Earlysurgical treatment of acu te coronary syndrome in patients with ST -segm ent elevation (at < h24), arrhy thm iccomp lications and severe mitral regu rgitation

Abstract

Treatment outcomes of acute coronary syndrome in 108 patients with ST-segment elevation (after more than 24 hours) complicated by arrhythmias (atrial fibrillation and atrial flutter) and subsequently developed severe (degrees 2 and 3) mitral insufficiency were analyzed. We elaborated an algorithm for the sequence of interventions. All the patients had coronary angiography and stenting of the symptom-dependent artery during the first 2 days after the admission. Depending on the localization of the left ventricular myocardial infarction zone, the patients were divided into 3 groups: 68 (63%) patients with anterior wall and apex infarction; 23 (21.3%) patients with posterior wall infarction; 17 (15.7%) patients with lower wall infarction. It was revealed that patients, who had undergone revascularization in the early stages, had a statistically significant increase in the main indicators of myocardial contractility, in contrast to patients receiving only conservative therapy. In the observation group, sinus rhythm was restored in all patients 1–4 days after hospitalization. 12 patients underwent emergency electrical cardioversion on the day of admission. In 31 patients, sinus rhythm was restored within the first 24 hours during therapy prior to revascularization. In 39 patients, sinus rhythm was restored during therapy on days 3–5 after primary revascularization. In 26 patients, sinus rhythm was restored 2–4 days after complete revascularization. Based on the study, several conclusions can be drawn: in conditions of heart failure, revascularization is best to perform at the earliest possible stage. The optimal values of vital functions for performing revascularization can be considered: systolic blood pressure ≥ 80 mm Hg; heart rate ≤ 110 beats per minute. In primary surgical treatment, it is most optimal to revascularize only the symptom-dependent artery. Reintervention for complete revascularization is most effective and safe 10–14 days after the initial intervention. The use of emergency electrical cardioversion in those patients in the preoperative period is fully justified, despite the existing risks. Application of our algorithm helps to restore sinus rhythm, reduce the degree of mitral regurgitation and reduce mortality.