Viddalena efektyvnist revaskuliaryzatsii miokarda u khvorykh pislia perenesenoho hostroho koronarnoho syndromu (literaturnyi ohliad; rezultaty vlasnykh doslidzhen)

Abstract

Introduction. Acute coronary syndrome (ACS) is an urgent problem in the world. The vast majority of publications indicate the effectiveness of myocardial revascularization in this pathology. However, the effectiveness of this method of treatment in the remote period of GIMeST has not been sufficiently studied. The aim of the study. Analyze the long-term effectiveness of myocardial revascularization in patients after ACS based on literature publications and own results of conducted research. Materials and methods. 42 sources of published literature were used and the results of our own research on increasing the clinical effectiveness of coronary artery stenting by combining it with medical treatment in patients with post-STEMI with cardiovascular events were presented. Results. It has been proven that the 30-month survival rate of a patient with a hemodynamically significant lesion of the coronary artery trunk with drug therapy was 6.4 %, and with CABG – 80.0 %. The best results of myocardial revascularization were observed with CA p-value more than 70.0 % stenosis. It was found that primary coronary intervention in comparison with thrombolytic therapy contributes to a more complete restoration of epicardial impact (III degree according to the TIMI scale). Successful endovascular recanalization of infarct-induced KA helps to limit the area of necrosis and restore the reduced inotropic function of the hibernating myocardium up to 2 hours after the start of ACS. In the later periods of restoration of anterograde blood flow, the beneficial effect is manifested within a year. On the basis of our own research, positive dynamics of improvement in late LV remodeling and reduction of cardiac arrhythmias (SHE, AF, LVPH, and HF) are observed in patients with post-GIMeST after medical treatment. Conclusions. On the basis of the cited literary sources and our own research, it should be noted that in patients who underwent STEMI with cardiovascular events compared to those without cardiovascular events and underwent myocardial revascularization and outpatient drug treatment for two years, there was an increase in LVEF by 12.6 %, respectively, and a decrease in angina attacks by 6.6 %, CHF III and II FC – by 11.9 %, reduces SHE, AF and BLPNH and improves the quality of life. However, mortality 2 years after myocardial revascularization compared with medical treatment did not change significantly, and according to the literature, it decreased after CABG.