EXPERIENCE WITH PRIMARY CORONARY ANGIOPLASTY IN MANAGEMENT OF PATIENTS SUFFERING FROM ACUTE MYOCARDIAL INFARCTION

Maslov L.N., Krylov A.L.
Federal Facility Research Institute of Cardiology, Tomsk Scientific Centre,
Siberian Branch of the Russian Academy of Medical Sciences,
Tomsk, Russia

The authors herein analysed the findings obtained in randomized studies carried out to compare the efficacy of percutaneous transluminal coronary angioplasty (hereinafter referred to as PTCA) and thrombolytic therapy for acute myocardial infarction (AMI). Some studies employed thrombolytic therapy with streptokinase, while others used plasminogen tissue activators as thrombolytic agents. Primary PTCA as compared with thrombolysis was noted to decrease the total lethality rate, lowering mortality related to cardiogenic shock, decreasing lethality amongst elderly and aged patients, decreasing the prevalence of stroke and secondary infarctions, as well as the incidence of repeat revascularizations. The obtained findings demonstrated that primary PTCA still remains a better means of management of patients with AMI as compared with thrombolytic therapy, irrespective of the thrombolytic agent used. The longterm forecasts in primary PTCA and coronary artery bypass are similar, with the average hospital stay in PTCA being, however, shorter as compared with that in coronary artery bypass and thrombolytic therapy. Hence, the authors came to a conclusion that primary PTCA is a more efficient method of management of AIM patients than thrombolytic therapy or coronary artery bypass.

We also analysed the findings of randomized studies aimed at comparing the efficacy of primary balloon dilatation and stenting of the infarctionassociated coronary artery, and came to a conclusion that primary stenting makes it possible to more efficiently, than balloon angioplasty, revascularize the infarctionaffected myocardium, since stenting decreases the incidence rate of relapsing secondary revascularizations as compared with primary balloon dilatation. However, stenting possesses no advantages over angioplasty as regards the influence on the incidence rate of lethal outcomes and secondary myocardial infarctions. Using the syrolimuscontaining stents may improve the longterm prognosis in patients presenting with AMI.

Preliminary administration of absiximab was observed to decrease the lethality rate amongst the patients subjected to primary angioplasty during the first 30 days following the development of AMI, exerting however no influence on the lethality rate during one year after the onset of AMI. Intravenous administration of ?adrenoblockers as compared with primary angioplasty improves survival in AMI patients. Aspirin treatment before and after primary angioplasty appears to improve the remote prognosis following PTCA as compared with the patients having received no aspirin. We believe that betaadrenoblockers and aspirin should be used in management of patients having undergone angioplasty of the infarctionassociated coronary artery.

KEY WORDS: acute myocardial infarction, primary coronary angioplasty, thrombolysis, stents, syrolimus.

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