Early Complications of Interventional Procedures in the Recanalization of Occlusion of Coronary Arteries in Patients with Acute Myocardial Infarction

The purpose of this work was to study the immediate results and complications of X-ray and endovascular recanalization of coronary arteries in patients with acute myocardial infarction (AMI). Material and methods. The survey included 626 patients with AMI. In the course of study we carried out diagnostic and therapeutic interventional procedures concerning to this pathology on the basis of the angiographic department of the N. Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine. The age of patients ranged from 62 to 73 years old (average age was 66.96±1.81). The area of left ventricular myocardium damage in the QRS-index calculating was 20.4±1.2%. 332 patients underwent primary percutaneous transluminal balloon angioplasty (PTBA) of the infarct-related artery (IRA) in the early stages of myocardial infarction (MI) development, and 294 patients underwent stenting of IRA with single stent implantation into different coronary arteries. The total number of implanted stents was 415 (1.4±0.3 per patient on average). Results and discussion. As a result, we noticed that the number of reported complications after the primary PTBA was 9.6% of cases. At the same time, the rates of hospital mortality were 2.1% of cases. Patients after PTBA showed a positive correlation between the development of dissection and the extent of the target stenosis, the presence of calcification of the target segment and "C" type of lesion of the target segment. There was a dissection of intima CA in 11 patients after predilatation before stent implantation and 3 after direct stent implantation. Those cases required the implantation of an additional stent. The appearance of a severe anginatic attack on the next day after successful stenting of PKA, accompanied by changes in ECG, was recorded in 5 patients. On the fourth day, such cardiological complications were noted in 3 patients who had stenting PMHG. In control coronary artery we detected artery occlusion in all cases at the level of the previously implanted stent. Thus, the total number of the above mentioned complications was registered in 59 patients (20.1% of cases), 7.8% (23 patients) of whom had an additional stent. There was an emergency coronary artery bypass surgery in 3 patients (1.02%). The fatal outcome was registered 15 patients (5.1% of cases). The unsatisfactory procedural result was registered in 8.5% of the cases (25 patients) among patients with AMI who had stented an occluded heart attack-related CA. Conclusions. There was a positive correlation between the fact of dissection development and the extent of target stenosis, the presence of calcinosis of the target segment, and "C" type of defeat of the target segment in patients after PTBA. In the group of patients with balloon angioplasty of the IPA, a correlation between the development of reocclusion and residual stenosis of CA was found to be more than 30%, the C-F type dissection (according to ACC / ANA classification), PV <40% and the percentage of initial stenosis before PTBA. The highest percentage of deaths 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 IRA.