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Myocardial revascularization in recurrent infarction with low ejectionfraction

Abstract

The Purpose. Improving the efficiency of treatment of patients with recurrent MI, including without ST-segment elevation with a low left ventricular ejection fraction (LVF), by expanding indications for the use of primary PCI, regardless of the timing of admission. The study included 743 patients with recurrent MI with a left ventricular ejection fraction (LV EF) < 45 % aged 31 to 95 years treated at the institute from 2008 to 2017 year. Primary PCI in up to 72 hours was performed in 373 patients. The comparison group consisted of 370 patients on drug therapy. Surgical myocardial revascularization was performed in 90 patients 1-6 months after repeated MI. Hospital and late cardiovascular mortality fin/e years after PCI was 8 and 6 %, in the comparison group - 16 and 61 %, in patients with surgical myocardial revascularization - 2.2 and 3.0 %, respectively. From the data obtained it follows that conservative treatment of recurrent myocardial infarction is unpromising. The severity of coronary disease and severe LV dysfunction increase the risk of reperfusion strategies. However, the use of primary PCI, including urgently delayed late admission, prevents the progression of LV dysfunction, the development of complications and deaths. Upon completion of the evolution of recurrent MI, the main method is surgical treatment. Complete myocardial revascularization increases the contractile function of the LV, prevents coronary events. The futility of drug therapy justifies the increased risk of reperfusion treatment strategies.

About the Authors

G. A. Gazaryan
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


M. N. Zhizhina
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


L. G. Tyurina
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


G. A. Nefyodova
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


D. A. Chepky
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


M. V. Parkhomenko
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


M. A. Sagirov
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


M. Kh. Mazanov
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


S. Yu. Kambarov
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


A. S. Ermolov
Research Institute of Emergency Care n.a. N. V. Sklifosovsky
Russian Federation


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Review

For citations:


Gazaryan G.A., Zhizhina M.N., Tyurina L.G., Nefyodova G.A., Chepky D.A., Parkhomenko M.V., Sagirov M.A., Mazanov M.Kh., Kambarov S.Yu., Ermolov A.S. Myocardial revascularization in recurrent infarction with low ejectionfraction. Medical alphabet. 2018;4(37):44-47. (In Russ.)

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ISSN 2078-5631 (Print)
ISSN 2949-2807 (Online)