ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 15 of 60
JMBS 2019, 4(6): 104–109
Clinical Medicine

X–Ray – Endovascular Procedures on the Background of Acute Myocardial Infarction

Aksenov E. V.

The work deals with the study of direct results and complications of X–ray–endovascular recanalization of coronary arteries in patients with acute myocardial infarction. Material and methods. The study included 626 patients with acute myocardial infarction who underwent diagnostic and medical intervention procedures for this pathology at the department of X–ray–surgical methods of diagnostic and treatment of heart and vascular diseases National Institute of Cardiovascular Surgery named M. M. Amosov NAMS of Ukraine. The age of patients ranged from 62 to 73 years (on average 66.96±1.81 years). The area of myocardial infarction of the left ventricle in the calculation of the QRS index was on average 20.4±1.2%. Results and discussion. The average time for patients to enter the department from the onset of symptoms of acute myocardial infarction was 115.4±37.4 minutes. The area of the left ventricular myocardium lesion when calculating the QRS index averaged 20.4±1.2%. We determined II functional class heart failure according to T. Killip in 438 patients (69.97%) upon admission. 332 patients underwent an initial percutaneous transluminal balloon angioplasty of the infarct–linked artery in the early stages of myocardial infarction development, and 294 patients had a stenting of infarct–linked artery with one–dimensional implantation of stents in different coronary arteries. The total number of implanted stents was 415 (on average of 1.4±0.3 per patient). As a result, we found out that the direct (technical) angiographic success of the balloon angioplasty of the infarct–linked artery was 90.4% of the cases. A good angiographic result in performing stenting was achieved in 96.6% of cases. At the same time, the procedural success with repeated interventions was 91.5%, and a good clinical outcome was noted in 86.7% of patients. The frequency of manifestations of “minor complications” (hemodynamically insignificant violations of the heart rhythm, subcutaneous hematoma at the puncture site, skin allergic reactions to drugs) amounted to 1% – 2% of the total number of procedures. Ventricular fibrillation was recorded in 8 operated patients (2.7% of cases) during stent implantation in the right coronary artery. Dissection of the coronary artery intima occurred in 11 patients during pre–implantation before stent implantation and in 3 after direct stent implantation, which required the installation of an additional stent. The phenomenon of "no–reflow" was observed in 20 (6.8%) cases. In 3 (1.02%) cases in the early postoperative period, there was a rupture of the calcified trunk of the left SC, which led to death. Perforation of the coronary artery occurred in 6 (2.04%) cases, which in one case led to hemopericardium. Conclusion. The total number of complications during stenting of infarct–linked artery was registered in 59 patients (20.1% of cases) with the development of fatal outcome in 5.1% of cases (15 patients). The highest percentage of fatal cases was observed in patients who had clinically confirmed myocardial ischemia for more than 90 minutes after the onset of thrombolysis followed by an emergency stenting of the infarct–linked artery.

Keywords: coronary stenting, acute myocardial infarction

Full text: PDF (Ukr) 266K

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