Sortie des soins intensifs pour les infarctus non compliqués

Sortie des soins intensifs pour les infarctus non compliqués

Pour un infarctus du myocarde non compliqué, c’est-à-dire huit patients sur dix, la durée de séjour en soins intensifs ne doit pas dépasser 72 heures. Le patient peut être levé dès la douzième heure et une activité autonome reprise dans les 24 premières heures. Le transfert en unité de médecine peut avoir lieu dès la quarantehuitième heure.

Le traitement de sortie des soins intensifs doit comprendre au moins de l’aspirine, un bêtabloquant en l’absence de contre-indications et un IEC s’il s’agit d’un infarctus antérieur ou si la fraction d’éjection mesurée en échocardiographie est basse. Une anticoagulation (HBPM ou HNF) n’est utile que s’il existe un risque thromboembolique.

La durée de séjour totale à l’hôpital de ces patients ne devrait pas dépasser 1 semaine [45, 66, 88].

Dix points essentiels - Les infarctus du myocarde avec sus-décalages du segment ST sur l’ECG sont pratiquement toujours dus à l’occlusion complète d’une artère coronaire. - Cette occlusion se développe à partir d’une plaque d’athérome rompue. - La précocité et la qualité de la reperfusion de cette artère conditionnent le pronostic vital à court et moyen termes. - La thrombolyse reste une modalité de reperfusion à la fois très efficace et sûre. Elle doit être administrée dans le délai le plus court possible après le diagnostic. - La thrombolyse par les dérivés du rt-PA peut être administrée par un simple bolus intraveineux de quelques secondes avec une efficacité équivalente à une administration continue de 90 minutes. - L’angioplastie primaire est une alternative au moins comparable et probablement supérieure à la thrombolyse si elle est réalisée très rapidement après la prise en charge. - Une angioplastie primaire doit être envisagée pour tout infarctus avec sus-décalage du segment ST qui survient au décours immédiat d’une chirurgie, quelle que soit sa nature. - L’aspirine est le traitement « universel » de tous les syndromes coronariens aigus. - Près de huit infarctus sur dix, s’ils sont convenablement traités, ont une évolution simple, sans complication. Leur sortie des soins intensifs est ainsi possible dès le deuxième ou le troisième jour et l’hospitalisation dure moins de 1 semaine. - La survie à 1 mois des infarctus correctement traités est de près de 90 %.

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