Clinical features of the acute period of myocardial infarction with ST segment elevation in patients after reperfusion therapy
DOI:
https://doi.org/10.14739/2310-1210.2020.5.214720Keywords:
ST-elevation myocardial infarction, STEMI, percutaneous coronary intervention, thrombolytic therapyAbstract
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.
References
Zaremba, E. H., Salo, V., Myzak, Y. V., & Zaremba, O. V. (2016). Klinichnyi perebih hostroho infarktu miokarda, uskladnenoho hostroiu livoshlunochkovoiu nedostatnistiu pislia koronarohrafichnoho obstezhennia zi stentuvanniam [The clinical course of acute myocardial infarction complicated by acute left ventricular failure after koronarografichnogo survey with stenting]. Simeina medytsyna, (3), 30-32. [in Ukrainian].
Babii, L. М., Shumakov, V. О., Pogurelska, О. P., Khomenko, Yu. O., & Kisilevich, L. F. (2018). Blizhaishie i otdalennye rezul'taty nablyudeniya za patsientami, perenesshimi ostryi infarkt miokarda s pod"emom segmenta ST i urgentnoe stentirovanie venechnykh arterii [Short- and long-term outcomes in patients after ST-elevation myocardial infarction with urgent percutaneous coronary intervention]. Ukrainskyi kardiolohichnyi zhurnal, (4), 40-47. http://doi.org/10.31928/1608-635X-2018.4.4047 [in Russian].
Sokolov, М. Yu. (2019). Reestr perkutannykh koronarnykh vmeshatel'stv. Izmeneniya za 2015 - 2018 gg. - sluchainyi vsplesk aktivnosti ili sistemnye preobrazovaniya? [Register of percutaneous coronary interventions.Are changes for 2015 - 2018 a casual splash of activities or system transformations?]. Sertse i sudyny, (3), 12-33. http://doi.org/10.30978/HV2019-3-12 [in Russian].
(2017). Rezoliutsiia KhVIII Natsionalnoho konhresu kardiolohiv Ukrainy (Kyiv, 20-22 veresnia 2017 r.) [Resolution of the 18th Ukrainian National Congress of Cardiologists (Kyiv, September 20-22, 2017)]. Ukrainskyi kardiolohichnyi zhurnal, (5), 114-117. [in Ukrainian].
Amosova, K. M., Sychenko, Yu. O., Rudenko, Iu. V., Prudkyi, I. V., Bezrodnyi, A. B., Katsytadze, I. Yu., & Gorda, I. I. (2016). Rezoliutsiia sehmenta ST pislia pervynnykh perkutannykh koronarnykh vtruchan: chastota dosiahnennia, klinichne znachennia i nezalezhni predyktory [ST-segment resolution after primary percutaneous coronary intervention: incidence, clinical significance and independent predictors]. Ukrainskyi kardiolohichnyi zhurnal, (6), 25-31. [in Ukrainian].
Sokolov, М. Yu. (2016). Reestr perkutannykh koronarnykh vmeshatel'stv: sravnitel'nyi analiz 2014-2015 gg. Regional'nye reperfuzionnye seti v Ukraine - dinamika razvitiya [Percutaneous Coronary Interventions Registry: comparative analysis of 2014-2015 years. The dynamics of regional reperfusion networks in Ukraine]. Sertse i sudyny, (3), 14-34. [in Russian].
Tseluiko, V., Doloh, M., & Leonenko, O. (2019). Vplyv medykamentoznoi terapii na klinichnyi perebih hostroho infarktu miokarda z pidiomom sehmenta ST u patsiientiv pislia provedennia cherezshkirnoho koronarnoho vtruchannia [The effect of therapy on the clinical course of acute myocardial infarction with st-segment elevation in patients after percutaneous coronary intervention]. ScienceRise: Medical Science, (1), 8-13. http://doi.org/10.15587/2519-4798.2019.155448 [in Ukrainian].
Grebenyk, M. V., & Levchyk, O. I. (2018). Osoblyvosti perebihu pisliainfarktnoho periodu u patsiientiv iz komorbidnistiu, yaki perenesly perkutanne koronarne vtruchannia [The peculiarities of the post-infarction period course in comorbidity patients, who had percutaneous coronary intervention]. Zdobutky klinichnoi i eksperymentalnoi medytsyny, (2), 42-47. http://doi.org/10.11603/1811-2471.2018.v0.i2.8955 [in Ukrainian].
