Cílem studie bylo zhodnotit, zda všechny indikace urgentní kardiochirurgické revaskularizace na našem pracovišti byly v souladu s doporučeními pro léčbu akutního koronárního syndromu (ACS) a zjistit, jak z této léčby profitovali nemocní. V jednoročním období bylo celkem 87 nemocných operováno do 24 hodin po diagnostické katetrizaci. Většina z nich vyžadovala urgentní revaskularizaci nebo i další kardiochirurgický výkon pro ACS (60 nemocných) nebo jinou formu ischemické choroby srdeční (ICHS). Indikace k těmto výkonům byly v souladu s doporučeními pro léčbu takových nemocných. Sledovali jsme jednak nemocniční mortalitu operovaných nemocných a dále jejich stav 30 dnů po operaci a také jsme porovnávali ejekční frakci levé komory srdeční před operací a při 30denní kontrole. Výsledky hodnocené jak nemocniční mortalitou, tak i funkčním stavem nemocných a ejekční frakcí levé komory srdeční ukazují, že i kardiochirurgická revaskularizace má své místo v léčbě akutního koronárního syndromu, především tam, kde perkutánní koronární intervenci (PCI) nelze z technických důvodů provést.

The aim of the study was to evaluate if all indications of urgent surgical revascularization in our institution were done in accordance with the guidelines for treatment of acute coronary syndromes (ACS) and to assess profit for the patients. Within one year period 87 patients underwent heart surgery within 24 hours after diagnostic catheterization. Majority of them needed urgent surgical revascularization or other surgical procedure because acute ACS (60 patients) or other forms of ischemic heart disease. All indications of those procedures were done in accordance with national guidelines for treatment of acute myocardial infarction and non-ST elevation acute coronary syndromes (NSTEACS). We evaluated in hospital mortality and the status of the patients 30 days after surgery as well as ejection fraction of the left ventricle comparing value immediately before surgery and 30 day follow-up. Our results indicate that surgical revascularization still may play a role in treatment of acute coronary syndromes, especially in patients in whom percutaneous coronary intervention (PCI) is not technically feasible.

• MeSH
• Adult MeSH
• Cardiac Surgical Procedures methods   MeSH
• Coronary Disease diagnosis   pathology   therapy   MeSH
• Coronary Stenosis diagnosis   pathology   therapy   MeSH
• Humans MeSH
• Coronary Artery Disease diagnosis   pathology   therapy   MeSH
• Myocardial Reperfusion methods   MeSH
• Myocardial Revascularization methods   MeSH
• Emergency Medical Services methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH

