Late myocardial revascularization: the main causes and results of delayed hospitalization of patients

Current recommendations for the treatment of patients with acute coronary syndrome (ACS) suggest the use of early invasive tactics aimed at rapid restoration of blood flow in the coronary arteries. Despite the results of numerous studies confirming the effectiveness of this approach, surgical revascularization is performed with a significant time delay in some patients. One of the reasons for this is the patient’s untimely request for qualified medical care or the complete absence of such. The aim of the study was to evaluate the treatment results of patients with acute myocardial infarction with ST segment elevation who were admitted to the hospital 48 hours after the manifestation of pain syndrome. Materials and methods. In the framework of this study, the treatment results of 69 patients who suffered acute myocardial infarction with ST segment elevation were analyzed. The patients were divided into two groups depending on the time characteristics of hospitalization and treatment tactics. Group 1 included 24 patients who were admitted to the hospital a few days after the onset of pain. At the time of admission, the condition of all patients remained stable: there was no pain syndrome, life-threatening cardiac arrhythmias, and hemodynamic parameters were within the physiological norm. After additional diagnostic examination and verification of ischemia, all patients in this group underwent coronary angiography (CAG). Group 2 consisted of 45 patients who were initially hospitalized in the central district hospitals of the Orel and Kursk regions for symptoms of acute myocardial infarction. Due to the refusal of patients from surgical treatment. Results. Before revascularization, all patients had manifestations of various classes of angina pectoris and heart failure. After revascularization, 32 (46.4%) patients in both groups had no symptoms of angina pectoris, and 23 (33.3%) patients had no symptoms of heart failure. Clinical manifestations of angina pectoris of functional class I (FC) were observed in 21 (30.4%) patients, of FC II – in 13 (18.8%), of FC III – in 3 (4.3%) patients. Symptoms of heart failure of FC I were recorded in 30 (43.4%), FC II – in 14 (20.3%) , FC III – in 2(2.9%) patients of both groups. In most patients in both the first and second groups after the performed endovascular treatment, manifestations of angina and heart failure remained, although their severity decreased. Conclusion. Late revascularization in patients with ST-segment elevation myocardial infarction has a positive effect on myocardial contractility and reduces the functional classes of angina and heart failure.