at stent implantation had significantly higher long term mortality after ST. RDafterSI and diabetes influenced MACE rate as well. RDafterSI and age >75 point out the group of patients with a high risk for death and MACE after ST already at the time of stent implantation. They should be payed special attention after stent implantation. Prolonged dual antiplatelet therapy or newer antiplatelet drugs might be considered for these patients. Patient’s tailored antiplatelet therapy according to renal function and bleeding risk may be the safest therapy. However, there are no data of these alternative approaches jet. Until then strict follow up should be advocated so patients will stick to the therapy vigorously.
Keywords:percutaneous coronary intervention, stent thrombosis, renal function, death, myocardial infarction, revascularization


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