The difficulty of revascularization at myocardial infarction with ST-segment elevation during the military conflict: clinical scenarios. Review

Abstract

Russian military aggression against Ukraine challenged serious difficulties in the treatment of acute myocardial infarction with ST segment elevation (STEMI). Continuous stress, depression and insufficient pharmacotherapy resulted in the chronic coronary syndrome exacerbation, the increased number of STEMI cases and increased mortality because of the absence of timely myocardial reperfusion. The golden standard of the STEMI treatment is percutaneous coronary intervention (PCI), the result of which is the most effective reperfusion and patients’ survival. At the military conditions PCI possibility is restricted. The alternative to this method should be the fibrinolytic therapy, which has recently been rarely used as a reperfusion method in acute STEMI due to the availability of a network of catheter laboratories. The optimal variant of treatment at the condition of complicated logistical circumstances during the military time must be pharmacoinvasive strategy based on fibrinolysis and further PCI. Since the capabilities of reperfusion centers differ in the regions of Ukraine depending on the distance from the war zone, treatment strategies may be different. The main task in the STEMI treatment always must be the earliest renovation of myocardial circulation in the ischemic myocardium.
 The authors highlighted scenarios of STEMI treatment at the condition of military conflict where pharmacoinvasive strategy might have advantages in case of difficulties with providing quick access to percutaneous coronary intervention.
 When choosing a treatment strategy for acute STEMI, it is important to consider the specific conditions, the resources of the medical system, and the availability of medical care. The use of pharmacoinvasive strategy may be useful if the initial PCI is delayed beyond the recommended time, allowing for early reperfusion and improving treatment outcomes.