Göğüs ağrısı ile acil servise başvuran hastaların geçmiş kag ve kardiyoloji poliklinik muayenesinin önemi
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Tarih
2023
Yazarlar
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Akut koroner sendrom (AKS) erken teşhis edilip gerekli invaziv işlemler veya medikal tedavi hızlı bir şekilde yapılmadığında mortalitesi yüksek seyreden göğüs ağrısı nedenlerinin başında gelir. Acil servislerde klinisyenler tarafından AKS’leri tespit etmek için hastaların geçmiş koroner anjiyografi (KAG) ve kardiyoloji poliklinik muayene sonuçları sorgulanıp risk durumu göreceli olarak tahmin edilmektedir. Bu noktadan yola çıkarak hastaların geçmiş KAG ve kardiyoloji poliklinik muayene sonuçlarının hastaları taburcu etmedeki güvenilirliğini değerlendirmeyi amaçladık.
GEREÇ VE YÖNTEM: Prospektif gözlemsel çalışmamıza 16.09.2020-30.07.2022 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Acil Servisi’ne göğüs ağrısı şikâyeti ile başvuran ve primer hekim tarafından akut koroner sendrom olabileceği düşünülerek takibe alınan, 18 yaşından büyük hastalar içerisinden, çalışma onam formunu okuyup kabul edenler dahil edildi. Hastaların acil servis sonlanım tanıları incelendi. ST yükselmeli olmayan miyokard enfarktüsü (NSTMI), ST yükselmeli miyokard enfarktüsü (STMI), kardiyak ölüm, koroner bypass gelişme durumları majör kardiyak olay (MACE) olarak değerlendirilip kaydedildi. MACE gelişen hastaların tespit edilememesi ihtimaline karşı taburcu olduktan sonra telefonla aranarak veya hasta kayıtlarına ulaşılarak taburculuk sonrası 3 gün içerisinde MACE gelişme durumu sorgulandı. Sonuçlar acil sonlanımdaki tanılara dahil edildi. Acil sonlanımda MACE gelişen ve gelişmeyen hastalar geçmiş anlamlı (stent varlığı ve/veya koroner arterlerde ≥%50 darlık olması) KAG ve son bir yıldaki anlamlı kardiyoloji poliklinik muayenesi açısından karşılaştırıldı. KAG veya koroner bypass önerilmesi, anti agregan ve/veya anti koagülan tedavi başlanması, efor testinin pozitif gelmesi kriterlerinden birinin bulunması halinde geçmiş kardiyoloji poliklinik muayenesi anlamlı kabul edildi.
BULGULAR: Çalışmaya 159 hasta dahil edildi. Çalışmaya katılan hastaların 102‘si (%64,2) erkek, 57’si (%35,8) kadındı. Çalışmaya katılan hastaların yaş ortalamaları 56±16,84 idi. Çalışmaya katılan 159 hastanın 46’sında (%28,9) acil sonlanım noktasında MACE saptandı, 113’ünde (%71) MACE saptanmadı. Hastaların 43’ünde (%27) NSTMI, 2’sinde (%1,3) STMI, 1’inde (%0,6) kardiyak ölüm, 2’sinde (%1,3) koroner bypass geçirme durumu tespit edildi.
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MACE gelişen hasta grubunda 6 hastada (%13,0) son bir yıl anlamlı KAG saptanırken, MACE gelişmeyen hasta grubunda 11 hastada (%11,5) son bir yıl içinde anlamlı KAG saptandı. Her iki grup hasta son bir yıl içindeki anlamlı KAG açısından karşılaştırıldığında, MACE gelişen hasta grubu ile MACE gelişmeyen hasta grubu arasında istatistiksel olarak anlamlı fark bulunmadı(p=0,576). MACE gelişen hasta grubunda 12 hastanın (%26,1) geçmiş kardiyoloji poliklinik muayenesinde koroner arter hastalığı (KAH) açısından risk saptanırken, MACE gelişmeyen hasta grubunda 13 hastanın (%11,5) geçmiş kardiyoloji poliklinik muayenesinde KAH açısından risk saptandı. Her iki grup hasta geçmiş kardiyoloji poliklinik muayenesinde KAH riski açısından karşılaştırıldığında, MACE gelişen hasta grubunda MACE gelişmeyen hasta grubuna göre, geçmiş kardiyoloji poliklinik muayenesinde KAH risk durumu istatistiksel olarak anlamlı yüksek bulundu(p=0,022).
