БЛИЖАЙШИЕ И ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ РАЗЛИЧНЫХ СТРАТЕГИЙ ЛЕЧЕНИЯ БОЛЬНЫХ С КРУПНООЧАГОВЫМ ПОВТОРНЫМ ИНФАРКТОМ МИОКАРДА

Aim of study: to assess the effectiveness of invasive treatment strategies in patients with repeated myocardial infarction (rMI). We compared results of three treatment strategies in 453 patients with rMI admitted to the Institute from 2003 to 2011 and analyzed long-term results (up to 2016): 139 roentgen-endovascular coronary interventions (RECI) (various types), including the delayed procedures (performed 24–72 h later), 25 surgical myocardial revascularizations 8–12 weeks after the onset of rMI and 289 cases of conservative therapy. Cardiovascular mortality had been assessed in 138 patients with different treatment strategies for 5 years after the discharge.Findings show that rMI is a predictor of high risk of death associated with high in-hospital and longterm mortality in the absence of reperfusion therapy. RECI in the early stages of rMI does not exclude its later performance. Different types of interventions, including the delayed ones, significantly reduce the incidence of complications and deaths, which occurence remains high in the absence of interventions. however, in a significant portion of patients with rMI, the severity of coronary lesions limits the possibility of RECI performance, determining indications for elective surgical myocardial revascularization. Coronary artery bypass surgery performed after myocardial scarring prevents the growth of left ventricular dysfunction, improves its contractile function, and prolongs the life of patients. Reperfusion strategies such as various types of RECI and/or delayed surgical myocardial revascularization improve the effectiveness of treatment in patients with rMI.Цель исследования: оценка эффективности инвазивных стратегий лечения больных с повторным инфарктом миокарда (пИМ). Проведено сопоставление результатов трех стратегий лечения 453 больных с пИМ, госпитализированных в институт с 2003 по 2011 г. с анализом отдаленных результатов до 2016 г.: различных видов рентгенэндоваскулярных коронарных вмешательств (РКВ), включая отсроченные, выполненные через 24–72 ч (n=139) от начала ИМ; хирургической реваскуляризации миокарда через 8–12 нед от начала пИМ (n=25) и консервативной терапии (n=289). В течение 5 лет после выписки у 138 больных с различными стратегиями лечения оцени- вали общую летальность, в том числе от сердечно-сосудистых заболеваний.Полученные данные свидетельствуют о том, что пИМ является предиктором высокого риска смерти, связанного с отсутствием реперфузионной терапии с высокой госпитальной и отдаленной летальностью. Установлено, что РКВ в ранние сроки пИМ не исключает возможности более позднего их применения. Отсроченные вмешательства существенно сокращают частоту осложнений и смертельных исходов. Вместе с тем, у значительной части больных с пИМ тяжесть поражения коронарного русла ограничивает возможности применения РКВ, определяя показания к хирургической реваскуляризации миокарда. Шунтирование коронарных артерий, выполненное после рубцевания миокарда, предотвращает нарастание дисфункции левого желудочка, улучшает его сократительную функцию и увеличивает продолжительность жизни больных. Применение реперфузионных стратегий в виде различных видов РКВ, в том числе отсроченных и/или хирургической реваскуляризации миокарда позволяет повысить эффективность лечения больных с пИМ

UDC 547

Abstract Known laboratory-scale and industrial methods are reviewed therein concerning the production of one of the most important vulcanization accelerators such as kaptax (2-mercaptobenzothiazol) those are based on modifying the substituents in the thiazol ring and synthesizing from acyclic precursors. The latter include also the main industrial method of obtaining kaptax based on the reaction between aniline, sulphur and carbon disulphide dangerous from the environmental point of view. Potentialities are demonstrated concerning the development of methods for producing kaptax without using carbon disulphide, which would significantly improve the environment safety of the process

IMMEDIATE AND LONG-TERM RESULTS OF VARIOUS TREATMENT STRATEGIES FOR PATIENTS WITH MACROFOCAL RECURRENT MYOCARDIAL INFARCTION

Aim of study: to assess the effectiveness of invasive treatment strategies in patients with repeated myocardial infarction (rMI). We compared results of three treatment strategies in 453 patients with rMI admitted to the Institute from 2003 to 2011 and analyzed long-term results (up to 2016): 139 roentgen-endovascular coronary interventions (RECI) (various types), including the delayed procedures (performed 24–72 h later), 25 surgical myocardial revascularizations 8–12 weeks after the onset of rMI and 289 cases of conservative therapy. Cardiovascular mortality had been assessed in 138 patients with different treatment strategies for 5 years after the discharge.Findings show that rMI is a predictor of high risk of death associated with high in-hospital and longterm mortality in the absence of reperfusion therapy. RECI in the early stages of rMI does not exclude its later performance. Different types of interventions, including the delayed ones, significantly reduce the incidence of complications and deaths, which occurence remains high in the absence of interventions. however, in a significant portion of patients with rMI, the severity of coronary lesions limits the possibility of RECI performance, determining indications for elective surgical myocardial revascularization. Coronary artery bypass surgery performed after myocardial scarring prevents the growth of left ventricular dysfunction, improves its contractile function, and prolongs the life of patients. Reperfusion strategies such as various types of RECI and/or delayed surgical myocardial revascularization improve the effectiveness of treatment in patients with rMI