PROBLEMS OF REVASCULARIZATION IN ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION
Abstract
SUMMARY. Based on the data of 370 patients with acute myocardial infarction with ST segment elevation, problems affecting the efficiency of revascularization treatment by PCI have been analyzed. It has been considered difficult to achieve further reduction in the timing of PCI compared to the available. The acceleration dynamics of ST segment on the electrocardiogram during PCI against thrombolysis and limitations of ECG monitoring during reperfusion in assessing myocardial perfusion have been specified. The necessity and appropriateness of PCI in different periods from the onset of MI have been reasoned. The prospects of using perfusion myocardial SPECT in assessing hypoperfusion and prognosis of restoration of myocardial function have been mentioned.
About the Authors
V. A. RyabininRussian Federation
P. Y. Lopotovsky
Russian Federation
E. V. Migunova
Russian Federation
A. P. Golikov
Russian Federation
N. E. Kudryashova
Russian Federation
References
1. Сборник среднемосковских основных показателей деятельности медицинских организаций Департамента здравоохранения города Москвы за 2012–2013 гг. / Государственное казенное учреждение здравоохранения г. Москвы; Бюро медицинской статистики ДЗ г. Москвы. – Москва, 2014. – Исх. № 99/1-14. – Дата 25.03.2014 г. Sbornik srednemoskovskikh osnovnykh pokazateley deyatel’nosti meditsinskikh organizatsiy Departamenta zdravookhraneniya goroda Moskvy za 2012-2013 gg. [A collection of medium-Moscow main indicators of activity of medical institutions of the Department of health of the city of Moscow for 2012-2013]. State institution of health, Bureau of medical statistics HD. Moscow, 2014. Ex. No. 99/1-14. 25.03.2014. (In Russian).
2. Menees D.S., Peterson E.D., Wang Y., et al. Door-to-balloon time and mortality among patients undergoing primary PCI // N. Engl. J. Med. – 2013. – Vol. 369, N. 10. – P. 901–909.
3. NCDR study shows D2B times for STEMI have improved, in-hospital mortality rates remain unchanged. Additional Strategies Needed to Reduce In-hospital Mortality September 4, 2013 / American College of Cardiology // CardioSource. – URL: http://www.cardiosource.org
4. Петросян Ю.С., Зингерман Л.С. Коронарография. – М.: Медицина, 1974. – С. 115–125. Petrosyan Yu.S., Zingerman L.S. Koronarografiya [Coronary Angiography]. Moscow: Meditsina Publ., 1974. 115–125. (In Russian).
5. TIMI-III B Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-ST elevation myocardial infarction. Results of the TIMI IIIB trial. Thrombolysis in Myocardial Ischemia // Circulation. – 1994. – Vol. 89, N. 4. – P. 1545–1556.
6. Труфанов Г.Е., Декан В.С., Романов Г.Г., Рыжкова Д.В. Перфузионная сцинтиграфия миокарда. – С-Петербург: ЭЛБИ-СПб., 2012. – С. 69. Trufanov G.E., Dekan V.S., Romanov G.G., Ryzhkova D.V. Perfuzionnaya stsintigrafiya miokarda [Perfusion scintigraphy of the myocardium]. Saint-Peterburg: ELBI-SPb. Publ., 2012. 69. (In Russian).
7. Голиков А.П., Рябинин В.А., Лопотовский П.Ю. и др. Оценка электро-кардиографических признаков реперфузии миокарда у больных с острым инфарктом миокарда с подъемом сегмента ST // Неотложная медицинская помощь. – 2012. – № 1. – С. 20–23. Golikov A.P., Ryabinin V.A., Lopotovskiy P.Yu. et al. Otsenka elektrokardiograficheskikh priznakov reperfuzii miokarda u bol’nykh s ostrym infarktom miokarda s pod’emom segmenta ST [Evaluation of electrocardiographic signs of myocardial reperfusion in patients with acute myocardial infarction-segment elevation ST]. Zhurnal im. N.V. Sklifosovskogo Neotlozhnaya meditsinskaya pomoshch’. 2012; 1: 20–23. (In Russian).
