COMPARATIVE ANALYSIS OF REPERFUSION THERAPY REGIMES IN MANAGEMENT OF PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION IN CONDITIONS OF REAL CLINICAL PRACTICE

Abstract

Aim. The primary transcutaneous coronary intervention (TCI) is a preferable strategy for management of patients with ST segment elevation myocardial infarction (STEMI). The aim of this work was conditioned by the necessity of taking into account the peculiar features of Perm Krai when organizing medical care to STEMI patients, that is, to present on the basis of real clinical practice the comparative analysis of efficiency of using different variants of reperfusion therapy. Materials and methods. The study joined 307 patients including 69 % of men and 41 % of women. No differences in IHD anamnesis duration between men and women both within the groups and between them were revealed. Results. Patients of group 1 underwent thrombolytic therapy (TLT) according to standard protocol using the drugs alteplase/tenectoplase. All patients before admission to the TCI-center received a double antiaggregant therapy; clopidogrel dose at the hospital stage when planning TCI increased to the load dose of 600 mg. Manifestation of resorption-necrotic syndrome taking into account opening of the infarction-dependent artery by the moment of hospitalization significantly prevailed in TLT group with intergroup differences absent in 12 hours. During the hospital stage, patients received MI therapy in accordance with up-to-date European Recommendations. Hospital lethality in the general group of STEMI patients was 8,46 %. Reliable rise in lethality in the group of primary TCI is determined by a severe status of patients in this group that confirms differences in hospital lethality index TIMI ( p = 0,003) and multivascular character of coronary artery lesions ( p = 0,000015) Conclusions. Thrombolytic therapy fulfilled in STEMI patients determines a 3-score restoration of TIMI blood flow in 26 % of cases (by coronaroangiography data). Pharmacoinvasive strategy for management of STEMI in Perm Krai contributes to a timely and adequate restoration of blood flow in the infarction-dependent artery, leads to reduction in lethality in the general group of patients to 2,67 %, among men and women to 2,2 % and 5,0 %, respectively.

Keywords

Myocardial infarction / pharmacoinvasive strategy / thromolytic therapy / transcutaneous coronary intervention

References

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Lapin O.M.