View More View Less
  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar Kardiológiai Tanszék – Kardiológiai Központ Budapest Városmajor u. 68. 1122
Open access

Az akut coronariaszindróma a koszorúér-betegség legsúlyosabb formája. Közvetlen életveszélyt jelent, megfelelő ellátás nélkül magas halálozással jár. Az első EKG alapján két formáját különböztetjük meg, ST-szakasz-elevációval járó, illetve ST-szakasz-elevációval nem járó kórképeket. Az akut coronariaszindrómás beteg első ellátásának rendkívül fontos része az adekvát gyógyszeres kezelés megkezdése mellett a beteg menedzselése. Az előbbi esetében a panaszok kezdetétől számított 24 órán belül koronarográfia és legtöbbször primer percutan coronariaintervenció szükséges. ST-elevációval nem járó akut coronariaszindróma során fel kell mérni a beteg ischaemiás kockázatát és az adatok alapján várható halálozását, majd ennek alapján kell dönteni az invazív kivizsgálás szükségességéről és annak időzítéséről. A hazai szívkatéteres laboratóriumi hálózat ma már lényegében lefedi az egész országot, így csaknem minden akut coronariaszindrómás beteg a legkorszerűbb ellátásban részesülhet. Bár a cardiovascularis megbetegedési mutatók sajnálatosan magasak, a szervezett katéteres ellátásnak köszönhetően az infarktuseredetű halálozás csökkenő tendenciát mutat. Orv. Hetil., 2012, 153, 2009–2015.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Schmucker, H. W., Seide, S., Fiehn, E., et al.: Smoking ban and incidence of STEMI: non-smokers benefit most? Eur. Heart J., 2012, 33 (Abstract Supplement), 613.

    Fiehn E. , 'Smoking ban and incidence of STEMI: non-smokers benefit most? ' (2012 ) 33 Eur. Heart J. : 613 -.

    • Search Google Scholar
  • Puymirat, L. L., Coste, P., Charpentier, S., et al.: Impact on early complications of non-compliance with guidelines-recommended timelines for reperfusion therapy in STEMI patients. The FAST-MI 2010 registry. Eur. Heart J., 2012, 33 (Abstract Supplement), 203–204.

    Charpentier S. , 'Impact on early complications of non-compliance with guidelines-recommended timelines for reperfusion therapy in STEMI patients. The FAST-MI 2010 registry ' (2012 ) 33 Eur. Heart J. : 203 -204.

    • Search Google Scholar
  • Becker, D., Fulop, G., Szabo, Gy., et al.: Importance of time of day and day of week in the treatment of ST-elevation myocardial infarction with primary PCI. Eur. Heart J., 2006, 27 (Abstract Supplement), 908.

    Szabo Gy. , 'Importance of time of day and day of week in the treatment of ST-elevation myocardial infarction with primary PCI ' (2006 ) 27 Eur. Heart J. : 908 -.

    • Search Google Scholar
  • Becker, D., Soos, P., Berta, B., et al.: Significance of off-hours in centralized primary percutaneous coronary intervention network. Croat. Med. J., 2009, 50, 476–482.

    Berta B. , 'Significance of off-hours in centralized primary percutaneous coronary intervention network ' (2009 ) 50 Croat. Med. J. : 476 -482.

    • Search Google Scholar
  • Steg, P. G., James, S. K., Atar, D., et al.: ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur. Heart J., 2012. Aug. 24. Epub ahead of print.

  • Hamm, C. W., Bassand, J. P., Agewall, S., et al.: ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J., 2011, 32, 2999–3054.

    Agewall S. , 'ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) ' (2011 ) 32 Eur. Heart J. : 2999 -3054.

    • Search Google Scholar
  • Montalescot, G., Dallongeville, J., van Belle, E., et al.: STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry). Eur. Heart J., 2007, 28, 1409–1417.

    Belle E. , 'STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry) ' (2007 ) 28 Eur. Heart J. : 1409 -1417.

    • Search Google Scholar
  • Thygesen, K., Alpert, J. S., Jaffe, A. S., et al.: Third universal definition of myocardial infarction. Eur. Heart J., 2012 Aug. 24. Epub ahead of print.

