Peculiarities of diagnostics and treatment of patients with recurrent myocardial infarction

Abstract

The aim of the study was to evaluate the efficiency of invasive strategies for the treatment of 306 patients with recurrent myocardial infarction (IM) admitted to our clinic in 2003-2007. We compared the results of three approaches: various forms of transdermal coronary interventions (TDI) including delayed (24-72 hr) ones (n=30), surgical myocardial revascularization within 8-12 weeks after the onset of recurrent myocardial infarction (n=25), and conservative therapy (n=251). Overall cardiovascular lethality was estimated during 5 years in 101 patients. It was shown that recurrent myocardial infarction is a predictor of high risk of death associated, in the absence of reperfusion therapy, with high intra-hospital and long-term lethality. TDI soon after recurrent IM does not exclude possibility of its application in a later period. Various interventions including delayed ones markedly decrease the frequency of complications and lethal outcome that remains high in their absence. At the same time, severe lesions of the coronary bed in many patients with recurrent MI limit the possibility of using TDI and should be regarded as indications for planned surgical myocardial revascularization. Coronary bypass surgery after myocardial scarring prevents progress of left ventricle dysfunction, improves its contractility and increases life expectancy. Enhanced availability of reperfusion strategies in the form of TDI and/or delayed surgical myocardial revascularization opens up new possibilities for effective treatment of recurrent MI.