V současné době se stále zvyšuje incidence infarktu myokardu s elevacemi úseku ST (STEMI) u starších osob. V nejnovějších guidelines se doporučuje okamžité invazivní vyšetření a případná primární perkutánní koronární intervence (PCI) u všech pacientů bez ohledu na věk. Podle literárních údajů se však intervenční léčba starších pacientů se STEMI neprovádí v dostatečné míře. Cílem naší studie bylo posoudit výsledky hospitalizace starších pacientů pro STEMI oproti mladším osobám z hlediska systematické intervenční léčby. Zajímali jsme se rovněž o některá, podle nás významná specifika léčby starších pacientů se STEMI. Posoudili jsme údaje 975 po sobě následujících pacientů se STEMI přijatých do jednoho centra v období od ledna 2012 do července 2013; z toho 203 (20,8 %) pacientů bylo ve věku 75 let a více. V porovnání s mladšími osobami byli starší pacienti většinou ženy (47,2 % vs. 22,7 %; p < 0,001) s vyšší prevalencí hypertenze (78,8 % vs. 65,0 %; p < 0,001), avšak nižší prevalencí kuřáctví (13,7 % vs. 48,8 %; p < 0,001) a dyslipidemie (54,7 % vs. 41,3 %; p = 0,03). Ve věkové kategorii ≥ 75 let jsme zaznamenali více kardiovaskulárních komorbidit: cévních mozkových příhod (11,8 % vs. 4,1 %; p < 0,001), fibrilací síní (23,6 % vs. 53,9 %; p < 0,001) a těžkých vaskulopatií (6,8 % vs. 1,2 %; p < 0,001). U starších pacientů byly častěji pozorovány známky srdečního selhání (Killipova třída > I: 21,1 % vs. 7,2 %; p < 0,001). U obou skupin byla stanovena podobná doba ischemie, 54,1 % vs. 55,1 % s převozem do nemocnice do šesti hodin. U starší skupiny bylo provedeno méně PCI (74,3 % vs. 85,7 %; p = 0,02). Rozsah lézí na koronárních tepnách se významně nelišil, až na dva případy postižení kmene levé věnčité tepny u starších pacientů (12,2 % vs. 5,1 %; p < 0,001). Mezi oběma skupinami nebyly významné rozdíly v léčbě během hospitalizace (duální antiagregační léčba, antikoagulace, beta-blokátory, inhibitory enzymu konvertujícího angiotensin [ACE]/blokátory receptorů AT1 pro angiotensin II a statiny). Nemocniční mortalita všech našich pacientů byla 4,41 %, s hodnotami 11,3 % u starší skupiny a 2,59 % ve skupině ve věku < 75 let (p < 0,001). Výsledky léčby starších pacientů se STEMI během pobytu v nemocnici byly horší, se zvýšenou mortalitou, zvláště u osob se srdečním selháním již při příjmu. U starších pacientů bylo provedeno méně PCI, i když ve farmakoterapii nebyl žádný rozdíl zjištěn. U všech pacientů bez ohledu na věk je nutno uplatňovat strategii okamžitého koronarografického vyšetření a v případě potřeby primární PCI.

Nowadays, ST elevation acute myocardial infarction (STEMI) is seen with greater incidence in older patients. Current guidelines recommend an immediate invasive evaluation and eventually primary percutaneous coronary intervention (PCI) in all STEMI patients regardless of age. Nevertheless, data in literature show a significant underuse of interventional treatment in older patients with STEMI. Our objective is to assess the in-hospital outcome of the elderly STEMI patients compared to the younger ones in the setting of systematic interventional management. We also discussed some particular aspects which we considered as significant concerning the management of elderly patients with STEMI. We evaluated 975 consecutive STEMI patients admitted to a single centre between January 2012 and July 2013. There were 203 (20.8 %) patients ≥ 75 years old. Compared to the younger group, in the older group there were more women (47.2% vs 22.7%; p < 0.001), an increased prevalence of hypertension (78.8% vs 65.0%; p < 0.001) but a decreased prevalence of smoking (13.7% vs 48.8%; p < 0.001) and dyslipidemia (54.7% vs 41.3%; p = 0.03). The ≥ 75 years group had more cardiovascular comorbidities: stroke (11.8% vs 4.1%; p < 0.001), atrial fibrillation (23.6% vs 53.9%; p < 0.001) and severe valvulopathies (6.8% vs 1.2%; p < 0.001). Elderly patients presented more frequently with signs of heart failure (Killip class > I: 21.1% vs 7.2%; p < 0.001). Both groups had similar ischemia time with 54.1% vs 55.1% presenting within 6 hours. There were fewer PCIs performed in the elderly group (74.3% vs 85.7%; p = 0.02). The extension of coronary lesions was not significantly different between the two groups, except for left main disease in favour of the elderly (12.2 % vs 5.1 %; p < 0.001). There were no significant differences between the two groups regarding the in-hospital treatment (dual antiplatelet, anticoagulation, beta-blockers, ACEI/ARB and statin).The in-hospital mortality for our entire study group was 4.41%, with a rate of 11.3% in the older group and 2.59 % in the < 75 years group (p < 0.001). In-hospital outcome in older patients with STEMI is worse, with an increased mortality rate, especially when associated with heart failure on admission. Fewer PCI were performed in the older patients, although there was no difference in the pharmacological treatment. A strategy based on urgent coronary angiography and, if necessary, primary PCI, should be applied in all eligible patients irrespective of age.

