Endovascular methods in complex treatment strategy for myocardial infarction in patients in coronary multivessel disease

DOI: https://doi.org/10.25512/DIR.2010.04.2.04

For quoting:
Goloschapov-Aksenov R.S., Zhamgyrchev Sh.T., Ternovykh M.V., Lebedev A.V., Obidin A.V. "Endovascular methods in complex treatment strategy for myocardial infarction in patients in coronary multivessel disease". Journal Diagnostic & interventional radiology. 2010; 4(2); 21-28.

authors:

Goloschapov-Aksenov R.S.

Zhamgyrchev Sh.T.

Ternovykh M.V.

Lebedev A.V.

Obidin A.V.

keywords:

myocardial infarction

endovascular interventions

complete anatomical coronary revascularization

PTCA

coronary stenting

Abstract:

Purpose. To assess safety and efficiency of simultaneous RCA and major branches of LCA stenting in patients with myocardial infarction (MI).

Material and methods. Authors analyzed data of 237 patients. Coronary angiography (CAG) revealed triple vessel stenotic and/or occlusive disease. Pre-procedure systemic thrombolysis (streptokinase) used in 54 patients. Endovascular interventions (PTCA and stenting of the infarct related artery) performed in all the cases; in 24 patients, simultaneous complete anatomical coronary revascularization (CACR) attempted. In 30 cases, after PTCA of the infarct related artery (PTCA IRA) patients were transferred to other hospitals for bypass surgery as a second stage.

Results. Systemic thrombolysis efficiency was 40 %(22 patients) according to echocardiography and 26% (14 patients) by CAG. TIMI III flow restored in 100%, immediate clinical success rate was 97,5%. There were no procedural complications. Six patients died early after the PTCA for cerebral hemorrhage, acute LV failure, and LV rupture. Absence of myocardial ischemia in CACR subgroup was confirmed clinically and in treadmill test. Patients of PTCA IRA subgroup presented with angina of various functional class.

Conclusions. Endovascular interventions are highly efficient as a component of complex IM treatment. Primary CACR is proved to decrease symptoms of myocardial ischemia.

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