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Кардиология

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Сравнение прямого стентирования и стентирования с предилатацией у пациентов с острым инфарктом миокарда с подъемом сегмента ST

https://doi.org/10087/cardio.2017.11.10048

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Аннотация

Aim. To study was to assess in-hospital outcomes of direct coronary stenting (DS) compared with stenting after predilation (PD) in patients with ST-elevation myocardial infarction (STEMI). Material and methods. Data were collected from all patients (n=1103) with STEMI subjected to primary PCI in Tyumen cardiology center from 2006 to 2014. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of no-reflow phenomenon were analyzed. The composite of in-hospital death, myocardial infarction (MI) and stent thrombosis were defined as major adverse cardiac events (MACE). Results. Altogether 563 patients (51%) underwent DS, and in 540 (49%) stents were implanted after PD. Patients in DS group compared with those in PD group were younger (57.9±10.9 vs 60±11.5 years; p=0.001), less often had chronic kidney disease (5.2 vs 8.4%; р=0.034), more often recieved prehospital thrombolysis (25 vs 11.9%; p<0.001). Rates of diabetes mellitus (16.1 vs 17.5%; р=0.522), and history of MI (15.5 vs 18.7%; р=0.162), time from onset symptoms to diagnosis (120 [73; 205] min и 120 [65.5; 239.5] min; р=0.289) were comparable between groups. Patients of DS group less often had occluded culprit arteries (47.4 vs 84.3%; p<0.001) and multivessel coronary artery involvement (23.8 vs 34.4%; p<0.001). There were no differences in rates of stent thrombosis (1.2 vs 2.8%; p=0.068) and repeat MI (1.4 vs 1.9%; p=0.572). Rates of angiographic success (95.7 vs 90%; р<0.001), death (2.5 vs 5.4%; p=0.013), MACE (6.7 vs 11.3%; p=0.008), as well as no-reflow (2.2 vs 7.4%; p<0.001) were significantly lower in the DS group. After multivariate adjustment, PD was associated with no-reflow [odds ratio 3.39; 95% confidence interval 1.83-6.28; p<0.001]. Conclusion. DS in STEMI is safe and effective and should be used in all cases when it is possible. PD is an independent predictor of no-reflow phenomen on during PCI.

Об авторах

И. С. Бессонов
«Тюменский кардиологический научный центр», «Томский национальный исследовательский медицинский центр РАН»
Россия


В. А. Кузнецов
«Тюменский кардиологический научный центр», «Томский национальный исследовательский медицинский центр РАН»
Россия


И. П. Зырянов
«Тюменский кардиологический научный центр», «Томский национальный исследовательский медицинский центр РАН»
Россия


С. С. Сапожников
«Тюменский кардиологический научный центр», «Томский национальный исследовательский медицинский центр РАН»
Россия


Ю. В. Потолинская
«Тюменский кардиологический научный центр», «Томский национальный исследовательский медицинский центр РАН»
Россия


Т. И. Зырянова
ФГБОУ ВО «Тюменский государственный медицинский университет» Минздрава РФ
Россия


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Для цитирования:


Бессонов И.С., Кузнецов В.А., Зырянов И.П., Сапожников С.С., Потолинская Ю.В., Зырянова Т.И. Сравнение прямого стентирования и стентирования с предилатацией у пациентов с острым инфарктом миокарда с подъемом сегмента ST. Кардиология. 2017;57(11):5-11. https://doi.org/10087/cardio.2017.11.10048

For citation:


Bessonov I.S., Kuznetsov V.A., Zyrianov I.P., Sapozhnikov S.S., Potolinskaya J.V., Zyrianova T.I. Comparison of Direct Stenting Versus Stending After Pre-Dilation in ST-Elevation Myocardial Infarction. Kardiologiia. 2017;57(11):5-11. (In Russ.) https://doi.org/10087/cardio.2017.11.10048

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ISSN 0022-9040 (Print)
ISSN 2412-5660 (Online)