The effectiveness of reperfusion therapy of myocardium infarction under different organization of functioning of roentgen-endovascular service: five-year observation

Abstract

The study was carried out to implement comparative estimate of effectiveness of reperfusion therapy of myocardium infarction with elevation of segment ST under various organization of functioning of Z-Ray endovascular service in conditions of single clinic. The study included all patients with frontal myocardium infarction with elevation of segment ST (n=997) applied during two periods: 2003-2007 (n=446) and 2008-2011 (n=551). In period I, service was represented by department of x-Ray endovascular diagnostic and treatment of ischemic heart disease in the department of emergency cardiology. In mode of 8 hours’ workday 155 (34%) various types of x-Ray endovascular coronary interventions were implemented. At that, predominantly postponed (after 24-72 hours after inception of myocardium infarction) and at initially increased risk of death. In period II, service was represented by x-Ray surgery department of large profile functioning in twenty-four-hours mode. In these conditions, 400 (72%) x-Ray endovascular coronary interventions were implemented. The comparison group comprised patients with myocardium infarction and without x-Ray endovascular coronary intervention (n=442). The received data testifies advantage of x-Ray endovascular coronary service organized at the basis of emergency cardiology. It became model for successful application of x-Ray endovascular coronary interventions, development of new reperfusion, optimization of treatment process. The success of x-Ray endovascular coronary interventions under myocardium infarction with elevation of segment ST determines by combined characteristics of reperfusion by way of accelerated evolution of indices of ECG directly following restoration of blood flow in infarction-related artery. The conserved elevation of of segment ST is associated with worse prognosis. The angiography evaluation is subjective and it cannot reflect achievement of myocardial reperfusion. At the same time, at restoration of blood flow in infarction-related artery without convincing signs of reperfusion the prognosis is better than in case of conservative treatment.