IMMEDIATE AND LONG-TERM RESULTS OF VARIOUS TREATMENT STRATEGIES FOR PATIENTS WITH MACROFOCAL RECURRENT MYOCARDIAL INFARCTION

Abstract

Aim of study: to assess the effectiveness of invasive treatment strategies in patients with repeated myocardial infarction (rMI). We compared results of three treatment strategies in 453 patients with rMI admitted to the Institute from 2003 to 2011 and analyzed long-term results (up to 2016): 139 roentgen-endovascular coronary interventions (RECI) (various types), including the delayed procedures (performed 24–72 h later), 25 surgical myocardial revascularizations 8–12 weeks after the onset of rMI and 289 cases of conservative therapy. Cardiovascular mortality had been assessed in 138 patients with different treatment strategies for 5 years after the discharge.Findings show that rMI is a predictor of high risk of death associated with high in-hospital and longterm mortality in the absence of reperfusion therapy. RECI in the early stages of rMI does not exclude its later performance. Different types of interventions, including the delayed ones, significantly reduce the incidence of complications and deaths, which occurence remains high in the absence of interventions. however, in a significant portion of patients with rMI, the severity of coronary lesions limits the possibility of RECI performance, determining indications for elective surgical myocardial revascularization. Coronary artery bypass surgery performed after myocardial scarring prevents the growth of left ventricular dysfunction, improves its contractile function, and prolongs the life of patients. Reperfusion strategies such as various types of RECI and/or delayed surgical myocardial revascularization improve the effectiveness of treatment in patients with rMI.

Keywords

• recurrent myocardial infarction
• early and delayed roentgen-endovascular coronary interventions
• surgical revascularization after myocardial scarring
• hospital and long-term mortality