PROGNOSTIC VALUE OF POLYVASCULAR ARTERY DISEASE AND SECOND REVASCULARIZATION PHASE IN TREATMENT OF PATIENTS WITH MYOCARDIAL INFARCTION

Purpose. To evaluate the impact of polyvascular artery disease (PolyVD) and the timing of the second revascularization phase on the treatment results in patients with ST elevation myocardial infarction (STEMI).

Materials and methods. During the hospital stay 227 patients had screening ultrasound of the aortic arch branches and lower extremity arteries performed. The patients were classified according to the presence or absence of PolyVD, which refers to the presence of extracardiac artery stenosis ≥ 30 % (lower limb arteries and \ or extracranial arteries). The first group consisted of patients with STEMI, multivessel coronary disease and PolyVD, who underwent primary PCI (n = 63) (STEMI + IPA), the second group consisted of similar patients without IPA (n = 164) (STEMI). Each of the groups was further subdivided into two subgroups: the second phase of coronary revascularization ≤ 60 days after primary PCI and > 60 days after primary PCI.

Results. Preventive revascularization was performed in 84 patients from Group 1 by the cardiac catheterization findings. The overall mortality rate was 4,62 % for Group 1 and 34,15 % for Group 2 (p < 0,001). The factors, increasing the overall mortality rate in both groups, were identified by the univariate analysis: disease course without preventive revascularization, age, peripheral artery interventions, perioperative complications (p < 0,05). The factors reducing the mortality rate were preoperative cardiac catheterization, carotid surgery, β-blockers, ACE inhibitors, aspirin (p < 0,05). The independent risk factors increasing the overall mortality rate were disease course without preventive revascularization, age, perioperative complications (p = 0,05).

Conclusion. Screening detection of extracranial artery disease and lower extremity artery disease is a necessary component in the management of patients with STEMI and multivessel disease undergoing primary PCI. In case of peripheral artery stenosis ≥ 30 % detection the second stage of coronary revascularization is required within no more than 60 days after primary PCI.

1. Значимость мультифокального атеросклероза для модификации шкалы риска отдаленной смертности GRACE у больных острым коронарным синдромом с подъемом сегмента ST / М. В. Зыков [и др.] // Атеросклероз. 2012. № 2. С. 11–17.

2. Шафранская К. С., Казачек Я. В., Кашталап В. В. Частота развития неблагоприятных сердечно-сосудистых событий у пациентов с мультифокальным атеросклерозом различной степени выраженности, подвергшихся коронарному шунтированию // Медицина в Кузбассе. 2011. № 3. С. 40–44.

3. ACC/AHA guidelines for the management of patients with unstable angina and non ST-elevation myocardial infarction: Executive summary and Recommendations. A report of the American College of Cardiology / American Heart Association task force on practice guidelines (committee on management of patients with unstable angina) / E. Braunwald [et al.] // Circulation. 2000. Vol. 102. P. 1193–1209.

4. Cavender M. A., Milford-Beland S., Roe M. T. Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). // Am. J. Cardiol. 2009. Vol. 104, № 4. Р. 507–513.

5. Guidelines and Indications for Coronary Artery Bypass Graft Surgery. A Raport of the American Heart Association / American College of Cardiology Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Coronary Artery Bypass Graft Surgery) / J. W. Kirklin [et al.] // J. Am. Coll. Cardiol. 1991. Vol. 17. P. 543–560.

6. Impact of clinical and subclinical peripheral arterial disease in mid-term prognosis of patients with acute coronary syndrome / P. Morillas [et al.] / /Am. J. Cardiol. 2009. Vol. 104, № 11. Р. 1494–1498.

7. Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients / H. Suryapranata [et al.] // Heart. 2005. Vol. 91, № 5. Р. 641–645.

8. Jeger R. V., Pfisterer M. E. Primary PCI in STEMI – dilemmas and controversies: multivessel disease in STEMI patients. Complete versus Culprit Vessel revascularization in acute ST- elevation myocardial infarction // Minerva Cardioangiol. 2010. Vol. 87. P. 28–38.

9. Magnitude of and Risk Factors for In-Hospital and Postdischarge Stroke in Patients With Acute Coronary Syndromes. Findings From a Global Registry of Acute Coronary Events / A. Budaj [et al.] // Circulation. 2005. Vol. 111. Р. 3242–3247.

10. The general prognosis of patients with peripheral artery disease differs according to the disease localization / V. Aboyans [et al.] // J. Am. Coll. Cardiol. 2010. Vol. 55. Р. 898–903.

11. Toma, M. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial // Eur. Heart J. 2010. Vol. 8. Р. 1172–1177.

12. Word Health Organization. The Word Health Report: conquering, suffering, enriching humanity. Geneva: Word Health Organization, 2005. P. 53–57.