• MeSH
• Acute Coronary Syndrome diagnosis   epidemiology   drug therapy   surgery   complications   mortality   pathology   MeSH
• Angioplasty, Balloon, Coronary utilization   MeSH
• Risk Assessment statistics & numerical data   MeSH
• Hospitalization MeSH
• Myocardial Infarction * diagnosis   epidemiology   drug therapy   surgery   complications   mortality   pathology   MeSH
• Clinical Trials as Topic statistics & numerical data   MeSH
• Quality of Health Care statistics & numerical data   MeSH
• Humans MeSH
• Myocardial Reperfusion MeSH
• Myocardial Revascularization MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Practice Guidelines as Topic MeSH
• Age Factors * MeSH
• Outcome and Process Assessment, Health Care * statistics & numerical data   MeSH
• Risk Adjustment MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Evaluation Study MeSH
• Review MeSH

• MeSH
• Denervation MeSH
• Stellate Ganglion MeSH
• Counterpulsation methods   MeSH
• Coronary Disease * therapy   MeSH
• Angiogenesis Inducing Agents MeSH
• Humans MeSH
• Myocardium MeSH
• Myocardial Reperfusion MeSH
• Myocardial Revascularization * methods   MeSH
• Severity of Illness Index MeSH
• Transcutaneous Electric Nerve Stimulation methods   MeSH
• Transmyocardial Laser Revascularization MeSH
• Check Tag
• Humans MeSH

• MeSH
• Myocardial Contraction MeSH
• Myocardium MeSH
• Myocardial Reperfusion methods   MeSH
• Myocardial Revascularization methods   MeSH
• Heart physiopathology   MeSH

Řízená reperfuze s cílem snížit ischemicko-reperfuzní posškození, kdy se pomocí manžety tonometru vyvolá ischemie tkání vzdálených od myokardu u pacientů se STEMI směrovanými k reperfuzní léčbě, snižuje morbiditu a mortalitu. Je to jednoduchá technika proveditelná jak v sanitním voze tak na urgentním příjmu, zatímco je pacient připravován k perkutánní koronární intervenci; snižuje riziko akutního poškození ledvin, signifikantně snižuje rozsah poškození myokardu při infarktu a snižuje riziko srdečního selhání a dysrytmií během intervence i po ní. Tyto účinky přetrvávají ještě delší dobu po zákroku a u pacientů je nižší pravděpodobnost další koronární nebo mozkové příhody v následujících měsících až letech. Kromě snížené mortality a lepší kvality života přináší metoda i měřitelné snížení nákladů vynaložených na zdravotní péči.

EMS of Central Bohemian Region had introduced the board portable ultrasonography devices for use in daily practice in the prehospital emergency care. The devices used are compact ultrasonographs GE-VScan with dual sector/linear probe. The devices were placed at EMS district stations. This article describes the scheme of training, possibilities of practical use for diagnostics and therapeutical procedures in EMS practice. We use modified emergency protocols FATE, FEEL, BLUE and FAST. The author describes individual clinical training in hospitals under supervision of clinical specialists which is provided after initial traininng. The first experience during 3 and half months´s praktice since start of this project are also described. Based on the ultrasound examination therapeutical management had been changed in 5 cases and once the difficult i.v. ultrasound guided access was in the field.

