Med Bull Sisli Etfal Hosp. 2019; 53(2): 179-185 | DOI: 10.14744/SEMB.2019.00878

In-hospital Outcomes of Patients with ST-segment Elevation Myocardial Infarction who were Intubated before Primary Percutaneous Intervention: Experience of a tertiary center

Süleyman Sezai Yýldýz, Serhat Sýðýrcý, Ahmet Gürdal, Kudret Keskin, Hakan Kilci, Güneþ Melike Doðan, Turgun Hamit, Kadriye Kýlýçkesmez
Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

Objectives: ST-segment elevation myocardial infarction (STEMI) complicated by respiratory failure is associated with a greater number of in-hospital and out-of-hospital adverse cardiovascular events (CVEs). The aim of this study was to analyze in-hospital outcomes and the factors affecting the outcomes of intubated patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI) at a single tertiary care center.
Methods: The data of 592 patients diagnosed with acute STEMI who were admitted to the emergency department between May 2017 and January 2019 and subsequently underwent pPCI were retrospectively reviewed. Cardiovascular risk factors as well as biochemical and angiographic characteristics of patients who were intubated in the emergency room or ambulance due to cardiac arrest and those who were not intubated were compared. Adverse CVEs were defined as in-hospital death, cerebrovascular stroke, and acute stent thrombosis.
Results: A total of 60 patients (70% male; mean age: 63.6±14.0 years) who were intubated and 532 non-intubated patients (81% male; mean age: 60.2±12.1 years) were included in the study. The angiographic features of the 2 groups were similar. An adverse CVE was experienced by 43.3% of the intubated patients and 3.6% of the non-intubated patients. Multivariate analysis indicated that age (odds ratio [OR]: 1.065; p<0.001), serum lactate level (OR: 1.308; p<0.001), and left ventricle ejection fraction (OR: 0.946; p<0.001) were independent predictors of in-hospital adverse CVE in the intubated patient group.
Conclusion: The results of this single-center study showed that 1 in 10 patients hospitalized with STEMI were intubated, and approximately 4 in 10 intubated STEMI patients had an in-hospital CVE.

Keywords: In-hospital outcomes, intubated patients; ST-segment elevation myocardial infarction.

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Primer perkütan giriþim öncesi entübe olan ST segment yükselmeli miyokart enfarktüslü hastalarýn hastane içi sonuçlarý: Üçüncü basamak merkez tecrübesi

Süleyman Sezai Yýldýz, Serhat Sýðýrcý, Ahmet Gürdal, Kudret Keskin, Hakan Kilci, Güneþ Melike Doðan, Turgun Hamit, Kadriye Kýlýçkesmez
Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Saðlýk Bilimleri Üniversitesi, Kardiyoloji Bölümü, Ýstanbul

Amaç: Solunum yetmezliði ile komplike olan ST segment yükselmeli miyokard infarktüsü (STEMI) hastane içi ve hastane dýþý artmýþ istenmeyen kardiyovasküler olaylarla (KVO) birliktedir. Çalýþmamýzda, üçüncü basamak merkezimizde STEMI tanýsý ile kabul edilmiþ ve entübe edilmiþ hastalarýn hastane içi sonuçlarýný ve etki eden faktörleri analiz etmeyi amaçladýk.
Yöntem: Mayýs 2017 ile Ocak 2019 arasýnda acil servisde akut ST segment elevasyonlu MI tanýsý alan 592 hasta retrospektif tarandý. Primer PKG öncesinde, acil servis veya ambulansda kardiyak arrest nedeniyle entübe edilen hastalar ile entübe edilmeyen hastalar biyokimyasal, kardiyovasküler risk faktörleri, anjiografik özellikleri ile karþýlaþtýrýldý. Ýstenmeyen KVO, hastane içi ölüm, serebrovasküler inme ve akut stent trombozu olarak tanýmlandý.
Bulgular: Entübe olan 60 hasta (%70 erkek, ortalama yaþ 63.6 ±14.0) ve entübe olmayan 532 hasta (%81 erkek, ortalama yaþ 60.2 ±12.1) çalýþmaya dahil edildi. Gruplar arasýnda anjiografik özellikler benzerdi. Entübe olan hastalarýn %43,3’de, entübe olmayan hastalarýn %3.6’sýnda istenmeyen KVO meydana geldi. Çok deðiþkenli analizde, yaþ (OO: 1.065, p<0.001), serum laktat düzeyi (OO: 1.308, p<0.001) ve sol ventrikül ejeksiyon fraksiyonu (SVEF) (OO: 0.946, p<0.001) entübe olan STYME hastalarýn hastane içi istenmeyen KVO’larýn baðýmsýz öngördürücüsü olarak tespit edildi.
Sonuç: Tek merkezli çalýþmamýz, STYME’lü her 10 hastadan birinin entübe edildiðini, entübe olan 10 hastadan yaklaþýk dördünün hastane içi istenmeyen olaylara sahip olduðunu gösterdi.

Anahtar Kelimeler: Hastane içi sonuçlar, entübe hastalar, STYME.

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