Abstract
Aim . To study clinical results and safety of delayed vs urgent stenting with application of modern antithrombotic drugs in massive coronary thrombosis in patients with ST-elevation acute myocardial infarction (STEMI). Material and methods . Totally, 28 STEMI patients included, age 52 (25-77) y.o., of those males 80% (n=23), who, during January 2014 to February 2016, in first 6-12 hours from the onset of the disease, received endovascular treatment with purpose to recover adequate blood flow without urgent stent implanting into infarct-related artery. Minimal invasive strategy with the aim to recover antegrade blood flow up to TIMI 2-3 was done for 14 (50%) patients. In all patients, after restoring of the antegrade flow, there was thrombus, visualized in artery lumen, with TIMI thrombus grade score (TTG) ≥3. Another criteria of efficacy was resolving of ST elevation by ≥50%. As antiplatelet support during the intervention all patients received the combination of IIb/IIIa blockers (eptifibatide) and 600 mg clopidogrel or 180 mg ticagrelor. Second coronary arteriography (CAG) was done in up to 5 days. Results. By 4,0±1,0 day, blood flow TIMI 2-3 in infarction-related artery was secure in 100% patients; there was marked decrease of the grade of target stenosis in infarction-related artery from 77,8±10,2% to 50,5±19,5%; decrease by its length from 21,5±8,5 to 15,5±5,5 mm; increase of the reference diameter of artery from 3,1±0,8 to 3,5±0,75 mm, and thrombosis bride by TTG — from 3,9 to 0,9. By the data from CAG, stenting of the target segment was done in 8 (29%) patients, and in 3 (10%) stenting done based on the data from intravascular ultrasound. In 17 (61%) patients the infarction-related stenosis was non-significant. In the group of delayed stenting there was no cases of no/slow-reflow development. At hospital stage of management, there were no cardiovascular events in the observation group. Conclusion. In patients with massive thrombosis of infarction-related artery (TTG ≥3) and restored antegrade coronary flow TIMI 2-3, the delayed stenting is a safe and effective strategy of treatment at hospital stage.
Highlights
The results of delayed endovascular intervention in ST elevation acute myocardial infarction due to thrombotic occlusion of coronary artery
В. — 1зав. сосудистым центром на базе больницы, 2к.м.н., доцент кафедры рентгенэндоваскулярных методов диагностики и лечения ФДПО, Семитко С
П. — д. м.н., профессор кафедры рентгенэндоваскулярных методов диагностики и лечения ФДПО, Глезер М
Summary
28 STEMI patients included, age 52 (25-77) y. o., of those males 80% (n=23), who, during January 2014 to February 2016, in first 6-12 hours from the onset of the disease, received endovascular treatment with purpose to recover adequate blood flow. After restoring of the antegrade flow, there was thrombus, visualized in artery lumen, with TIMI thrombus grade score (TTG) ≥3. Another criteria of efficacy was resolving of ST elevation by ≥50%. In patients with massive thrombosis of infarction-related artery (TTG ≥3) and restored antegrade coronary flow TIMI 2-3, the delayed stenting is a safe and effective strategy of treatment at hospital stage. КАГ — коронароангиография, ИМ↑ST — инфаркт миокарда с подъемом сегмента ST, ЧКВ — чрескожное коронарное вмешательство, ДАТ — двойная антиагрегантная терапия, TTG — индекс ангиографической оценки коронарного тромбоза TIMI (thrombus grade score). Целью данного исследования было оценить эффективность и безопасность отсроченного стентирования у больных ИМ↑ST и массивным тромбозом инфаркт-ответственной артерии
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