Львівський клінічний вісник (Sep 2015)
Results of Artery Stenting in Patients with Acute Myocardial Infarction with Comorbid Hypertension
Abstract
Introduction. The study of the effectiveness of treatment of acute myocardial infarction (AMI) with comorbide arterial hypertension (AH) is an actual problem of the modern cardiology. According to the statistics of 2010, 8.6 million of Ukraine’s population suffer from the coronary heart disease (CHD), the AMI occurs in 50 thousand of these patients annually. Hypertension affects more than 12 million people. The question of the effectiveness of coronary stenting in patients with AMI and comorbide AH is insufficiently studied. Aim. To analyze the results of the effectiveness of coronary stenting in patients with AMI with comorbide AH. Material and methods. The inclusion criteria in the study were patients with Q–IM, Q–IM and comorbide hypertension, complicated by lesions of the organs of the circulatory system. The exclusion criterion was the age over 80 years, heart failure (HF) of the functional class IV, neoplasms, severe kidney and liver diseases. Results and discussion. A retrospective analysis of the medical records of 105 patients with AMI with comorbide hypertension who were undergoing treatment in the cardiology Department N 1 of the clinical hospital N 1 in Vinnytsia from 2011 to 2014. Acute Q–IM with elevate ST-segment was observed in 84,8 % of patients, acute not Q–IM with elevate ST-segment – in 15.2 %, acute anterior Q–IM – in 39.0 %, inferior Q–IM – in 42.9 %. Repeated myocardial infarction in the anamnesis was observed in 14.2 % of patients. The average age of patients was 56.7 ± 0.80 years. Patients got into the infarction department up to 3 hours after the occurrence of AMI in 39,0 % of cases; in 4–6 hours – in 18.1 %; in 7–24 hours – in 20.0 %; in more then 24 hours – in 22.9 %. The duration of AH in anamnesis was 9.0 ± 0,45 years, chronic CHD – 2.8 ± 0.25 years. In examined patients the values of systolic blood pressure was 138.0 ± 2.15 mm Hg, diastolic – 89.4 ± 1.27 mm Hg. The examined patients underwent the general blood analysis, determination of the lipid spectrum of blood, troponin I and T, ECG. Angiographic examination was performed using the Siemens Axiom Artis (Germany) for 2-3 hours after hospitalization of the patients. In the unit of resuscitation and intensive care cardiology Department N 1 for patients with AMI and comorbide AH was administered pain medication, were prescribed dual antiplatelet therapy, beta-blocker bisoprolol at a dose of 5.0–10.0 mg/day, ACE inhibitor perindopril at a dose of 5.0–10.0 mg/day and lipid-lowering therapy with atorvastatin at a dose of 20 mg/day. Examined patients with AMI with comorbid hypertension often experience such cardiovascular complications: heart failure of І-III NYHA functional classes – in 100 %, acute left ventricular insufficiency of І–III of classes according to the classification of T. Killip, J. Kimbal occurs in 19.0 %, arterial fibrillation in 7.6 %, ventricular extrasystoles II–V grades in Launam – in 7.0 %, ventricular fibrillation – in 3.8 %, cardiogenic shock – in 2.9 percent. One-vascular lesions of the coronary arteries (VA) was observed in 26.7 % of patients, 2-vascular – in 28.5 %, 3-vascular – in 44.8 %, subclause and occlusion – in 57,1 % of patients. Patients with comorbid hypertension were installed one stent in 86.3 % of cases; two stents – in 13.7 %. Restoration of blood flow in the anterior mishloach VA occurred in 58.1 %, the right VA – in 26.7 %, in the envelope VA – in 12.4 %. Failure to restore the coronary blood flow was observed in 2.9 % of patients. Clinical efficacy of restoring coronary flow in patients with AMI with comorbid AH according to the results of the TIMI: TIMI 1 (partial) – 0.9 %, TIMI 2 (significant) – in 20.0 %, TIMI 3 (complete, normal) – in 76.2 %, TIMI 0 (not restarted) – in 2.9 % of patients. Conclusions. 1. Сoronary blood flow in patients with AMI with comorbid AH was renewed in the front interventricular VA in 58.1 % of the patients, in the right VA – in 26.7 %, in the envelope VA – 12.4 %, failed to restore coronary blood flow in right VA – in 2.9 % of cases. 2. Reparation of coronary blood flow in patients with AMI with comorbid AH took place according to the criteria of TIMI 1 (partial) in 0.9 %, TIMI 2 (significant) – at 20.0 %, TIMI 3 (normal) – 76,2 %, TIMI 0 (did not happen) – 2.9 % of cases, which shows the effectiveness of the interventional treatment.
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