Powikłania ostrego zespołu wieńcowego i jego inwazyjnego leczenia jako problem intensywnej terapii

Małgorzata Nowicka¹, Justyna Kardacz¹, Małgorzata Pyda², Paweł Sobczyński¹, Roman Szulc¹

Summary
Background. Acute coronary syndromes should always be regarded as life-threatening situations. Primary percutaneous coronary intervention (PCI) in the acute coronary syndrome includes coronary angioplasty (PTCA), and the placement of a stent in an occluded coronary artery. These procedures are highly effective, but can be complicated by cardiac failure and shock, cardiac arrest, and respiratory distress. We present a retrospective analysis of 70 complicated cases treated in the general ICU that arose from 1731 PCI´s performed under the national coronary programme in the Wielkopolska region over two years (2002-2003). Methods and results. 55 men, aged 43-95, and 15 women, aged 39-80, were admitted to the ICU following either angioplasty (16), stent implantation (38), or cardiac failure without previous PCI (16). 41 patients were admitted to ICU following sudden cardiac arrest and resuscitation, 7 because of a pulmonary oedema, 1 due to ARDS, 3 were in the cardiogenic shock, 4 had renal failure, and 2 had suffered an acute cerebral stroke. PCI was complicated by cardiac tamponade (1) and acute limb ischemia (1). Various haemorrhagic complications occurred in 8 cases. One patient developed DIC and multi organ failure. 68 patients required endotracheal intubation and ventilation, and 64 patients required inotropic support. Aortic contrapulsation was used in 16 cases, intracardiac pacing in 7, and haemofiltration in 3. 34 patients died, while the other 36 were stabilized and discharged from the ICU. Conclusions. Despite highly effective treatment, acute coronary syndrome can still be associated with a number of complications, among which cardiac arrest and post-resuscitation pathology require major attention. Patients receiving antithrombotic therapy experience a significant risk of bleeding complications.

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