Вплив перкутанної тактики повної і неповної реваскуляризації міокарда при гострому коронарному синдромі з елевацією сегмента ST на динаміку лабораторних та інструментальних показників протягом госпітального періоду лікування

Abstract

The aim – to identify and study the effect of percutaneous tactics of complete and incomplete myocardial revascularization on the dynamics of laboratory and instrumental indicators in patients with acute coronary syndrome (ACS) with ST-segment elevation at the hospital stage of treatment.Materials and methods. 120 patients with ACS with ST segment elevation were examined. The criteria for inclusion in the study were the presence of acute coronary syndrome with ST segment elevation and the presence of at least one lesion of the non infarct-related (non-IRA) coronary artery with stenosis of 70 % or more according to coronary angiography. Exclusion criteria were severe clinical condition of the patient (ischemic time of more than 24 hours, cardiogenic shock, clinical death at the pre-hospital stage, presence of mechanical complications of myocardial infarction), coronary artery bypass grafting, unsuitable for PCI coronary anatomy, etc. All patients were divided into a group of complete (n=60) and a group of incomplete (n=60) revascularization. The complete revascularization group included patients who received stenting of all hemodynamically significant stenoses of the coronary arteries either during primary PCI (subgroup of immediate non-IRA stenting, n=7) or during a separate planned PCI procedure (subgroup of staged stenting non-IRA, n=53).Results and discussion. According to the echocardiography before discharge from the hospital, patients who underwent a complete procedure (both one-time and staged) had a significantly higher left ventricular ejection fraction compared to patients in the incomplete revascularization group (46.3±6.41 % vs. 43.2±8.32 %, p=0.03). The anatomical complexity of the infarct-related lesion according to the SYNTAX score had a positive correlation with the duration of the primary PCI (correlation coefficient r=0.2; p<0.05) and a decrease in the left ventricular ejection fraction before discharge from the hospital (r=–0.26, p<0.05). An increase in the duration of PCI was associated with an increase in leukocyte count and creatinine levels in the first 48-72 hours after the intervention. However, there was no significant difference in the incidence of contrast-induced nephropathy. A positive correlation was found between the level of LDL and the deterioration of kidney function after pPCI (r=0.27, p<0.05), as well as the degree of non-IRA stenosis (3.39±0.99 mmol/l in patients with with non-IRA stenoses > 90 % versus 2.77±0.68 mmol/l in patients with non-IRA stenoses 70-89 %, p<0.05). While the complexity of non-IRA lesions according to the SYNTAX score had a negative correlation with the level of LDL (r=–0.26, p<0.05).Conclusions. Complete revascularization in ACS with ST-elevation patients was associated with higher LVEF before hospital discharge. Immediate stenting of all non-IRA during pPCI is associated with increased procedure time but has a lower total radiation burden compared with a staged PCI strategy. The complexity of the infarct-related lesion according to the SYNTAX score is an unmodified predictor of the duration of the pPCI and the reduction of LVEF in the short observation period. Increasing the duration of pPCI leads to a more pronounced inflammatory response with an increase in the level of leukocyte count and an increase of creatinine in the first 48-72 hours after pPCI. LDL is a risk factor for the deterioration of renal function after PCI and the presence of > 90 % non-IRA lesions. However, these lesions have less anatomical complexity.