SONUÇ: Çalışmamızda acil servise göğüs ağrısı ile başvuran hastalarda MACE gelişen ve gelişmeyenler arasında son bir yılda anlamlı KAG olma oranı benzer bulundu. Ayrıca MACE gelişen grupta son bir yıldaki anlamlı kardiyoloji muayene geçmişi, MACE gelişmeyen gruptaki anlamlı kardiyoloji muayene geçmişine göre istatistiksel olarak anlamlı yüksek saptandı.
INTRODUCTION:: Acute coronary syndrome (ACS) is the leading cause among the most common causes of chest pain with high mortality if not diagnosed early and the necessary invasive procedures or medical treatment not performed quickly. In order to detect ACS in the emergency departments by clinicians, patients' history of past coronary angiography (CAG) and cardiology outpatient examination outcomes are queried and the risk status is relatively determined. From this perspective, we aimed to evaluate the reliability of patients' history of CAG and cardiology outpatient examination outcomes in discharging patients. MATERIALS AND METHODS: In our prospective observational study, among patients older than 18 years of age who presented with chest pain to the Emergency Department of the Necmettin Erbakan University Meram Faculty of Medicine between 16.09.2020-30.07.2022, and who were monitored by their primary physician with the thought of acute coronary syndrome, those who read and gave informed consent were included in our study. Evaluation of the Emergency Department outcome diagnoses of the patients was done. Non-ST elevation myocardial infarction (NSTEMI), ST elevation myocardial infarction (STEMI), cardiac death, coronary bypass development were evaluated and recorded as major cardiac events (MACE). In order to cover up for the possibility of missing patients who could develop MACE, after discharge MACE development status was queried within 3 days via patient calling or by accessing patient records. The results were included in the Emergency Department outcome diagnoses. At the end of their Emergency Department stay, patients with and without MACE were compared in terms of past significant CAG history (presence of stent and/or ≥50% coronary stenosis) and significant cardiology outpatient examination in the last one year. Presence of any one of the following criteria was accepted as history of a significant previous cardiology outpatient examination: CAG or coronary bypass recommendation, start of antiaggregant and/or anticoagulant therapy, and a positive stress test. v RESULTS: 159 patients were included in the study. Of the patients participating in the study, 102 (64.2%) were male and 57 (35.8%) were female. The mean age of the patients participating in the study was 56±16.84. At the end of their Emergency Department stay, MACE was detected in 46 (28.9%) of the 159 patients included in the study, and was not detected in 113 (71%) patients. NSTEMI was detected in 43 (27%) patients, STEMI in 2 (1.3%), cardiac death in 1 (0.6%), and coronary bypass in 2 (1.3%) patients. Whereas significant CAG was detected in the last one year in 6 patients (13.0%) in the patient group with MACE, significant CAG was detected in 11 patients (11.5%) in the patient group without MACE in the last one year. When both groups of patients were compared in terms of significant CAG within the last one year, no statistically significant difference was found between the patient group developing MACE and the patient group not developing MACE (p=0.576). While a risk for coronary artery disease (CAD) was found in the previous cardiology outpatient examination of 12 patients (26.1%) in the patient group that developed MACE, a risk for CAD was found in the past cardiology outpatient examination of 13 patients (11.5%) in the patient group that did not develop MACE. When both groups of patients were compared in terms of CAD risk in the previous cardiology outpatient examination, the risk status of CAD in the previous cardiology outpatient examination was found to be statistically significantly higher in the patient group with MACE compared to the group without MACE (p=0.022). DISCUSSION: In our study, among patients who presented to the Emergency Department with chest pain the rate of significant CAG in the last one year was found to be similar between patients who developed MACE and those who did not. In addition, significant cardiology examination history in the last one year in the group developing MACE was found to be statistically significantly higher than that for the group without MACE.
