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Abstract:

Coronary flow limitation during high risk angioplasty in acute coronary syndrome (ACS) patients is an important problem, connecting with inadequate myocardial protection during the coronary intervention.

Aim: was to compare intraoperative cardiohemodynamic in ACS patients during the high risk angioplasty of difficult stenoses in anterior heart arteries with- or without a coronary venous retroperfusion support.

Methods: intervention results of 14 ACS patients were analyzed. In 1st group there were 6 patients (42,9%) with intraoperative myocardial retroperfusion support. In 2nd group - 8 patients (57,1%) without any intraoperative myocardial perfusion support.

Results: during the retroperfusion support in the 1st group , «ST»-segment elevation at 60 sec left main (LM) or left anterior descending artery (LAD) occlusion was significantly lower (ST in V4-V6 - 1,9±1,7 mm) than in patients without retroperfusion (ST in V4-V6 - 3,1±1,7; p = 0,043). In the 2nd group, patients without coronary flow support the «ST»-segment elevation at 60 sec LM or LAD occlusion was significantly higher (ST в V4-V6 - 2,5±0,5; p = 0,043) than at 5 sec LM or LAD occlusion. No significant differences between «ST»-segment and «T»-wave deviation in the beginning and in the end of intervention were in both groups. The same dynamics was demonstrated at the time of blood pressure indexes measurement.

Conclusion: coronary venous retroperfusion is an effective method of coronary flow support during the high risk angioplasty in ACS patients. Retroperfusion technology had no influence on cardiohemodynamic, but reduced the risk of intraoperative adverse cardiac events. 

 

References

1.     Antman E.M., Anbe D.T., Armstrong P.W. et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J. Am. Coll. Cardiol. 2004; 44: E1-E211.

2.     Trusov V.V., Kazakova I.A., Kuznecov D.N. Analiz raboty pervichnogo sosudistogo centra na baze MUZ MSCh «ZhMASh» [Analysis of functioning of primary angiologic center on the base of medical-sanitary unit of «IZhMASh»]. PJeM . 2011; 43-44(3-4):20-22 [In Russ].

3.     Silber S., Albertsson P., Aviles F.F., et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur. Heart J. 2005; 26: 804-847. P05-04673.

4.     Kononov A.V., Kostjanov I.Ju., Kuznecova I.Je., Aligishieva Z.A., Abil'dinova A.Zh., Cereteli N.V., Koledinskij A.G., Gromov D.G., Suhorukov O.E., Ioseliani D.G. Stentirovanie stvola levoj koronarnoj arterii u bol'nyh s razlichnymi formami ishemicheskoj bolezni serdca: blizhajshie i sredneotdalennye rezul'taty [Stenting of left main coronary artery in patients with different forms of ischemic heart disease: early- and long-term results.]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii (Moskva). 2013;23: 26-33 [In Russ].

5.     ACC/AHA Guidelines for the Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). JACC. 2000; 36: 970-1062.

6.     ESC/EACTS Guidelines. Guidelines on myocardial revascularization/The Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAP- CI). European Heart Journal.2010; 31: 2501-2555.

7.     Almany S.L. Interventional in patient with LV dysfunction. PI 57 in New manual of interventional radiology by Mark Freed et al. - Birmingham, Michigan: Physicians T. Press, 1997.

8.     ACC/AHA Guidelines for Percutaneous Coronary Intervention. PTCA Guidelines. JACC 2001; 37: 8: 2239-2306.

9.     Kardiologija: nacional'noe rukovodstvo [Cardiology: national guide-book] (pod red. Ju.N. Belenkova, R.G. Oganova) M.: GJeOTAR-Media, 2008; 1232 s [In Russ].

10.   Belov Ju.V. Varaksin V.A. Postinfarktnoe remodelirovanie levogo zheludochka serdca. Ot koncepcii k hirurgicheskomu lecheniju [Postinfarction remodeling of left atrium. From concept to surgical treatment]. M.: DeNovo, 2002; 5587 [In Russ].

11.   Shiller N.B., Osipov M.A. Klinicheskaja jehokardiografija [Clinical echocardiography]. M.: Praktika, 2005; 344 [In Russ].

12.   Serruys P.W., Onuma Y, Garg S. et all. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009; 5:50-56.

13.   Incorvati R.L., Tauberg S.G., Pecora M.G., et all. Clinical applications of coronary sinus retroperfusion during high risk percutaneous transluminal coronary angioplasty. JACC. 1993; 22(1): 127-34.

14.   Petrov V.I., Nedogoda S.V. «Medicina, osnovannaja na dokazatel'stvah»: Uchebnoe posobie [Medicine, based on evidence]. Moskva: Gjeotar-Media, 2009; 144 s [In Russ].

15.   Javelov I.S. Vybor antikoaguljanta dlja rannego lechenija ostrogo koronarnogo sindroma [Choise of anticoagulants for early treatment of acute coronary syndrome]. Trudnyj pacient (Moskva). 2013;11(10): 12-24 [In Russ].

16.   Lazar H.L. Coronary sinus retroperfusion: can forward progress still be achieved by using a backward technique? J. Thorac. Cardiovasc. Surg., 2004; 127(6): 1549-52.

17.   Zemgulis V., Wikstrom G., Bjerner T., Henze A., Lahtinen M., Waldens^m A., Thelin S., Ronquist G. Discrepant outcome between myocardial energy-related metabolites and infarct size limitation during retroperfusion of the coronary sinus. Scand. J. Clin. Lab. Invest. 2001; 61(8): 651-62.

18.   Leung W.H. Coronary and circulatory support strategies for percutaneous transluminal coronary angioplasty in high-risk patients. Am. Heart J., 1993; 125(6): 1727-38.

19.   Thiele H., Zeymer U., Neumann F.J. et all. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N. Engl. J. Med. 2013; 368:80-81. 

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