Аннотация:

В исследовании оценивались непосредственные и отдаленные результаты чрескожных коронарных вмешательств (ЧКВ) у 172 больных острым инфарктом миокарда, облегченных предшествующей тромболитической терапией (ТЛТ) стрептокиназой или тенектеплазой (81 %) либо комбинацией ТЛТ с блокатором ИЬ/1Иа гликопротеиновых рецепторов тромбоцитов (РеоПро) - абциксимабом (19%). Среднее время от развития болевого синдрома до реперфузии составило 197±103 мин. У 88% пациентов в обеих подгруппах комбинированной терапии после 4KB достигался кровоток TIMI 3 (р < 0,01 с исходным кровотоком).

За время госпитализации у 4 больных (после ТЛТ + ЧКВ у 3 пациентов и после ТЛТ + РеоПро + 4KB у одного) было повторно выполнено ЧКВ в связи с возвратной ишемией или подострой окклюзией. 2 больным проводилась операция коронарного шунтирования. Госпитальная выживаемость после облегченного ЧКВ - 98,6-100%. До 6 месяцев после ЧКВ контакт был с 67% выживших пациентов. За этот период 16% больных были снова госпитализированы. Причиной послужила возвратная стенокардия, обусловленная рестенозом. Повторное ЧКВ перенесли 9% пациентов, а операция коронарного шунтирования выполнена в 6% случаев. Все повторные вмешательства были успешными. Общая летальность — 5% за 6 месяцев.

Это проспективное исследование показало высокую непосредственную и отдаленную эффективность и безопасность облегченных чрескожных вмешательств, проводимых при остром инфаркте миокарда.

Список литературы

1.     Lincoff A.M., Topol E.J. Illusion of reperfusion: does anyone achieve optimal reperfusion during acute myocardial infarction? Circulation. 1993; 87: 1792-1805.

2.     FibrinolyticTherapy Trialist's (FTT) Collaborative Group. Indication for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1,000 patients. Lancet. 1994; 343: 311-322.

3.     Gibbons R.J., Holmes D.R., Reeder G.S. et al. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. N. Engl.J. Med. 1993; 328: 685-691.

4.     Grines C.L., Browne K.F., Marco J. et al. For the Primary Angioplasty in Myocardial Infarction Study Group. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial Infarction. N. Engl. J. Med. 1993; 328: 673-679.

5.     Simoons M.L., Serruys P.W., van den Brand M. et al. Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. J. Am. Coll. Cardiol. 1986; 7: 717-728.

6.     The GUSTO IIb Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N. Engl.J. Med. 1997; 336: 1621-1628.

7.     GUSTO Angiographic Investigators.The comparative effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function, and survival after myocardial infarction. N. Engl. J.Med. 1993; 329: 1615-1622.

8.     Vermeer F., Oude Ophuis A.J.M. et al. Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study. Heart. 1999; 82: 426-431.

9.     CORAMI Study Group. Outcome of attempted rescue coronary angioplasty after failed thrombolysis for acute myocardial infarction. Am. J. Cardiol. 1994; 74: 172-174.

10.   Ellis S.G., Da Silva R.E., Heyndrickx G. et al. Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction. Circulation. 1994; 90: 2280-2284.

11.   Ross A.M., Lundergan C.F., Rohrbeck S.C. et al. Rescue angioplasty after failed thrombolysis: technical and clinical outcomes in a large thrombolysis trial. J. Am. Coll. Cardiol. 1998; 31: 1511-1517.

12.   Ellis S.G., Da Silva E.R., Spaulding C.M. et al. Review of immediate angioplasty after fibrinolytic therapy for acute myocardial infarction: insights from the RESCUE I, RESCUE II, and other contemporary clinical experiences. Am. Heart. J. 2000; 139: 1046-1053.

13.   Lefkovits J., Ivanhoe R.J., Califf R.M. et al. Effects of platelet glycoprotein IIb/IIIa receptor blockade by a chimeric monoclonal antibody (abciximab) on acute and six-month outcomes after percutaneous transluminal coronary angioplasty for acute myocardial in farction. Am.J. Cardiol. 1996; 77: 1045-1051.

14.   Neumann F.J., Blasini R., Schmitt C. et al. Effect of glycoprotein I Ib/II Ia receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998; 98: 2695-2701.

15.   Antoniucci D., Santoro G.M., Bolognese L. et al. A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: Results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.J. Am. Coll. Cardiol. 1998; 31: 1234-1239.

16.   Antoniucci D., Valenti R., Santoro G.M. et al. Primary coronary infarct artery stenting in acute myocardial in farction. Am.J. Cardiol. 1999; 84: 505-510.

17.   Pershukov I., Batyraliev T., Niyazova-Karben Z. et al. Efficacy and Safety of Direct Stenting in Patients with Acute Myocardial Infarction. Catheter. Cardiovasc. Intervent. 2003; 59: 125-126.

18.   Rodriguez A., Bernardi V., Fernandez M. et al. In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Am.J. Cardiol. 1998; 81:1286-1291.

19.   Stone G.W., Brodie B.R., Griffin J.J. et al. Clinical and angiographic follow-up after primary stenting in acute myocardial infarction. Тhe Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial. Circulation. 1999; 99: 1548-1554.

20.   Petronio A.S., Musumeci G., Limbruno U. et al. Abciximab Improves 6-Month Clinical Outcome After Rescue Coronary Angioplasty. Am. Heart.J. 2002; 143 (2): 334-341.

21.   Miller J.M., Smalling R., Ohman M. et al. Effectivennes of early coronay angioplasty and abciximab for failed thrombolysis (reteplase or alteplase) during acute myocardial infarction (results from the GUSTO-III Trial). Am.J. Cardiol. 1999; 84: 779-784.

22.   Jong P., Lazzam C., Cohen E. et al. Bleeding risks with abciximab post thrombolysis in rescue or urgent angioplasty for acute myocardial infarction [abstract 971]. Circulation. 1999; 100: 188.

23.   Sundlof D.W., Rerkpattanapitat P., Wongprapanut N. et al. Incidence of bleeding complications associated with abciximab use in conjunction with thrombolytic therapy in patients requiring percutaneous transluminal coronary angioplasty. Am.J. Cardiol. 1999; 83: 1569-1571.

24.   Neumann F.J., Blasini R., Schmitt С et al. Effect of glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998; 98: 2695-2701.

25.   Keeley E.C., Boura J.A., Grines C.L. Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet. 2006; 367: 579-588.

26.   Stone G.W., Gersh B.J. Facilitated angioplasty: paradise lost. Lancet. 2006; 367: 543-546.

27.   Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acutemyocardial infarction (ASSENT-4 PCI): randomized trial. Lancet. 2006; 367: 569-578.

           28.   Шпектор А.В., Васильева Е.Ю., Артамонов В.Г. и др. Комбинированная реперфузия у больных острым инфарктом миокарда. Кардиология. 2007; 6: 27-30.