• MeSH
• Myocardial Infarction surgery   MeSH
• Ischemic Preconditioning, Myocardial * methods   MeSH
• Percutaneous Coronary Intervention MeSH
• Humans MeSH
• Postoperative Complications prevention & control   MeSH
• Myocardial Reperfusion methods   MeSH
• Myocardial Reperfusion Injury prevention & control   MeSH
• Emergency Medical Services methods   MeSH
• Check Tag
• Humans MeSH

AIMS: The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1-70.1%) for timely reperfusion. CONCLUSIONS: The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

• MeSH
• ST Elevation Myocardial Infarction * therapy   MeSH
• Cardiology * MeSH
• Percutaneous Coronary Intervention * MeSH
• Humans MeSH
• Hospitals MeSH
• Prospective Studies MeSH
• Registries MeSH
• Myocardial Reperfusion MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

• MeSH
• Myocardial Ischemia MeSH
• Coronary Disease MeSH
• Myocardium metabolism   MeSH
• Myocardial Reperfusion MeSH
• Myocardial Revascularization MeSH
• Heart physiopathology   MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• kardiologie
• angiologie

• MeSH
• Myocardial Ischemia surgery   physiopathology   MeSH
• Coronary Angiography methods   MeSH
• Laser Therapy MeSH
• Humans MeSH
• Swine MeSH
• Myocardial Reperfusion methods   MeSH
• Myocardial Revascularization methods   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Congress MeSH

• MeSH
• Time Factors MeSH
• Adult MeSH
• Myocardial Infarction diagnosis   pathology   therapy   MeSH
• Clinical Protocols MeSH
• Disease Attributes diagnosis   pathology   MeSH
• Humans MeSH
• Refusal to Treat MeSH
• Myocardial Reperfusion MeSH
• Myocardial Revascularization MeSH
• Check Tag
• Adult MeSH
• Humans MeSH

This paper describes the opportunities and challenges in building ST-elevation acute myocardial infarction (STEMI) systems of care in Stent for Life affiliated and collaborating so-called emerging countries, namely India, China, South Africa and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem. The Stent for Life model supports the implementation of ESC STEMI Guidelines in Europe and endeavours to impact on morbidity and mortality by improving services and developing regional STEMI systems of care, whereby STEMI patients' timely access to a primary percutaneous coronary intervention (PPCI) is assured. In India, the STEMI India model incorporates a dual approach of combining PPCI with a pharmacoinvasive strategy of reperfusion. The architecture of the system is based on a hub and spoke model with each unit called a STEMI cluster. The project is driven by a private non-profit organisation. In China, the STEMI PCI programme is led by the Chinese College of Cardiovascular Physicians and supported by the national government. Although primary PCI is performed nationwide, a thrombolytic treatment strategy is still the first option in many rural areas because of logistic considerations. Establishing local STEMI transfer networks and then implementing a pharmacoinvasive strategy of reperfusion are being considered and promoted currently. In South Africa, the pharmacoinvasive approach currently dominates as STEMI treatment option in many areas. A pilot study shows that low symptom awareness leads to long patient delays. The education of all role players, from patients to healthcare professionals and including institutions and governmental structures, is needed to achieve prompt diagnosis and treatment. In Mexico, improving the treatment of STEMI requires considering myocardial infarction to be an emergency that must be treated by an entire system and not just by a particular service. Patients need to receive quick treatment from clinical and interventional cardiologists, and the emergency medical system (EMS) must understand the importance of early reperfusion therapy when appropriate. Mexican health authorities have used registries as their main strategy for improving the use of health resources for ACS patients. In general, building regional STEMI systems of care and an EMS system infrastructure are critical success factors in the stepwise development of STEMI systems of care at a national level in emerging countries as they are in Europe. An in-depth understanding of healthcare system-level barriers to timely and appropriate reperfusion therapy facilitates the development of more effective strategies for improving the quality of STEMI care in each region and country.

• MeSH
• Myocardial Infarction therapy   MeSH
• Percutaneous Coronary Intervention * methods   MeSH
• Humans MeSH
• Delivery of Health Care * MeSH
• Myocardial Reperfusion methods   MeSH
• Stents * MeSH
• Emergency Medical Services * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Europe MeSH