THE RESULTS OF DELAYED ENDOVASCULAR INTERVENTION IN ST ELEVATION ACUTE MYOCARDIAL INFARCTION DUE TO THROMBOTIC OCCLUSION OF CORONARY ARTERY

• Published in: Кардиоваскулярная терапия и профилактика
• Main Authors: A. V. Azarov, S. P. Semitko, М. G. Glezer, R. V. Akhramovich, A. I. Maloroev, I. S. Melnichenko, G. Yu. Atarov, A. V. Lebedev
• Format: Article
• Language: Russian
• Published: «SILICEA-POLIGRAF» LLC 2017-02-01
• Subjects: acute myocardial infarction with st segment elevation; percutaneous coronary intervention; coronary stenting
• Online Access: https://cardiovascular.elpub.ru/jour/article/view/561
• ISSN: 1728-8800; 2619-0125

Aim. To study clinical results and safety of delayed vs urgent stenting with application of modern  antithrombotic drugs  in massive coronary thrombosis  in patients  with ST-elevation acute  myocardial infarction (STEMI).Material and methods. Totally, 28 STEMI patients  included, age  52 (25-77) y.o., of those males 80% (n=23), who, during January 2014 to February 2016, in first 6-12 hours from the onset of the disease, received endovascular  treatment  with purpose  to recover adequate blood flow without urgent  stent  implanting into  infarct-related  artery.  Minimal invasive strategy with the aim to recover antegrade blood flow up to TIMI 2-3 was done for 14 (50%) patients. In all patients, after restoring of the antegrade flow, there was thrombus, visualized in artery lumen, with TIMI thrombus grade score (TTG) ≥3. Another criteria of efficacy was resolving of ST elevation by ≥50%. As antiplatelet support during the intervention all patients  received the combination of IIb/IIIa blockers  (eptifibatide) and 600 mg clopidogrel or 180 mg ticagrelor. Second coronary arteriography (CAG) was done in up to 5 days.Results. By 4,0±1,0 day, blood flow TIMI 2-3 in infarction-related artery was secure in 100% patients; there was marked decrease of the grade of target   stenosis   in  infarction-related   artery   from  77,8±10,2%   to 50,5±19,5%;  decrease by its length from 21,5±8,5  to 15,5±5,5  mm; increase  of the reference  diameter  of artery from 3,1±0,8 to 3,5±0,75 mm, and thrombosis bride by TTG — from 3,9 to 0,9. By the data from CAG, stenting of the target segment  was done in 8 (29%) patients, and in 3 (10%) stenting done based on the data from intravascular ultrasound. In 17 (61%) patients the infarction-related stenosis was non-significant. In the group of delayed stenting there was no cases  of no/slow-reflow development. At hospital stage  of management, there were no cardiovascular events in the observation group.Conclusion. In patients  with massive thrombosis  of infarction-related artery  (TTG ≥3) and  restored  antegrade coronary  flow TIMI  2-3,  the delayed stenting is a safe and effective strategy of treatment at hospital stage.