| Autor: |
Fokin AA; Railway Clinical Hospital at the Chelyabinsk Station of the Open Joint-Stock Company 'Russian Railways', Chelyabinsk, Russia; South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia., Kireev KA; Railway Clinical Hospital at the Chelyabinsk Station of the Open Joint-Stock Company 'Russian Railways', Chelyabinsk, Russia; South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia., Mikhaĭlov EV; Railway Clinical Hospital at the Chelyabinsk Station of the Open Joint-Stock Company 'Russian Railways', Chelyabinsk, Russia; South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia. |
| Abstrakt: |
The purpose of the study was to objectively assess lethal outcomes in patients with the final diagnosis of 'ST-segment elevation acute myocardial infarction' (STEAMI) in order to reveal the circumstances and peculiarities of an unfavourable outcome. The work was performed on the basis of the medical records over 2014-2016, retrospectively analysing cases of STEAMI: a total of 131 lethal outcomes regardless of reperfusion therapy and 1,004 patients having survived after percutaneous coronary intervention (PCI). The data statistically significantly (p<0.05) distinguishing lethal outcomes were as follows: prevalence of female patients - 59.5%; transmural myocardial lesion - 90.1%; recurrent myocardial infarction - 32.1%; a history of functional class I-III angina of effort - 31.3%; a high average value of acute heart failure according to T. Killip classification - 2.4±0.2; cardiogenic shock - 30.6%; high frequency of previously endured acute cerebral circulatory impairments - 9.9%, a history of type 2 diabetes mellitus - 32.8% and degree I-III obesity - 35.1%. Amongst the deceased patients with AMI complicated by postinfarction cardiosclerosis and preexisting FC I-III angina of effort there was a low proportion of coronary angiography (CAG) (8.4%) and coronary operations (6.9%) previously performed. Also registered was a low frequency of reperfusion treatment (45.8%), which was associated with early mortality (within the first 2 hours of admission - 51.9%, within 3 to 24 hours - 16.8%). A decrease in efficacy of the interventions performed was influenced by syndromes of slow or absent blood flow (20.7% of PCI), as well as a multivessel haemodynamically significant lesion of three and more coronary arteries (56.2% of the CAGs performed). The obtained data concerning concomitant pathology and the condition are used to draw up a portrait of a patient jeopardised by a lethal outcome associated with AMI. These factors should be taken into consideration at the outpatient stage for a more active reperfusion policy aimed at preventing AMI. |
