Clinical and hemodynamic particularities of patients with acute ST-segment elevation myocardial infarction subjected to late interventional treatment

Abstract

To save the viability of the ischemic myocardium in a patient with ST-segment elevation myocardial infarction and improve the survival, coronary blood flow must be restored as soon as possible, preferably within the first 12 hours after the onset of pain. The current dilemma of interventional cardiologists is the decision about the possibility of performing interventional myocardial reperfusion in the patients with delayed presentation (more than 12 hours from the onset) and establishing the predictive factors of the procedures performed in this category of patients. In ths study 63 patients with STEMI were included, divided into 2 groups: the first one included 33 patients presentetd at the emergency department within the first 12 hours after the onset of STEMI, and the second group consited of 30 subjects with STEMI in whom the first medical contact was more than 12 hours after the onset of symptoms. The groups were compared with each other according to the well-established criteria. The primary end points were the assessment of major cardiovascular events (MACE), as well of ventricular myocardium remodeling/reverse-remodeling and predictors of interventional procedures. The improvement of left ventricular myocardial contractile function (LVEF), seems to be associated with early myocardial revascularization. Early presentation in STEMI can be considered an independent predictor of the improvement of the regional kinetics affected by AMI. The contractile function of the LV myocardium represented by the ejection fraction is considered an independent predictor of long-term and short-term mortality in patients with STEMI. The preliminary results of the research highlight the applicative value of PCI procedures also for patients with delayed presentation - more than 12 hours from the onset of the disease and the first medical contact.