ABSTRACT
The purpose of the study was to evaluate different methods of myocardial revascularization. Three hundred and twenty-two patients with non-stable stenocardia were divided into two groups: group one consisted of 226 patients with mono-, bi-, or tri-vascular lesion of the coronary arteries (CA), who underwent percutaneous coronary intervention (PCCI) on the symptom-related CA (128 patients) or coronary bypass surgery (CBS) without cardiopulmonary bypass (59 patients); group two consisted of 96 patients with tri-vascular lesion of CA only, who underwent CBS with cardiopulmonary bypass (CPB) (32 patients) or without CPB (52 patients). The rest patients in both groups received drug therapy. The data from the research show that PCCI on the symptom-related CA is the method of choice in most patients, including those with tri-vascular lesion. In cases with extensive isolated stenosis of anterior descendent coronary artery and chronic occlusions preference may be given to CBS without CPB. CBS with CPB is the method of choice in patients with left CA trunk stenosis and left ventricular dysfunction. In this group of patients, CBS without CPB does not lead to complete myocardial revascularization and thus does not make surgery successful.
Subject(s)
Angina, Unstable/physiopathology , Angina, Unstable/therapy , Angioplasty, Balloon, Coronary , Coronary Artery Bypass , Ventricular Dysfunction, Left/physiopathology , Adult , Aged , Angina, Unstable/complications , Angina, Unstable/surgery , Cardiopulmonary Bypass , Coronary Artery Bypass/methods , Female , Humans , Male , Middle Aged , Myocardial Revascularization/methods , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Ventricular Dysfunction, Left/etiologyABSTRACT
In order to evaluate the effectiveness of reperfusive therapy, 33 patients with right ventricular (RV) myocardial infarction (MI) were examined. Thirty-two of the RVMI patients had acute MI of inferior localization; in one case RVMI was found during postmortem examination in a patient who had anterior MI complicated by myocardial rapture. Thrombolytic therapy (TLT) was conducted in 23 patients, including 17 cases where TLT was combined with successful transcutaneous intervention (TCCI) in the infarction-associated right coronary artery (RCA) (16 cases) and anterior descending artery (ADA) (1 case). Among those patients, in 4 out of 7 TCCI was performed right after unsuccessful thrombolysis, in 7 out of 9 patients it was performed because of ischemia recurrence, and in 6 out of 7 cases it was carried out on the next day after successful thrombolysis because of subtotal RCA occlusion. In 5 cases successful TCCI in the infarction-associated coronary artery was performed during the first 3 hours, and in 3 cases it was done on the 2nd or 3d day from the onset of the disease. In 5 cases TCCI in ADA was carried out in addition to TCCI the infarction-associated RCA. Elective coronary bypass surgery with cardiopulmonary bypass was recommended in 6 cases. Lethal outcome took place in 2 patients who had undergone TLT within the first hours after admission. Early detection of ST segment elevation in the right thoracic leads in patients with inferior MI allows for timely diagnosis of RVMI and choice of correct therapeutic strategy. Successful thrombolysis should not be considered completed reperfusive therapy. TLT in this category of patients is accompanied by high frequency of ischemia recurrence, which is connected with critical lesion RCA and ADA, which participate in RV blood supply with collateral vessels. The success of primary and deferred TCCI in the infarction-associated, including patients after TLT, shows that invasive interventions in such patients are methods of choice; they provide the completeness of reperfusive therapy and improve the course and prognosis of the disease significantly.
