Оценка влияния медикаментозной и механической реваскуляризации при комплексной терапии в остром периоде инфаркта миокарда

Abstract

Background: The effectiveness of the integrated use of monopril, propranolol with heparin and percutaneous coronary intervention (PCI); PCI separately conducted on hemodynamics, on cardiohemodynamics and the clinical course during the acute phase and during the follow of myocardial infarсtion (MI) was studied. Comparison of the results of the complex medical and mechanical revascularization with PCI conducted separately was carried out. Material and methods: 42 patients with acute coronary syndrome were examined: anterior MI with Q-wave and ST-segment elevation in age from 30 to 70 years (56.7 ± 1.20 years). 21 patients out of 42 were treated by monopril, propranolol, heparin and PCI (group 1); 21 patients were treated only by PCI (group 2). In both groups, with echocardiography and Doppler echocardiography were investigated end-systolic ( CSR) and end-diastolic (EDV) volumes, ejection fraction (EF), stroke index (SI), cardiac index (CI), a violation of local contractility index (VLCI) of LV, restenosis by re-coronarography, ECG ST-segment elevation and re-anginal pain. And also the dynamics of systolic and diastolic (BP), clinical features of myocardial infarction in the period of observation were identified/ Results: Patients treated by monopril, propranolol, heparin and PCI demonstrated stabilized central hemodynamics, reduced CSR, EDV, VLCI, improved systolic function of LV and increased EF. However, in this group, in one patient on the third day was recorded congestive heart failure (CHF), in another one recurrent MI. In the group subjected only to PCI, 2 patients developed recurrence of MI, 3 restenosis at 2 CHF and two patients died. Conclusions: Combined application of medical therapy with PCI improves clinical current of MI and provides predictive positive results more noticeably than separately conducted by PCI in ACS-MI.