Abstract: We present the clinical case of the effective and safe application of the «Filterwire EZ» embolic protection device (Boston Scientific, USA) for prevention of «no-reflow» phenomenon during primary percutaneous coronary angioplasty in a patient with acute myocardial infarction. During performing of balloon angioplasty of infarct-related segment of the circumflex left coronary artery with the protection of the distal segments of artery by «Filterwire EZ» device the embolic event was observed. After the final stent implantation the thrombus was removed by embolic protection device, size of the thrombus - 3x4 mm. Control coronarography confirmed the TIMI 3 blood flow in the infarct-related coronary artery. Presence of different types of devices for capturing or removing of thrombotic masses in the arsenal of interventional cardiologist can improve the results of primary percutaneous coronary angioplasty in patients with acute myocardial infarction. References 1. Jerlih A.D., Gracianskij N.A. i uchastniki registra REKORD. Nezavisimyj registr ostryh koronarnyh sindromov REKORD. Harakteristika bol'nyh i lechenie do vypiski iz stacionara. Aterotromboz 2009; 1: 105-119 [In Russ]. 2. Jerlih A.D., Gracianskij N.A. i uchastniki registra REKORD. Lechenie bol'nyh s ostrym koronarnym sindromom s pod#emom ST v stacionarah imejuwih i ne imejuwih vozmozhnosti vypolnenija chreskozhnyh koronarnyh vmeshatel'stv (dannye registra «REKORD»). Aterotromboz. 2009; 1: 120-122 [In Russ]. 3. Jerlih A.D., Gracianskij N.A. ot imeni uchastnikov registra REKORD. Registr ostryh koronarnyh sindromov REKORD. Harakteristika bol'nyh i lechenie do vypiski iz stacionara. Kardiologija. 2009; 7: 4-12 [In Russ]. 4. Anderson J.L., Adams C.D., Antman E.M. et al. ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction — executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction). J. Am. Coll. Cardiol. 2007; 50: 652-726. 5. Bhatt D.L., Roe M.T., Peterson E.D. et al. Utilization of early invasive management strategies for high-risk patients with non-ST segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA. 2004; 292: 2096-104. 6. Birkhead J.S., Walker L., Pearson M. et al., on behalf of the MINAP Steering Group Improving care for patients with acute coronary syndromes: initial results from the National Audit of Myocardial Infarction Project (MINAP). Heart. 2004; 90: 1004-1009. 7. 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Med. 2005; 353: 2758-2768. 11. Kushner F.G., Hand M., Smith S.C. et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2009; 54: 2205-2241. 12. Eeckhout E., Kern M.J. The coronary no-reflow phenomenon: a review of mechanisms and therapies. European. Heart. Journal. 2001; 22: 729-739. 13. Van de WF, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation. Acute Myocardial Infarction of the European Society of Cardiology. Eur. Heart. J. 2008; 29: 2909-2945. 14. Baim D.S., Braunwald E., Feit F., Knatterud G.L., Passarnani E.R., Robertson T.L., et al. The Thrombolysis in Myocardial Infarction (TIMI) Trial phase II: additional information and perspectives. J. Am. Coll. Cardiol. 1990; 15: 1188-1192. 15. Leonardo Galiuto, Antonio G. Rebuzzi, Filippo Crea. The no-reflow phenomenon. JACC. 2009; 2(1): 85-86. 16. Rogers W.J., Baim D.S., Gore J.M., Brown B.G., Roberts R., Williams D.O., et al. Comparison of immediate invasive, delayed invasive, and conservative strategies after tissue-type plasminogen activator. Results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II-A trial. Circulation. 1990; 81: 1457-1476. 17. Hori M., Inoue M., Kitakaze M. et al. Role of adenosine in hyperemic response of coronary blood flow in microembolization. Am. J. Physiol. 1986; 250: 509-518. 18. Tanaka A. No-reflow phenomenon and lesion morphology in patients with acute myocardial infarction. Circulation. 2002; 105: 2148-2152. 19. 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High-tech medical care for patients with acute coronary syndrome in the central district hospital of the Moscow region
DOI: https://doi.org/10.25512/DIR.2011.05.3.10
For quoting:
Semenov V.Yu., Gorenkov R.V., Mirzonov V.A., Goloshchapov-Aksenov R.S. "High-tech medical care for patients with acute coronary syndrome in the central district hospital of the Moscow region ". Journal Diagnostic & interventional radiology. 2011; 5(3); 79-93.
