THE RESULTS OF DELAYED ENDOVASCULAR INTERVENTION IN ST ELEVATION ACUTE MYOCARDIAL INFARCTION DUE TO THROMBOTIC OCCLUSION OF CORONARY ARTERY

Aim. To study clinical results and safety of delayed vs urgent stenting with application of modern  antithrombotic drugs  in massive coronary thrombosis  in patients  with ST-elevation acute  myocardial infarction (STEMI).

Material and methods. Totally, 28 STEMI patients  included, age  52 (25-77) y.o., of those males 80% (n=23), who, during January 2014 to February 2016, in first 6-12 hours from the onset of the disease, received endovascular  treatment  with purpose  to recover adequate blood flow without urgent  stent  implanting into  infarct-related  artery.  Minimal invasive strategy with the aim to recover antegrade blood flow up to TIMI 2-3 was done for 14 (50%) patients. In all patients, after restoring of the antegrade flow, there was thrombus, visualized in artery lumen, with TIMI thrombus grade score (TTG) ≥3. Another criteria of efficacy was resolving of ST elevation by ≥50%. As antiplatelet support during the intervention all patients  received the combination of IIb/IIIa blockers  (eptifibatide) and 600 mg clopidogrel or 180 mg ticagrelor. Second coronary arteriography (CAG) was done in up to 5 days.

Results. By 4,0±1,0 day, blood flow TIMI 2-3 in infarction-related artery was secure in 100% patients; there was marked decrease of the grade of target   stenosis   in  infarction-related   artery   from  77,8±10,2%   to 50,5±19,5%;  decrease by its length from 21,5±8,5  to 15,5±5,5  mm; increase  of the reference  diameter  of artery from 3,1±0,8 to 3,5±0,75 mm, and thrombosis bride by TTG — from 3,9 to 0,9. By the data from CAG, stenting of the target segment  was done in 8 (29%) patients, and in 3 (10%) stenting done based on the data from intravascular ultrasound. In 17 (61%) patients the infarction-related stenosis was non-significant. In the group of delayed stenting there was no cases  of no/slow-reflow development. At hospital stage  of management, there were no cardiovascular events in the observation group.

Conclusion. In patients  with massive thrombosis  of infarction-related artery  (TTG ≥3) and  restored  antegrade coronary  flow TIMI  2-3,  the delayed stenting is a safe and effective strategy of treatment at hospital stage.

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