Abstract:

Aim: was to evaluate the safety and efficacy of delayed endovascular treatment without stent implantation in ST-elevation myocardial infarction (STEMI) caused by massive thrombotic load and ectasia of infarct-related coronary artery.

Material and methods: out of 4263 primary percutaneous coronary interventions (PCI) performed for STEMI for the period from January 2016 to September 2021, retrospective analysis included data of 21 patients with ectasia of infarct-related coronary artery and massive thrombotic load (TTG ? 3).

Results: method of delayed endovascular treatment, without stent implantation, in STEMI caused by massive thrombotic load and ectasia of infarct-related coronary artery, allowed to significantly improve parameters of epicardial coronary blood flow according to  TIMI and CFTC scales in 71% and 67% of examined patients (p <0,001, p=0,001); increase myocardial perfusion according to MBG in 62% of patients (p=0,001); reduce the severity of thrombotic load according to TTG scale in 71% of the subjects (p=0,001).

Conclusion: in patients with ST-elevation myocardial infarction caused by massive thrombotic load and ectasia of infarct-related coronary artery, the strategy of delayed endovascular treatment with-out stent implantation is safe and effective at the hospital stage.

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:

Background: prolonged vasospasm of coronary arteries (CA) is quite often cause of myocardial infarction (MI) in young patients. As a rule, it is associated to drug-using, as an example, cocaine that among other things has systemic vasoconstrictive effect.

Material and methods: article describes the development of acute large myocardial infarction with ST elevation in a 50-year-old patient with no risk factors for cardiovascular complications (RF CVC), except for obesity 1 grade. Previously, she was observed with mild bronchial asthma and chronic allergic rhinitis, for which she used a nasal spray with xylometazoline at doses many times higher than the therapeutic ones for a long time. These conditions we consider to be a cause of her persistent coronary spasm, which led to acute coronary insufficiency and myocardial infarction.

Results: coronary angiography revealed multiple subtotal lesions in the basin of left coronary artery (LCA) and acute occlusion of right coronary artery (RCA), which was the source of MI. Patient underwent recanalization of occlusion and balloon angioplasty with partial restoration of blood flow. Intracoronary injection of isosorbide dinitrate led to recovery of arterial lumen in all segment except distal third where stenosis was ment to be atherosclerotic plaque and the the initial trigger of complete RCA obstruction. After stent implantation in the zone of stenosis and several intra-arterial injections of isosorbide dinitrate, RCA lumen was fully restored. During control angiography of left coronary artery basin, spasm was totally treated with full recovery of lumen of all previously defeated arteries.

During hospitalization period, pain did not recur; prolongedrelease oral nitrates (isosorbide mononitr 40 mg) were prescribed to prevent vasospasm. However, less than a 1,5 month, acute coronary syndrome recurred: the cause was a pronounced spasm of circumflex artery (Cx), that was treated by intracoronary injection of nitrates. Subsequently, therapy was changed: instead of nitrates, calcium channels blocking agents were recommended (CCB - felodipine 5 mg per day). During 9 months of observation, the pain did not recur.

Conclusion: this is the first case report of developed myocardial infarction due to an overdose of xylometazoline, described in the literature. It should be kept in mind, that in case of spastic lesions detected with coronary angiography, especially in young patients without risk factors for cardiovascular diseases, carefully obtaining of anamnesis  should be done, and nobody should neglect the intracoronary injection of low doses of nitrates even if blood pressure is low.

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https://doi.org/10.1007/s12471-019-1232-7

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https://doi.org/10.1093/eurheartj/ehv351

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Abstract:

One of the most significant problems in interventional cardiology is a correct drug-support after held procedure. First of all it is the prevention of stent thrombosis - application of anticoagulants and antiaggregants. The variety of these drugs on sale constantly grows - that leads to have clear ideas of their properties.

Article presents the review of clinical researches devoted to the recently appeared and early not used in Russia, drug Angioks (Bivalirudin), which has the same efficiency as well-known drugs, but is more safe.

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Article exists only in Russian.

Abstract:

Aim: was to identify relationship between risk factors (RF) and severity of coronary artery (CA) defeat in patients, hospitalized with acute coronary syndrome (ACS), without the presence of ishemic heart disease (IHD) earlier.

Materials and methods: the research includes 201 patients, who were hospitalized to N.V Sklifosovsky Research Institute of Emergency Medicine from february 2011 to apri 2012 with the diagnosis «ACS». Main criteria of patients selection was the absence of IHD clinics in past. All patients underwent coronarography, obtained data was fixed in data base. At the time of arrival to hospital - risk factors were determined. To identify relationship between RF and CA defeat - statistic analyzes were made: the number of defeated CA (1,2 or 3); severity of CA defeat was measured with Syntax Score (SS) Scale (<22 and >22 points); praesence or absence of acute occlusion of CA of infarction zone.

Results: research consisted of 149 male (74,1%) and 52(25,9%) female, mean age of all patients was 56,6±10,6 yrs. ACS with elevation of ST-segment was diagnosed in 136 (67,7%) of patients. Haemodynamic significant stenosis (HSS) of 1, 2 or 3 CA were found in 56 (27,9%), 61 (30,4%) and 64 (30,8%) respectively In 20 (10%) patients - there was no HSS. Acute thrombotic occlusion (ATO) in myocardial infarction related(MI-related) CA was revealed in 146 (72,6%) of patients. It was noted, tht such RF as arterial hypertention (AH), smoking, low physical activity (LPA), was more spread with increasing numer of defeated CA. Patients with lot of defeated CA, were older, had higher figures of systolic arterial pressure (SAP). After examination and primary analysis, only age and number of RF had independent relation with prevalence of CA defeat. Patients with SS >22 points in comparison with patients <22 points, had higher AP, obesity, diabetes mellitus (DM), and more ofted had lack of fruits and vegetables. Also they were older had higher SAP, more RF. Analysis showed that only AH, DM, and age had independent relation with savere CA defeat (Syntax Score >22 points). Patients with ATO of CA, had higher such RF as smoking, LPA, DM. They also had more RF. After analysis - smoking and LPA were independently connected with ATO.

Conclution: such RF as age, AH, DM, LPA and number of combined RF in patient can have independent relation with volume and prevalence of CA defeat. Smoking and LPA can have relation with ATO, with clinics of ST-elevated ACS and macrofocal MI. Obtained data show necessity of inlarged reseach for a broad understanding og RF in connection with coronary atherosclerosis and thrombosis. All that can increase effectiveness of treatment and prophylaxis of cardiovascular morbidity and mortality.

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