2017 St Yükselmeli Miyokart Enfarktüsü Kılavuzunda Yenilikler
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2017
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Abstract
Bu derlemede ESC (European Society of Cardiology) 2017 ST segment yükselmeli miyokart enfarktüsü (STYME) kılavuzunda değişen ve yeni eklenen öneriler ele alınacaktır. Bu kılavuzda, ST segment yükselmeli miyokart enfarktüsü tanımı genişletilerek hasta kapsamı arttırılmıştır. Acil tedavide oksijen tedavisinin ve opioidlerin önemi azalırken, reperfüzyon süresinin kısaltılmasına yönelik ‘tanıdan tel geçişine’ kavramı geliştirilmiştir. Koroner anjiyografi süresi 2-24 saate indirilirken, 48 saatten sonra perkütan koroner girişim (PKG) iskemi yokluğunda önerilmemiştir. Radial girişim ve ilaç kaplı stent kullanımı ön plana çıkarken, rutin trombüs aspirasyonu artık önerilmemektedir. Komplet revaskülarizasyon artık hastaneden çıkmadan önerilmektedir. Stent trombozunu artırdığından bivalirudin endikasyonu azalırken, enoxaparin heparine alternatif olarak PKG de daha güçlü önerilmektedir. Potent P2Y12 inhibitörlerinin kullanımı klopidogrele üstün gözükmektedir. Kangrelor, oral alımı olmayanlarda intravenöz olarak ilk kez kullanıma girmiştir. Maksimum doz statine rağmen, 70 mg/dl LDL olanlarda ek ilaçların kullanımı önerilmektedir. İkili antiplatelet tedavi bir yıl süre ile önerilirken, 36 aya uzatılabileceğinden bahsedilmiştir. Kalite kontrolü değerlerinin standardizasyonu için kriterler belirlenmiştir.
In this review, we will discuss new and revised concepts in the ESC (European Society of Cardiology) 2017 ST-segment elevation myocardial infarction (STEMI) guideline. The definition of STEMI has been expanded to increase the patient coverage. The concept of 'diagnosis to wire crossing’ has been developed for shortening the duration of reperfusion while the importance of oxygen therapy and opioids has been diminished in emergency treatment. The time to coronary angiography has been reduced to 2-24 hours, and percutaneous coronary intervention (PCI) has not been recommended after 48 hours in the absence of ischemia. While radial intervention and the use of drug-eluting stents are at the forefront, routine thrombus aspiration is no longer recommended. Complete revascularization is recommended before leaving the hospital. Bivalirudin is recommended less as it increases stent thrombosis. Enoxaparine is used as an alternative to heparin in PCI. The use of potent P2Y12 inhibitors seems superior to clopidogrel. Cangrelor has been used for the first time in patients not taking oral administration. The use of additional medications is recommended in patients with LDL 70 mg / dL despite the use of maximum dose of statin. It has been mentioned that while dual antiplatelet therapy is recommended for one year, it can be extended to 36 months. Criteria have been set for standardization of quality indicators.
In this review, we will discuss new and revised concepts in the ESC (European Society of Cardiology) 2017 ST-segment elevation myocardial infarction (STEMI) guideline. The definition of STEMI has been expanded to increase the patient coverage. The concept of 'diagnosis to wire crossing’ has been developed for shortening the duration of reperfusion while the importance of oxygen therapy and opioids has been diminished in emergency treatment. The time to coronary angiography has been reduced to 2-24 hours, and percutaneous coronary intervention (PCI) has not been recommended after 48 hours in the absence of ischemia. While radial intervention and the use of drug-eluting stents are at the forefront, routine thrombus aspiration is no longer recommended. Complete revascularization is recommended before leaving the hospital. Bivalirudin is recommended less as it increases stent thrombosis. Enoxaparine is used as an alternative to heparin in PCI. The use of potent P2Y12 inhibitors seems superior to clopidogrel. Cangrelor has been used for the first time in patients not taking oral administration. The use of additional medications is recommended in patients with LDL 70 mg / dL despite the use of maximum dose of statin. It has been mentioned that while dual antiplatelet therapy is recommended for one year, it can be extended to 36 months. Criteria have been set for standardization of quality indicators.
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Kırıkkale Üniversitesi Tıp Fakültesi Dergisi
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Volume
19
Issue
3
Citation
Şimşek, V. (2017). 2017 St Yükselmeli Miyokart Enfarktüsü Kılavuzunda Yenilikler. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 19(3), 214 - 219.
