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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

RISK STRATIFICATION AND TREATMENT FOLLOWING ACUTE MYOCARDIAL INFARCTION
P. Urban and J. Alibegović
Hopital de la Tour1, Geneve, Clinic of Cardiology2, Clinical Center University of Sarajevo, Switzerland, Bosnia and Herzegovina

Medical care and risk profile assessment of patients with AMI can be divided in three phases: pre-hospital phase, hospital admission and evaluation before discharge. During the pre-hospital phase, the risk of sudden death due to the ventricular arrhythmias is the highest so the priority must be to monitor the cardiac rhythm as early as possible. Out-of-hospital thrombolysis should be considered for patients with transmural ischemia where the transport delays are important, since this is associated with significant long-term survival benefit. Following hospital admission, the majority of deaths in patients with ST segment elevation occur in first 48 hours, and is strongly associated with the presence of cardiac failure or cardiogenic shock. The higher risk, the more important is the strategy to obtain fast and complete coronary reperfusion. The AMIS project in Switzerland revealed that the following admission parameters were associated with the hospital death in the course of MI: age >65, Killip class III and IV, delay between the start of symptoms and arrival to the hospital >6 hours, history of prior cerebrovascular accident, DC shock prior to hospitalisation, LBBB or ST segment elevation. For the patients with ST elevation where the catch lab is available, an immediate invasive approach is preferable to thrombolysis. It is associated with a lower risk of death/reinfarction at 30 days and a lower incidence of cerebral haemorrhages. During the hospitalisation phase, the minimum tests should include lipid profile, evaluation of other risk factors and LV function (echocardiography) as well as sub-maximal stress test or other functional test, prior to discharge. Coronary angiography is clearly indicated in cases where the LV function is reduced (EF<40%) or if the stress test shows ischemia or a bad functional performance.

Drugi kongres kardiologa i angiologa Bosne i Hercegovine
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