  • Vago, H., Toth, A., Apor, A., et al.: Images in cardiovascular medicine. Cardiac contusion in a professional soccer player: visualization of acute and late pathological changes in the myocardium with magnetic resonance imaging. Circulation, 2010, 121, 2456–2461.

    Apor A. , 'Images in cardiovascular medicine. Cardiac contusion in a professional soccer player: visualization of acute and late pathological changes in the myocardium with magnetic resonance imaging ' (2010 ) 121 Circulation : 2456 -2461.

    • Search Google Scholar
  • Kern, K. B., Rahman, O.: Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest. Catheter Cardiovasc. Interv., 2010, 75, 616–624.

    Rahman O. , 'Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest ' (2010 ) 75 Catheter Cardiovasc. Interv. : 616 -624.

    • Search Google Scholar
  • Nolan, J. P., Hazinski, M. F., Billi, J. E., et al.: Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation, 2010, 81 (Suppl. 1), e1–e25.

    Billi J. E. , 'Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations ' (2010 ) 81 Resuscitation : e1 -e25.

    • Search Google Scholar
  • Belohlavek, J., Kucera, K., Jarkovsky, J., et al.: Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”. J. Transl. Med., 2012, 10, 163.

    Jarkovsky J. , 'Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study” ' (2012 ) 10 J. Transl. Med. : 163 -.

    • Search Google Scholar
  • Wiviott, S. D., Braunwald, E., McCabe, C. H., et al.: Prasugrel versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med., 2007, 357, 2001–2015.

    McCabe C. H. , 'Prasugrel versus clopidogrel in patients with acute coronary syndromes ' (2007 ) 357 N. Engl. J. Med. : 2001 -2015.

    • Search Google Scholar
  • Wallentin, L., Becker, R. C., Budaj, A., et al.: Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med., 2009, 361, 1045–1057.

    Budaj A. , 'Ticagrelor versus clopidogrel in patients with acute coronary syndromes ' (2009 ) 361 N. Engl. J. Med. : 1045 -1057.

    • Search Google Scholar
  • Patti, G., Barczi, G., Orlic, D., et al.: Outcome comparison of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results from the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) randomized study. J. Am. Coll. Cardiol., 2011, 58, 1592–1599.

    Orlic D. , 'Outcome comparison of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results from the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) randomized study ' (2011 ) 58 J. Am. Coll. Cardiol. : 1592 -1599.

    • Search Google Scholar
  • Abbate, A., Biondi-Zoccai, G. G., Appleton, D. L., et al.: Survival and cardiac remodeling benefits in patients undergoing late percutaneous coronary intervention of the infarct-related artery: evidence from a meta-analysis of randomized controlled trials. J. Am. Coll. Cardiol., 2008, 51, 956–964.

    Appleton D. L. , 'Survival and cardiac remodeling benefits in patients undergoing late percutaneous coronary intervention of the infarct-related artery: evidence from a meta-analysis of randomized controlled trials ' (2008 ) 51 J. Am. Coll. Cardiol. : 956 -964.

    • Search Google Scholar
  • Vlaar, P. J., Svilaas, T., van der Horst, I. C., et al.: Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet, 2008, 371, 1915–1920.

    Horst I. C. , 'Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study ' (2008 ) 371 Lancet : 1915 -1920.

    • Search Google Scholar
  • Patelm, M. R., Smalling, R. W., Thiele, H., et al.: Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial. JAMA, 2011, 306, 1329–1337.

    Thiele H. , 'Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial ' (2011 ) 306 JAMA : 1329 -1337.

    • Search Google Scholar
  • Fox, K. A., Dabbous, O. H., Goldberg, R. J., et al.: Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ, 2006, 333, 1091–1094.

    Goldberg R. J. , 'Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) ' (2006 ) 333 BMJ : 1091 -1094.

    • Search Google Scholar
  • Antman, E. M., Cohen, M., Bernink, P. J., et al.: The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA, 2000, 284, 835–842.

    Bernink P. J. , 'The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making ' (2000 ) 284 JAMA : 835 -842.

    • Search Google Scholar