Miokardo reperfuzijos adekvatumo po pirminės perkutaninės transliuminės vainikinių arterijų angioplastikos ir stentavimo palyginimas

Edvardas Vaicekavičius, Virgilijus Grinius, Ramūnas Navickas, Ramūnas Unikas, Arnoldas JanavičiusKaunas University of Medicine, Institute of CardiologyE-mail: [email protected] Background / objective Reperfusion may limit the amount of potentially salvageable ischemic but viable myocardium due to reperfusion damage and injury. The objective of this study was to compare primary percutaneous transluminal coronary angioplasty (PTCA) with stenting according myocardial reperfusion quality in early hospital period. Methods One hundred nineteen patients presenting with acute myocardial infarction < 12 hours were treated by primary PTCA or stenting (n = 26). PTCA patients (n = 93) were divided in to 1st group (n = 75) of survived and 2nd group (n = 18) of died patients. Stented patients consisted 3rd gr. (n = 26). The main indications for stenting after angioplasty were: 1) significant (type D, E, or F) dissection of coronary arteries, 2) significant elastic recoil. Peri-procedural TIMI flow, resolution of ST elevation and evolution of ECG stages were used for assessment of reperfusion quality. QRS score and left ventricle EF were used for assessment of LV function. Results The highest TIMI flow, the most intensive resolution of ST, the evolution of ECG stages and the lowest QRS score were noticed for 3rd gr. of stented patients. The died patients (2nd gr.) had lower TIMI flow (p = 0,097472), higher ST (p = 0,0073) and lower EF (p = 0,0005) in comparing with the 1st gr. of patients. Conclusions The procedural in-hospital outcome demonstrate that coronary stenting can be used as the primary modality for patients undergoing coronary interventions for acute myocardial infarction, increasing TIMI flow myocardial, reducing reperfusion damage and infarct size. Keywords: myocardial infarct reperfusion, myocardial infarct size, primary percutaneous transluminal coronary angioplasty and stenting

Stents in interventional cardiology

Since the first percutaneous transluminal coronary angioplasty performed by A. Gruentzig in 1977, percutaneous coronary interventions have become the most important treatment modality for coronary heart disease. Coronary angioplasty carried a significant risk of coronary flow-limiting dissections and restenosis during the first six months following the procedure. Two main studies comparing percutaneous transluminal coronary angioplasty and coronary stenting (STRESS and BENESTENT) performed in 1994 showed a significant reduction in restenosis rate using stents. Thus, until now stents are the most widely used devices for coronary intervention despite two problems: subacute stent thrombosis (1–2%) and still high restenosis rate (5–40%). Subacute stent thrombosis occurs within the first month after stent placement and can be prevented using the double antiplatelet regimen with aspirin and clopidogrel. Some risk of subacute thrombosis remains beyond the first month when drug-eluting stents are used. This requires prolonged antiplatelet therapy. Drugeluting stents are the most significant innovation in interventional cardiology. They can reduce the incidence of restenosis in native stable coronary arteries to 3–5%. However, the long-term studies comparing bare-metal stents and drug-eluting stents did not show any significant differences in the rate of major adverse cardiac events (death, myocardial infarction), especially in patients with diabetes after the treatment of bifurcational lesions. According to proposed recommendations, drug-eluting stents should be used in small vessels, restenotic lesions, and in saphenous vein grafts. Despite some disadvantages, the results of coronary stenting using drugeluting stents continue to improve