| Abstract [eng] |
The most common cause of death in the world is ischaemic heart disease whose prevalence is increasing. There are a lot of risk factors which increase mortality from myocardial infarction, like older age, Killip class, time from onset of symptoms to start of treatment, comorbidities, reduced left ventricle ejection fraction and the network of hospitals which treat patients with miocardial infarction. The diagnosis of myocardial infarction is based on characteristic symptoms, changes in electrocardiogram and elevation of cardiac troponines. Various comorbidities, such as left or right bundle branch block, Takotsubo cardiomyopathy complicates the diagnosis of myocardial infarction. Primary percutaneous coronary intervention is the standard choice of treatment for patients presenting with myocardial infarction if the time from onset of symptoms is less than 12 hours, time from diagnosis of ST elevation myocardial infarction is less than 120 minutes and there is an experienced medical team. However, there are various situations when there is no possibility to perform primary percutaneous coronary intervention in 120 minutes from diagnosis. In that case it is advised to perform fibrinolytic therapy. Recent data recommends to search for alternative analgetic therapy other than opioids and other ways to deliver P2Y12 inhibitors to the patients organism. It is recommended to not supply additional oxygen to normoxemic patients because it may increase the size of myocardium damage. Clinical trials have proven that if paramedics skip the triage and deliver the patient straight to the catheterization laboratory, it would save 20 minutes of time. It is recommended to use prasugrel as the first choice drug rather than ticagrelor as it causes less side effects and leads to better clinical outcomes. In the beginning of COVID-19 pandemic there were less cases of STEMI due to patients being afraid to acquire the infection in hospitals. COVID-19 infection is associated with hypercoagulable states, therefore PCI produces less favourable outcomes in patients presenting with STEMI and concomitant COVID infection. |
