Прогноз пацієнтів із гострим інфарктом міокарда з підйомом сегмента ST після проведення первинного черезшкірного коронарного втручання

Abstract

Myocardial infarction claims million lives on the planet each year. Ischemic heart injury is diagnosed with increasing incidence among younger people of working age, posing significant medical and social problem. Percutaneous coronary interventions (PCI) are the primary treatment for ST-segment elevation myocardial infarction (STEMI). The aim of the study was to optimize the prognosis of acute STEMI after primary PCI. Materials and methods. The study included 98 patients with STEMI who were undergoing primary PCI. As a part of revascularization procedure, a manual thromboaspiration was performed for each patient. Thrombotic material was obtained at a volume sufficient for histological analysis with further macro- and microscopic examination. Prognosis was assessed by the probability of occurrence of major coronary events, such as death, myocardial infarction, repeated revascularization or reappearance of angina. In order to single out the factors that, when combined, have a reliable influence on the prognosis, a step-by-step method of logistic regression with forward selection was used. To assess the level of plausibility of the obtained model, a pseudo R-square Nagelkerkes analysis, an analogue of R-square for linear regression, was performed. The results. During two years of follow-up, major coronary events occurred in 34 patients (34.69%). After analysis of the obtained data, four characteristics of thrombi were separated, which, when combined, had an impact on the development of the end-point. These were old thrombi, the presence of microchannels, inflammatory infiltration, and macroscopically mixed thrombi. The resulting formula was as follows: Z = 0.5•V2 – 0.04•V1 – 0.1•V3 + 1.77•V4 – 1.51, where V1 = old thrombus, V2 = presence of microchannels, V3 = inflammatory infiltration, V4 = macroscopically mixed thrombus. Conclusions. Analysis of the morphological characteristics of intracoronary thrombi allowed assessing the long-term prognosis in patients with STEMI. Article received: 28.11.2022