Zaporožskij Medicinskij Žurnal (Oct 2020)
Clinical features of the acute period of myocardial infarction with ST segment elevation in patients after reperfusion therapy
Abstract
Aim: to determine the clinical features of the course of myocardial infarction with ST segment elevation in the acute period in patients after reperfusion therapy. Materials and methods. The clinical and instrumental examination data of 100 patients with ST-elevation myocardial infarction (STEMI) in the acute period were analyzed. The patients were divided into 3 groups: group 1 – patients (n = 46) who underwent primary percutaneous coronary intervention (PCI) or thrombolytic therapy (TLT) followed by PCI in the acute period of myocardial infarction (MI), group 2 – patients (n = 33) who underwent TLT, group 3 – patients (n = 21) who received standard drug therapy. Results. The left ventricular (LV) end-systolic diameter and LV myocardial mass index were significantly smaller by 5.73 % (P = 0.0471) and 10.06 % (P = 0.0076), respectively, in group 1 patients than in group 3. Among the group 1 patients, pulmonary hypertension, local hypokinesia and LV systolic dysfunction were significantly less often detected by 17.72 % (P = 0.028), 26.15 % (P = 0.0293) and 1.99 % (P = 0.0135), respectively, compared with group 2, and zones of LV dyskinesia were much less identified by 19.46 % (P = 0.027) than in group 3. Among the group 2 patients, there was a tendency towards the prevalence of ventricular fibrillation and extrasystolic arrhythmia occurrence. Acute LV failure (ALVF) was less common in group 2 as compared with group 1 and 3, by 24.34 %, P = 0.0067 and 7.7 %, P = 0.0049, respectively. Conclusions. Reperfusion syndrome (RS) after restoration of coronary blood flow, manifested in ALVF and arrhythmias, was transient and sometimes required short-term symptomatic therapy. A common manifestation of RS after TLT was extrasystolic arrhythmia, in contrast to RS after PCI with more common ALVF (Killip III). In patients who did not undergo reperfusion therapy, systolic and diastolic myocardial function violation as well asLV aneurysm formation occurred more frequently. Restoration of coronary blood flow using PCI had advantages over TLT, such as less pronounced clinical manifestations of systemic inflammation, dilatation, local and global contractility impairment and indicators ofLV afterload.
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