Tseluyko, V., Mishchuk, N., & Matuzok, O. (2017). Doslidzhennia pokaznykiv, shcho vplyvaiut na klinichnyi prohnoz ta remodeliuvannia sertsia u viddalenomu periodi u khvorykh na infarkt miokardu z elevatsiieiu sehmentu ST [Study of factors that affect clinical prognosis and heart remodeling in patients with myocardium infarction with ST segment elevation in remote period]. ScienceRise: Medical Science, (11), 36-43. http://doi.org/10.15587/2519-4798.2017.116676 [in Ukrainian].
Shved, M. I., Tsuglevich, L. V., Heryak, S. M., Kovbasa, N. M., Prokopovich, O. O., & Jastremska, I. O. (2019). Shliakhy pidvyshchennia efektyvnosti likuvannia ta profilaktyky reperfuziinoho syndromu u khvorykh na hostryi koronarnyi syndrom (infarkt miokarda), yakym provedeno balonnu anhioplastyku ta stentuvannia koronarnoi arterii [Ways for improvement of central and peripheral hemodynamics in patients with acute coronary syndrome (myocardial infarction), who underwent balloon angioplasty and stenting of the coronary artery]. Zdobutky klinichnoi i eksperymentalnoi medytsyny, (1), 173-181. http://doi.org/10.11603/1811-2471.2019.v0.i1.10071 [in Ukrainian].
Shved, M., Tsuglevych, L., & Heryak, S. (2019). Klinichna efektyvnist kardiotsytoprotektornoi terapii u khvorykh na hostryi koronarnyi syndrom (infarkt miokarda), yakym provedeno balonnu anhioplastyku ta stentuvannia koronarnoi arterii [Clinical effectiveness of cardioсytoprotective therapy in patients with acute coronar syndrome (ACS) - myocardial infarction (MI), who were performed balloon angioplasty and coronary artery stenting]. Arkhiv klinichnoi medytsyny, 25(1), 31-37. http://doi.org/10.21802/acm.2019.1.2 [in Ukrainian].
Mostovyi, Yu. M., & Rasputina, L. V. (Eds.). (2017). Ishemichna khvoroba sertsia, hostryi koronarnyi syndrom. Kliuchovi polozhennia. Tezy lektsii [Ischemic heart disease, acute coronary syndrome. Key provisions. Abstracts of lectures]. Tsentr DZK. [in Ukrainian].
Skybchyk, V. A., & Melen, Y. P. (2019). Osoblyvosti klinichnoho perebihu ta remodeliuvannia livoho shlunochka u patsiientiv iz hostrym infarktom miokarda z elevatsiieiu sehmenta ST protiahom 1-ho roku pislia pervynnoho stentuvannia koronarnykh arterii [Features of the clinical course and remodeling of left ventriculi in patients with acute myocardial infarction with ST segment elevation for 1 year after the primary coronary artery stenting]. Ukrainskyi medychnyi chasopys, 2(5), 45-48. http://doi.org/10.32471/umj.1680-3051.133.162704 [in Ukrainian].
Yankevich, O. O. (2018). Klinichne znachennia ekhokardiohrafii pry obstezhenni khvorykh na hostryi infarkt miokarda [Clinical meaning of echocardiography for examination of patients with acute myocardial infarction]. Liky Ukrainy, (2), 36-41. [in Ukrainian].
Tseluyko, V. I., Matuzok, O. E., Mishchuk, N. Y., & Yakovleva, L. M. (2019). Vmist leikotsytiv u peryferychnii krovi ta prohnoz u khvorykh na infarkt miokarda, yakym provedeno trombolitychnu terapiiu [Peripheral blood leukocyte count and prognosis in patients with myocardial infarction treated with thrombolytic therapy]. Sertse i sudyny, (1), 53-58. http://doi.org/10.30978/HV2019-1-53 [in Ukrainian].
Matuzok, O. Е. (2018). Klinichni ta prohnostychni chynnyky perebihu infarktu miokarda u khvorykh, yakym provedena trombolitychna terapiia. (Dis. … kand. med. nauk). [Clinical and prognostic factors of myocardial infarction course in patients treated with thrombolytic therapy]. (Dr. med. sci. diss.). Zaporizhzhia. [in Ukrainian].
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
