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The randomized Physiologic Assessment of Thrombus Aspiration in ST-segment Elevation Myocardial Infarction patients treated with primary percutaneous intervention (PATA STEMI) study

dc.contributor.advisorOstojić, Miodrag
dc.contributor.otherBeleslin, Branko
dc.contributor.otherAšanin, Milika
dc.contributor.otherSavić, Sava
dc.creatorOrlić, Dejan N.
dc.date.accessioned2016-01-05T12:07:14Z
dc.date.available2016-01-05T12:07:14Z
dc.date.available2020-07-03T08:54:43Z
dc.date.issued2014-12-01
dc.identifier.urihttp://eteze.bg.ac.rs/application/showtheses?thesesId=1933
dc.identifier.urihttp://nardus.mpn.gov.rs/handle/123456789/2482
dc.identifier.urihttps://fedorabg.bg.ac.rs/fedora/get/o:9658/bdef:Content/download
dc.identifier.urihttp://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=46736143
dc.description.abstractCilj. Primarni cilj doktorske teze je bio da se odredi srednja vrednost indeksa mikrocirkulatorne rezistencije (IMR) kod bolesnika sa infarktom miokarda sa elevacijom ST segmenta (STEMI) koji su lečeni primarnom perkutanom koronarnom intervencijom (pPCI) i kojima je randomizovano dodeljen jedan oblik lečenja- manuelna aspiracija tromba ili drugi oblik lečenjastandardna pPCI bez aspiracije tromba. Na ovaj način poređene su dve grupe bolesnika, jedna grupa sa rutinskom manuelnom aspiracijom tromba u infarktnoj arteriji i druga grupa, bez aspiracije tromba. Obzirom na potencijalni uticaj kolateralne cirkulacije na vrednost srednjeg IMR, određen je i korigovani IMR (IMR corr) koji uzima u obzir koronarni „wedge“ pritisak u infarktnoj arteriji. Obzirom da se ne zna da li je IMR u infarktnoj arteriji povišen, IMR je određen i u susednoj i kontralateralnoj neinfarktnoj arteriji. Pored primarnog cilja određeni su i sekundarni ciljevi koji ukazuju na stepen miokardne perfuzije (angiografski, elektrokardiografski), veličinu infarkta (enzimski, EKG, jednofotonska kompjuterizovana tomografija-SPECT), remodelovanje leve komore (ehokardiografski indeksi, SPECT) i klinički ishod bolesnika tokom perioda praćenja od 12 meseci (glavni neželjeni srčani i cerebralni događaji, MACCE: smrt, reinfarkt miokarda, šlog, hospitalizacija zbog srčane insuficijencije i revaskularizacija infarktne arterije-TVR). Metod. IMR je određivan kao proizvod distalnog pritiska merenog u distalnog trećini infarktne ili neinfarktne arterije (susedna i kontralateralna neinfarktna arterija sa dijametrom stenoze <70%) i srednjeg vremena prolaska fiziološkog rastvora na sobnoj temperaturi merenog između proksimalnog šafta žice i distalnog termistora za merenje pritiska i temperature. Koronarni „wedge“ pritisak je meren tokom okluzije stentiranog segmenta infarktne arterije semikomplijanntnim balonom na 2 atm pomoću koronarne žice za merenje pritiska i temperature (Certus, St Jude)...sr
dc.description.abstractAim. Primary end point of doctoral thesis was an assessment of mean value of index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) randomly alocated to either one teatment modality – manual thrombus aspiration or the other treatment modality - standard pPCI without thrombus aspiration. In this way two groups of patients were compared, one group with routine manual thrombus aspiration in infarct related artery and the other group, without thrombus aspiration. Corrected IMR (IMRcorr) was calculated because it accounted for the potential influence of collateral circulation on the value of IMR: Its calculation is based on the mean value of capillary wedge pressure. Secondary end points which indicated the magnitude of myocardial reperfusion (angiographic and electrovardiographic indices), the final infarct size (enzyme release, ECG, SPECT), remodeling rate of left ventricle (echocardiographic indices, SPECT) at 4months and clinical outcome (MACCE: death, myocardial reinfarction, stroke, hospitalization due to congestive heart failure and target vessel revascularization) at 12 months of follow-up, were also determined. Method. IMR was assessed as a product of distal pressure measured in the distal third of infarct related artery or non-infarct related artery (both adjacent and contralateral with diameter stenosis of <70%) and mean transit time of saline at room temperature measured between proximal shaft of pressure-termistor tipped coronary wire. Coronary wedge pressure was measured during occlusion of stented segment of infarct related artery by a semicompliant balloon inflated at 2 atmospheres by means of pressure-termistor tipped coronary wire (Certus, St Jude,MN). Results. Primary end point was achieved. „Intention to treat analysis“ and „per protocol analysis“ were both done. The main difference between these two analysis is 10 (15,9%) patients who were transfered from the standard pPCI group into thrombus aspiration group, according to the study protocol. In the „intention to treat“ analysis mean IMR was decreased in the thrombus aspiration group as compared with the standard pPCI group (RR 28,7%; 31,2±18,18 vs. 43,79±33,77 U, P=0.0505)...en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Београду, Медицински факултетsr
dc.relationinfo:eu-repo/grantAgreement/MESTD/Integrated and Interdisciplinary Research (IIR or III)/41022/RS//
dc.rightsopenAccessen
dc.sourceУниверзитет у Београдуsr
dc.subjectaspiracija trombasr
dc.subjectthrombus aspirationen
dc.subjectindeks mikrocirkulatorne rezistencijesr
dc.subjectinfarkt miokarda sa elevacijom ST segmentasr
dc.subjectindex of microcirculatory resistanceen
dc.subjectST-segment elevation myocardial infarctionen
dc.titleRandomizovana studija o fiziološkoj proceni aspiracije tromba kod bolesnika sa akutnim infarktom miokarda sa elevacijom ST segmenta lečenih primarnom perkutanom koronarnom intervencijomsr
dc.titleThe randomized Physiologic Assessment of Thrombus Aspiration in ST-segment Elevation Myocardial Infarction patients treated with primary percutaneous intervention (PATA STEMI) studyen
dc.typedoctoralThesis
dc.rights.licenseBY-SA
dcterms.abstractОстојић, Миодраг; Белеслин, Бранко; Aшанин, Милика; Савић, Сава; Орлић, Дејан Н.; Рандомизована студија о физиолошкој процени аспирације тромба код болесника са акутним инфарктом миокарда са елевацијом СТ сегмента лечених примарном перкутаном коронарном интервенцијом; Рандомизована студија о физиолошкој процени аспирације тромба код болесника са акутним инфарктом миокарда са елевацијом СТ сегмента лечених примарном перкутаном коронарном интервенцијом;
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/11275/Disertacija.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/11276/Dejan_Orlic_Izvestaj_Komisije_MDF.pdf


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