Abstract:

Aim: was to compare results of using of direct stenting and coronary artery stenting after pre-dilation (CSaPD) in STEMI patients with occlusive coronary artery thrombosis in terms of frequency of no-reflow syndrome and adverse cardiovascular events (MACE) during in-hospital period.

Material and methods: study included 620 patients with acute myocardial infarction with elevation of the ST segment of the electrocardiogram and occlusive thrombosis of the infarct-dependent coronary artery, who successfully underwent endovascular revascularization by stenting. The CSaPD group included 297 patients who underwent stenting after a preliminary balloon angioplasty. The direct stenting group consisted of 323 patients who underwent stenting without prior dilation. The primary endpoint of the study was the occurrence of no-reflow syndrome, secondary endpoints were cardiac death, certain stent thrombosis, recurrence of myocardial infarction, as well as the combined MACE point. Patients of both groups were monitored during in-hospital period.

Results: there were no significant differences between the groups of CSaPD and direct stenting in main clinical-demographic and clinical-angiographic indicators, with the exception of the average length of hospitalization (11 [8;12] vs 8 [7;9], respectively, p = 0,04). Endpoint analysis revealed differences in the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting groups, respectively, p = 0,03), cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04), as well as the combined MACE point (37 (12,46%) vs 8 (2,48%) in the CSaPD and direct stenting groups, respectively, p = 0,02).

Conclusion: in STEMI patients with occlusive coronary artery thrombosis, direct stenting of the infarct-dependent artery during the restoration of coronary blood flow to TIMI I after passage of coronary guide-wire, significantly reduces the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting, respectively, p = 0,03) and cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04).

Abstract:

Introduction: percutaneous coronary intervention plays an important role in treatment of acute myocardial infarction with ST-segment elevation. However, the benefit of performing delayed PCI is controversial (>12h after onset of symptoms typical for STEMI).

Aim: was to compare results of PCI and medical therapy (MT) in patients, who had been admitted to the hospital with verified STEMI, diagnosed 12 hours after the onset of symptoms, and to estimate their effect on clinical outcomes.

Material and methods: data of 100 patients was analyzed, PCI was performed in 62 patients and 38 patients underwent medical therapy. The task was to compare clinical outcomes, which included mortality and major adverse cardiac events (MACE).

Results: all-cause mortality in groups of delayed PCI and MT was 4 (6,45%) and 9 (23,6%) respectively (p <0,05). It was also recorded that minor cases of cardiac death occurred in the group of delayed PCI in comparison with the MT group, 1 (1,6%) and 6 (15,7%) respectively (p <0,05).

Conclusion: delayed PCI (12 hours after the onset of the myocardial infarction in STEMI patients) leads to improvement in all-cause mortality and cardiac death rates compared with conservative treatment.

Abstract:

Aim: was to optimize treatment of patients with acute myocardial infarction without significant stenotic lesions of coronary arteries.

Materials and methods: authors present a clinical case of treatment of patient, who was admitted in few hours from onset of myocardial infarction. At first-stage, patient underwent manual vacuum thrombectomy, and it revealed the absence of significant stenotic lesions of coronary arteries. Patient underwent coronary angiography, left ventriculography, optical-coherence tomography of the infarct-dependent artery

Results: in this clinical case the cause of myocardial infarction in patient without significant stenotic coronary lesions was the presence of intramural fibrecalcific plaque without signs of instability

Conclusions: according to authors, in order to reduce the incidence of re-thrombosis of coronary arteries in patients with myocardial infarction without stenotic lesions of coronary arteries, it is recommended to perform optical-coherence tomography to reveal unstable atherosclerotic plaque; in such cases it may be warranted stenting of coronary artery.

References

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Abstract:

Article presents the results of analysis of risk factors associated with early stent thrombosis after percutaneous coronary intervention (PCI) ir patients with acute myocardial infarction (AMI). The study is designed as an observational cohort study prospectively including 140 patients with a PCI treated AMI admitted to our hospital. Patients were divided into two groups: with and without type 2 diabetes rnellitus (DM). A number of early stent thrombosis risk factors including a complete or not complete revascularization and myocardial blush grade during PCI, based on the predictive model were analyzed. The results of the study show that DM in patients with AMI who underwent PCI was not associated with a high risk of early stent thrombosis, however, incomplete revascularization was.

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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. 

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Hemorrhagic and thrombotic complications after percutaneous coronary intervention in acute myocardial infarction (case report)