INTRODUCTION:: Acute coronary syndrome (ACS) is the leading cause among the most common causes of chest pain with high mortality if not diagnosed early and the necessary invasive procedures or medical treatment not performed quickly. In order to detect ACS in the emergency departments by clinicians, patients' history of past coronary angiography (CAG) and cardiology outpatient examination outcomes are queried and the risk status is relatively determined. From this perspective, we aimed to evaluate the reliability of patients' history of CAG and cardiology outpatient examination outcomes in discharging patients. MATERIALS AND METHODS: In our prospective observational study, among patients older than 18 years of age who presented with chest pain to the Emergency Department of the Necmettin Erbakan University Meram Faculty of Medicine between 16.09.2020-30.07.2022, and who were monitored by their primary physician with the thought of acute coronary syndrome, those who read and gave informed consent were included in our study. Evaluation of the Emergency Department outcome diagnoses of the patients was done. Non-ST elevation myocardial infarction (NSTEMI), ST elevation myocardial infarction (STEMI), cardiac death, coronary bypass development were evaluated and recorded as major cardiac events (MACE). In order to cover up for the possibility of missing patients who could develop MACE, after discharge MACE development status was queried within 3 days via patient calling or by accessing patient records. The results were included in the Emergency Department outcome diagnoses. At the end of their Emergency Department stay, patients with and without MACE were compared in terms of past significant CAG history (presence of stent and/or ≥50% coronary stenosis) and significant cardiology outpatient examination in the last one year. Presence of any one of the following criteria was accepted as history of a significant previous cardiology outpatient examination: CAG or coronary bypass recommendation, start of antiaggregant and/or anticoagulant therapy, and a positive stress test. v RESULTS: 159 patients were included in the study. Of the patients participating in the study, 102 (64.2%) were male and 57 (35.8%) were female. The mean age of the patients participating in the study was 56±16.84. At the end of their Emergency Department stay, MACE was detected in 46 (28.9%) of the 159 patients included in the study, and was not detected in 113 (71%) patients. NSTEMI was detected in 43 (27%) patients, STEMI in 2 (1.3%), cardiac death in 1 (0.6%), and coronary bypass in 2 (1.3%) patients. Whereas significant CAG was detected in the last one year in 6 patients (13.0%) in the patient group with MACE, significant CAG was detected in 11 patients (11.5%) in the patient group without MACE in the last one year. When both groups of patients were compared in terms of significant CAG within the last one year, no statistically significant difference was found between the patient group developing MACE and the patient group not developing MACE (p=0.576). While a risk for coronary artery disease (CAD) was found in the previous cardiology outpatient examination of 12 patients (26.1%) in the patient group that developed MACE, a risk for CAD was found in the past cardiology outpatient examination of 13 patients (11.5%) in the patient group that did not develop MACE. When both groups of patients were compared in terms of CAD risk in the previous cardiology outpatient examination, the risk status of CAD in the previous cardiology outpatient examination was found to be statistically significantly higher in the patient group with MACE compared to the group without MACE (p=0.022). DISCUSSION: In our study, among patients who presented to the Emergency Department with chest pain the rate of significant CAG in the last one year was found to be similar between patients who developed MACE and those who did not. In addition, significant cardiology examination history in the last one year in the group developing MACE was found to be statistically significantly higher than that for the group without MACE.
Açıklama
Anahtar Kelimeler
Göğüs ağrısı, Akut Koroner Sendrom, Koroner Anjiyografi, Majör Kardiyak Olay, Chest pain, Acute Coronary Syndrome, Coronary Angiography, Major Cardiac Event
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demiryürek, M. (2023). Göğüs ağrısı ile acil servise başvuran hastaların geçmiş kag ve kardiyoloji poliklinik muayenesinin önemi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
