Doctoral theses
Search command : Author="Ραϊσάκη"
And Author="Μαρία"
Current Record: 44 of 1070
|
|
| Identifier |
000454329 |
| Title |
Εκτίμηση του μυοκαρδιακού εμφράκτου σε τυχαιοποιημένους ασθενείς με οξύ στεφανιαίο σύνδρομο με ανάσπαση του ST διαστήματος, οι οποίοι υποβάλλονται σε θρομβόλυση, υπό κλοπιδογρέλη η τικαγρελόρη |
| Alternative Title |
Assesment of myocardial infarct in randomized patients with acute coronary syndrome with ST swgment elevation who undergo thrombolysis under clopidogrel or ticagrelor |
|
Author
|
Πετούσης, Στυλιανός
|
|
Thesis advisor
|
Βάρδας, Παναγιώτης
|
|
Reviewer
|
Σκαλίδης, Εμμανουήλ
Λαζόπουλος, Γεώργιος
Κοχιαδάκης, Γεώργιος
Σημαντηράκης Εμμανουήλ
Μαρκέτου, Μαρία
Κοντοπόδης, Νικόλαος
|
| Abstract |
Coronary artery disease is characterized by atherosclerotic lesions of the coronary arteries and it can remain ‘’silent’’, it can be revealed as a chronic coronary syndrome with stable angina or an equivalent clinical syndrome , or can have a more dramatic expression as myocardial infarction.
Myocardial infarction represents a major cause of mortality and morbidity in the developed countries and it can be manifested as sudden cardiac death or having long term adverse clinical consequences due to ischemic cardiomyopathy.
Although coronary artery disease is responsible for a large number of deaths , in the developed countries where relative data exist, a gradual reduction in mortality is noted. An important part of the reduction in the mortality rates is attributed to the better primary and secondary prevention measures but also in interventions that aim to the more effective treatment of patients during the acute phase of myocardial infarction.
Myocardial infarction due to coronary artery disease is caused by the rupture or the erosion of an atheromatous plaque and thrombus formation in a coronary artery provoking the partial or total occlusion of the culprit artery. This occlusion leads to myocardial ischemia and death of myocardial cells if sufficiently prolonged. The total occlusion of the coronary artery corresponds to ST segment elevation in electrocardiographic recording while the partial occlusion of the coronary artery corresponds in other electrocardiographic changes such as ST segment depression and negative T waves.
In case of STEMI the main therapeutic target is the timely opening of the occluded coronary artery and the restoration of myocardial perfusion in the ischemic myocardial region, limiting the extent of myocardial injury and necrosis. Primary PCI is the preferred reperfusion method when it can be performed within indicated time limits and by adequately trained specialized personnel. If primary PCI it is not possible, thrombolysis using appropriate pharmaceutical regimen, represents an alternative reperfusion method, while in regions with geographic peculiarities or poor developed primary PCI networks, is a frequent therapeutic option.
The location of the coronary culprit lesion, the presence of collateral coronary circulation, the reperfusion time interval but also the extent of myocardial reperfusion injury determine the size of the myocardial infarction, a parameter of important prognostic value.
Dual antiplatelet therapy with low dose aspirin and inhibitors of P2Y12 receptors constitutes the base of the antithrombotic therapy administered during the acute phase of myocardial infarction. The sufficient platelets inhibition in this clinical scenario is of paramount importance for the limitation of myocardial injury as platelets have a key role in the formation of thrombus due to the coronary atheromatous plaque rupture/erosion, but also in the deleterious processes of myocardial reperfusion injury that often follows the restoration of coronary artery patency. The more potent agent ticagrelor is preferred in patients with myocardial infarction who undergo primary PCI compared to clopidogrel, due to its more favourable effects, revealed by relative clinical studies. The more beneficial actions of ticagrelor have not been sufficiently studied in patients with ST segment elevation myocardial infarction treated with thrombolysis and the aim of this study was to evaluate the potential benefit of the administration of this agent compared to clopidogrel in this group of patients.
The present study included forty two patients with ST segment elevation myocardial infarction coming from regional hospitals, previously randomized to treatment with clopidogrel (n=21) or ticagrelor(n=21) along with aspirin, who underwent thrombolysis.
Primary endpoint of this study was Myocardial Salvage Index (MSI). Secondary endpoints were FIS and CMR-derived left ventricular ejection fraction (LVEF) at 5-6 months post-randomization. Myocardial area at risk (AAR) was calculated according to the BARI and the APPROACH jeopardy scores. FIS and LVEF were quantified by cardiac magnetic resonance imaging (CMR) performed 5–6 months post-randomization. MSI was calculated as (AAR-FIS)/AAR×100%.
Results: By using the BARI score for AAR calculation, mean MSI was 52.25±30.5 for the clopidogrel group and 54.29±31.08 for the ticagrelor group (p=0.83), while mean MSI using the APPROACH score was calculated at 51.94±30 and 53.09±32.39 (p=0.9), respectively. Median CMR-derived FIS—as a percentage of LV—was 10.7%±8.25 in the clopidogrel group and 12.09%±8.72 in the ticagrelor group (p=0.6). Mean LVEF at 5–6 months post-randomization did not differ significantly between the two randomization groups.
Conclusions: Although discussing a small sample size, the results of this study suggest that the administration of ticagrelor in STEMI patients undergoing thrombolysis offer a similar degree of myocardial salvage, compared to clopidogrel.
|
| Language |
Greek, English |
| Subject |
Θρομβόλυση |
|
Μυοκαρδιακό έμφρακτο |
| Issue date |
2023-04-05 |
| Collection
|
School/Department--School of Medicine--Department of Medicine--Doctoral theses
|
|
|
Type of Work--Doctoral theses
|
| Permanent Link |
https://elocus.lib.uoc.gr//dlib/4/e/b/metadata-dlib-1683706238-707846-9846.tkl
|
| Views |
652 |
Collections
