Кардиоваскулярная терапия и профилактика (Feb 2017)

THE RESULTS OF DELAYED ENDOVASCULAR INTERVENTION IN ST ELEVATION ACUTE MYOCARDIAL INFARCTION DUE TO THROMBOTIC OCCLUSION OF CORONARY ARTERY

  • A. V. Azarov,
  • S. P. Semitko,
  • М. G. Glezer,
  • R. V. Akhramovich,
  • A. I. Maloroev,
  • I. S. Melnichenko,
  • G. Yu. Atarov,
  • A. V. Lebedev

DOI
https://doi.org/10.15829/1728-8800-2017-1-40-45
Journal volume & issue
Vol. 16, no. 1
pp. 40 – 45

Abstract

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Aim. To study clinical results and safety of delayed vs urgent stenting with application of modern antithrombotic drugs in massive coronary thrombosis in patients with ST-elevation acute myocardial infarction (STEMI).Material and methods. Totally, 28 STEMI patients included, age 52 (25-77) y.o., of those males 80% (n=23), who, during January 2014 to February 2016, in first 6-12 hours from the onset of the disease, received endovascular treatment with purpose to recover adequate blood flow without urgent stent implanting into infarct-related artery. Minimal invasive strategy with the aim to recover antegrade blood flow up to TIMI 2-3 was done for 14 (50%) patients. In all patients, after restoring of the antegrade flow, there was thrombus, visualized in artery lumen, with TIMI thrombus grade score (TTG) ≥3. Another criteria of efficacy was resolving of ST elevation by ≥50%. As antiplatelet support during the intervention all patients received the combination of IIb/IIIa blockers (eptifibatide) and 600 mg clopidogrel or 180 mg ticagrelor. Second coronary arteriography (CAG) was done in up to 5 days.Results. By 4,0±1,0 day, blood flow TIMI 2-3 in infarction-related artery was secure in 100% patients; there was marked decrease of the grade of target stenosis in infarction-related artery from 77,8±10,2% to 50,5±19,5%; decrease by its length from 21,5±8,5 to 15,5±5,5 mm; increase of the reference diameter of artery from 3,1±0,8 to 3,5±0,75 mm, and thrombosis bride by TTG — from 3,9 to 0,9. By the data from CAG, stenting of the target segment was done in 8 (29%) patients, and in 3 (10%) stenting done based on the data from intravascular ultrasound. In 17 (61%) patients the infarction-related stenosis was non-significant. In the group of delayed stenting there was no cases of no/slow-reflow development. At hospital stage of management, there were no cardiovascular events in the observation group.Conclusion. In patients with massive thrombosis of infarction-related artery (TTG ≥3) and restored antegrade coronary flow TIMI 2-3, the delayed stenting is a safe and effective strategy of treatment at hospital stage.

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