Akut Koroner Sendromlar
Özet
Toplumumuzda en önemli mortalite sebebi akut koroner sendromlardır (AKS). Bu sendrom kendi içinde unstabil anjina pektoris (USAP), ST yükselmesi olmayan miyokard infarktüsü (NSTEMI) veya ST yükselmesi olan miyokard infarktüsü (STEMI) gibi alt gruplara ayrılan klinik durumdur. Genellikle koroner damarlarda aterosklerotik plak yırtılması ile ilişkili trombüse bağlı ani gelişen kısmi veya tam tıkanıklığa bağlı gerçekleşir. Yoğun bakım ünitelerinde hastalarda semptomlara yönelik erken dönemde tanı konulması, tetkiklerin yapılması ve tedavisinin verilmesi, tedavi veya girişimsel işlem sonrası AKS’li hastaların bakımında sağlık çalışanlarının yetkin olması hastanelerde daha iyi sonuçların oluşmasını sağlarlar. Bu bölümde AKS’nin tanım ve sınıflandırılması, tanı ve tedavisinden bahsedilecektir.
The most important cause of mortality in our society is acute coronary syndromes (ACS). This syndrome is a clinical condition divided into subgroups such as unstable angina pectoris (USAP), non-ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI). It usually occurs due to sudden partial or complete obstruction due to thrombus associated with atherosclerotic plaque rupture in the coronary vessels. Early diagnosis of patients' symptoms in intensive care units, examination and treatment, and competent healthcare professionals in the care of patients with ACS after treatment or interventional procedures ensure better results in hospitals. In this section, the definition, classification, diagnosis and treatment of ACS will be discussed.
Referanslar
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019;40:237–269. https://doi.org/10.1093/eurheartj/ehy462
Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, et al. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J 2022;43:716-799. https://doi.org/10.1093/eurheartj/ehab892
Erol, Ç., 2004. Klinik Kardiyoloji. Medikal & Nobel Tıp Kitap Sarayı. 3, 9-15
Koeng, W., 1999. Athersclerosis involves more than just lipids: Fcus on inflammation. Eur. Heart. J. 19-26.
Vallace, P., 1996. Vascular endothelium, its physiology and pathophysiology. In: Weatherall DJ et al. Oxford text book of medicine, 3rd ed. Oxford Medical Publications. 2, 2295-2300.
Paini A, Tarozzi L, Bertacchini F, et al. Cardiovascular prognosis in patients admitted to an emergency department with hypertensive emergencies and urgencies. J Hypertens 2021; 39:2514.
Astarita A, Covella M, Vallelonga F, et al. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. J Hypertens 2020; 38:1203.
Diercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV, Kirk JD, et al. Frequency and consequences of recordingan electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative). Am J
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. Published online August 25, 2023. doi:10.1093/eurheartj/ehad191
Kosuge M, Kimura K, Ishikawa T, Hongo Y, Shigemasa T, Sugiyama M, Tochikubo O, Umemura S. Implications of the absence of ST-segment elevation in lead V4R in patients who have inferior wall acute myocardial infarction with right ventricular involvement. Clin Cardiol. 2001 Mar;24(3):225-30. doi: 10.1002/clc.4960240310. PMID: 11288969; PMCID: PMC6655134.
Nestelberger T, Boeddinghaus J, Badertscher P, Twerenbold R, Wildi K, Breitenbücher D, Sabti Z, Puelacher C, Rubini Giménez M, Kozhuharov N, Strebel I, Sazgary L, Schneider D, Jann J, du Fay de Lavallaz J, Miró Ò, Martin-Sanchez FJ, Morawiec B, Kawecki D, Muzyk P, Keller DI, Geigy N, Osswald S, Reichlin T, Mueller C; APACE Investigators. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J Am Coll Cardiol. 2017 Sep 26;70(13):1558-1568. doi: 10.1016/j.jacc.2017.07.774. PMID: 28935032.
Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, Gitt A, Hasdai D, Hasin Y, Marrugat J, Van de Werf F, Wallentin L, Behar S; Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006 Oct;27(19):2285-93. doi: 10.1093/eurheartj/ehl196. Epub 2006 Aug 14. PMID: 16908490.
Kulkarni AU, Brown R, Ayoubi M, Banka VS. Clinical use of posterior electrocardiographic leads: a prospective electrocardiographic analysis during coronary occlusion. Am Heart J. 1996 Apr;131(4):736-41. doi: 10.1016/s0002-8703(96)90280-x. PMID: 8721648.
Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Koechlin L, Münch T, Miro O, Gimenez MR, Mueller C; APACE Investigators. Prospective Validation of the ESC 0/1h-Algorithm Using High-Sensitivity Cardiac Troponin I. Am J Cardiol. 2021 Nov 1;158:152-153. doi: 10.1016/j.amjcard.2021.08.007. Epub 2021 Aug 30. PMID: 34470703.
Chapman AR, Anand A, Boeddinghaus J, Ferry AV, Sandeman D, Adamson PD, Andrews J, Tan S, Cheng SF, D'Souza M, Orme K, Strachan FE, Nestelberger T, Twerenbold R, Badertscher P, Reichlin T, Gray A, Shah ASV, Mueller C, Newby DE, Mills NL. Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction. Circulation. 2017 Apr 25;135(17):1586-1596. doi: 10.1161/CIRCULATIONAHA.116.025021. Epub 2016 Dec 29. PMID: 28034899; PMCID: PMC5404406.
Mueller C. Biomarkers and acute coronary syndromes: an update. Eur Heart J. 2014 Mar;35(9):552-6. doi: 10.1093/eurheartj/eht530. Epub 2013 Dec 18. PMID: 24357507.