8. Braunwald E., Kloner R.A. The stunned myocardium: prolonged postischemic ventricular dysfunction // Circulation. –1982. – Vol. 66, N. 6. – Р. 1146–1149.
9. Галанкина И.Е. Морфологические особенности эволюции инфаркта миокарда после эффективной тромболитической терапии // Архив патологии. – 1988. – № 7. – С. 63–70. Galankina I.E. Morfologicheskie osobennosti evolyutsii infarkta miokarda posle effektivnoy tromboliticheskoy terapii [The Morphological features of the evolution of myocardial infarction after successful thrombolytic therapy]. Arkhiv patologii. 1988; 7: 63–70. (In Russian).
10. Полумисков В.Ю. Влияние бета-адреноблокатора пропранолола и антиоксиданта дибунола на формирование очага некроза у больных инфарктом миокарда: автореф. дис. … канд. мед. наук. – М., 1983. Polumiskov V.Yu. Vliyanie beta-adrenoblokatora propranolola i antioksidanta dibunola na formirovanie ochaga nekroza u bol’nykh infarktom miokarda: avtoref. dis. … kand. med. nauk [Effect of beta-blocker propranolol and antioxidant BHT on the formation of necrosis in patients with myocardial infarction. Abstract cand. med. sci. diss. ]. Moscow, 1983. (In Russian).
11. Ваниев С.Б. Гемодинамические эффекты препаратов адреноблокирующего действия при артериальной гипертензии в остром периоде инфаркта миокарда: автореф. дис. … канд. мед. наук. – М., 1981. Vaniev S.B. Gemodinamicheskie effekty preparatov adrenoblokiruyushchego deystviya pri arterial’noy gipertenzii v ostrom periode infarkta miokarda: avtoref. dis. … kand. med. nauk [Hemodynamic effects of drugs adrenoceptor blocking action in hypertension in acute myocardial infarction. Abstract cand. med. sci. diss.]. Moscow, 1981. (In Russian).
12. Крыжановский С.А., Вититнова М.Б., Рябинин В.А. Фосфокреатин (неотон) как представитель нового класса мембранопротекторов (Теория, эксперимент, клиника). – Воронеж: Истоки, 2000. – С. 230– 237. Kryzhanovskiy S.A., Vititnova M.B., Ryabinin V.A. Fosfokreatin (neoton) kak predstavitel’ novogo klassa membranoprotektorov (Teoriya, eksperiment, klinika) [Phosphocreatine (Neoton) as the representative of a new class of membranoproliferative (Theory, experiment, clinic)]. Voronezh: Istoki Publ., 2000. 230–237. (In Russian).
13. Иоселиани Д.Г., Роган С.В., Семитко С.П. и др. Сравнительные результаты раннего (до 24 часов) и отсроченного (до 21 дня) стентирования у пациентов с острым инфарктом миокарда // Интервенционная кардиология. – 2005. – № 8. – С. 25–29. Ioseliani D.G., Rogan S.V., Semitko S.P., et al. Sravnitel’nye rezul’taty rannego (do 24 chasov) i otsrochennogo (do 21 dnya) stentirovaniya u patsientov s ostrym infarktom miokarda [The comparative results of early (within 24 hours) and delayed (up to 21 days) stenting in patients with acute myocardial infarction]. Interventsionnaya kardiologiya. 2005; 8: 25–29. (In Russian).
14. Хубутия М.Ш., Газарян Г.А., Захаров И.В. Реперфузионная терапия в остром периоде инфаркта миокарда. – М.: ГЭОТАР-МЕДИА, 2010. – 168 с. Hubutiya M.Sh., Gazaryan G.A., Zakharov I.V. Reperfuzionnaya terapiya v ostrom periode infarkta miokarda [Reperfusion therapy in acute myocardial infarction]. Moscow: GEOTAR-MEDIA, 2010. 168 p. (In Russian).
Review
For citations:
Ryabinin V.A., Lopotovsky P.Y., Migunova E.V., Golikov A.P., Kudryashova N.E. PROBLEMS OF REVASCULARIZATION IN ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION. Russian Sklifosovsky Journal "Emergency Medical Care". 2014;(4):25-28.