Article exists only in Russian.
Abstract: Aim: was to evaluate results of endovascular treatment of patients with acute coronary syndrome (ACS) without ST-segment elevation, with multivessel coronary disease. Materials and methods: 346 patients were enrolled in study and initially randomized into 3 groups. 1st group included 100 patients with complete myocardial revascularization which had been performed during initial PCI. 2nd group included 124 patients with complete myocardial revascularization, performed during initial hospitalization: 3rd group - 122 patients with complete revascularization, performed at different times after initial hospitalization. Inclusion criteria: ACS patients without ST-segment elevation; multivessel coronary disease (risk SYNTAX score = 23-32); high and medium risk for the GRACE scale; absence of previous myocardial revascularization. Results: long-term results of treatment were evaluated in 192 patients. After 12 months, patients in 3rd group was significantly more likely to have greater cardiovascular complications and re-interventions on the target vessel. It was found that complete myocardial revascularization, performed after 30 days from the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease (r = 0,58, p <0,05). Risk factors adversely affecting the prognosis of ACS patients without ST-segment elevation and presence of multivessel disease include: subtotal stenosis in non-symptomatic arteries; circulation failure Killip class III; myocardial infarction in past; high risk on GRACE scale; lesion length in non-symptomatic arteries more than 20 mm diabetes mellitus; degree of risk on a SYNTAX scale-score> 25; overweight/obesity; high cholesterol 6.5 mmol/l. Conclusions: when performing PCI in patients with ACS without ST-segment elevation with multivessel coronary disease, performing a complete myocardial revascularization 30 days after the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease. References 1. Bockeria L.A., Alekyan B.G.(eds). Rentgenjendovaskuljarnaja diagnostika i lechenie zabolevanij serdca i sosudov v Rossijskoj Federacii - 2015 god. [Endovascular diagnosis and treatment of the heart and blood vessels diseases in Russian Federation - 2015]. Moscow: Nauchnyy tsentr serdechno-sosudistoi khirurgii imeni A.N. Bakuleva; 2016 [In Russ]. 2. Filatov A.A, Krylov V.V. Rezul'taty jendovaskuljarnogo lechenija bol'nyh infarktom miokarda bez zubca Q na jelektrokardiogramme. [Results of endovascular treatment of patients with myocardial infarction without Q-wave on the ECG]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2012;30:29-32 [In Russ]. 3. 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Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late Percutaneous coronary Intervention trial in NSTEMI (LIPSIA-NSTEMI Trial). Eur Heart J. 2012;33(16):2035-43. 7. Henderson R.A., Jarvis C., Clayton T. et al. 10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial. J Am Coll Cardiol. 2015; 66(5):511-20. doi: 10.1016/j.jacc.2015.05.051. 8. Damman P, Nan van Geloven, Wallentin L. et al. Timing of Angiography With a Routine Invasive Strategy and Long-Term Outcomes in Non-ST-Segment Elevation Acute Coronary Syndrome: A Collaborative Analysis of Individual Patient Data From the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials. J Am Coll Cardiol Intv. 2012;5(2):191-199. doi:10.1016/j.jcin.2011.10.016. 9. Badings E.A., Salem H.K., Dambrink J.E. et al. Early or late intervention in high-risk non-ST-elevation acute coronary syndromes: results of the ELISA-3 trial. EuroIntervention. 2013;9:54-61. 10. 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