Collinson PO, Saenger AK, Apple FS; IFCC C-CB. High sensitivity, contemporary and point-of-care cardiac troponin assays: educational aids developed by the IFCC Committee on Clinical Application of Cardiac Bio-Markers. Clin Chem Lab Med. 2019 Apr 24;57(5):623-632. doi: 10.1515/cclm-2018-1211. PMID: 30530880.
Kimenai DM, Lindahl B, Jernberg T, Bekers O, Meex SJR, Eggers KM. Sex-specific effects of implementing a high-sensitivity troponin I assay in patients with suspected acute coronary syndrome: results from SWEDEHEART registry. Sci Rep. 2020 Sep 17;10(1):15227. doi: 10.1038/s41598-020-72204-2. PMID: 32943674; PMCID: PMC7499170.
Referanslar
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019;40:237–269. https://doi.org/10.1093/eurheartj/ehy462
Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, et al. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J 2022;43:716-799. https://doi.org/10.1093/eurheartj/ehab892
Erol, Ç., 2004. Klinik Kardiyoloji. Medikal & Nobel Tıp Kitap Sarayı. 3, 9-15
Koeng, W., 1999. Athersclerosis involves more than just lipids: Fcus on inflammation. Eur. Heart. J. 19-26.
Vallace, P., 1996. Vascular endothelium, its physiology and pathophysiology. In: Weatherall DJ et al. Oxford text book of medicine, 3rd ed. Oxford Medical Publications. 2, 2295-2300.
Paini A, Tarozzi L, Bertacchini F, et al. Cardiovascular prognosis in patients admitted to an emergency department with hypertensive emergencies and urgencies. J Hypertens 2021; 39:2514.
Astarita A, Covella M, Vallelonga F, et al. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. J Hypertens 2020; 38:1203.
Diercks DB, Peacock WF, Hiestand BC, Chen AY, Pollack CV, Kirk JD, et al. Frequency and consequences of recordingan electrocardiogram >10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE Initiative). Am J
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. Published online August 25, 2023. doi:10.1093/eurheartj/ehad191
Kosuge M, Kimura K, Ishikawa T, Hongo Y, Shigemasa T, Sugiyama M, Tochikubo O, Umemura S. Implications of the absence of ST-segment elevation in lead V4R in patients who have inferior wall acute myocardial infarction with right ventricular involvement. Clin Cardiol. 2001 Mar;24(3):225-30. doi: 10.1002/clc.4960240310. PMID: 11288969; PMCID: PMC6655134.
Nestelberger T, Boeddinghaus J, Badertscher P, Twerenbold R, Wildi K, Breitenbücher D, Sabti Z, Puelacher C, Rubini Giménez M, Kozhuharov N, Strebel I, Sazgary L, Schneider D, Jann J, du Fay de Lavallaz J, Miró Ò, Martin-Sanchez FJ, Morawiec B, Kawecki D, Muzyk P, Keller DI, Geigy N, Osswald S, Reichlin T, Mueller C; APACE Investigators. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J Am Coll Cardiol. 2017 Sep 26;70(13):1558-1568. doi: 10.1016/j.jacc.2017.07.774. PMID: 28935032.
Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, Gitt A, Hasdai D, Hasin Y, Marrugat J, Van de Werf F, Wallentin L, Behar S; Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006 Oct;27(19):2285-93. doi: 10.1093/eurheartj/ehl196. Epub 2006 Aug 14. PMID: 16908490.
Kulkarni AU, Brown R, Ayoubi M, Banka VS. Clinical use of posterior electrocardiographic leads: a prospective electrocardiographic analysis during coronary occlusion. Am Heart J. 1996 Apr;131(4):736-41. doi: 10.1016/s0002-8703(96)90280-x. PMID: 8721648.
Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Koechlin L, Münch T, Miro O, Gimenez MR, Mueller C; APACE Investigators. Prospective Validation of the ESC 0/1h-Algorithm Using High-Sensitivity Cardiac Troponin I. Am J Cardiol. 2021 Nov 1;158:152-153. doi: 10.1016/j.amjcard.2021.08.007. Epub 2021 Aug 30. PMID: 34470703.
Chapman AR, Anand A, Boeddinghaus J, Ferry AV, Sandeman D, Adamson PD, Andrews J, Tan S, Cheng SF, D'Souza M, Orme K, Strachan FE, Nestelberger T, Twerenbold R, Badertscher P, Reichlin T, Gray A, Shah ASV, Mueller C, Newby DE, Mills NL. Comparison of the Efficacy and Safety of Early Rule-Out Pathways for Acute Myocardial Infarction. Circulation. 2017 Apr 25;135(17):1586-1596. doi: 10.1161/CIRCULATIONAHA.116.025021. Epub 2016 Dec 29. PMID: 28034899; PMCID: PMC5404406.
Mueller C. Biomarkers and acute coronary syndromes: an update. Eur Heart J. 2014 Mar;35(9):552-6. doi: 10.1093/eurheartj/eht530. Epub 2013 Dec 18. PMID: 24357507.
Collinson PO, Saenger AK, Apple FS; IFCC C-CB. High sensitivity, contemporary and point-of-care cardiac troponin assays: educational aids developed by the IFCC Committee on Clinical Application of Cardiac Bio-Markers. Clin Chem Lab Med. 2019 Apr 24;57(5):623-632. doi: 10.1515/cclm-2018-1211. PMID: 30530880.
Kimenai DM, Lindahl B, Jernberg T, Bekers O, Meex SJR, Eggers KM. Sex-specific effects of implementing a high-sensitivity troponin I assay in patients with suspected acute coronary syndrome: results from SWEDEHEART registry. Sci Rep. 2020 Sep 17;10(1):15227. doi: 10.1038/s41598-020-72204-2. PMID: 32943674; PMCID: PMC7499170.
