INFLUENCE OF RETHROMBOSIS OF INFARCTION-RELATED ARTERY AFTER THROMBOLYSIS ON SHORTEST TERM AND LONG TERM PROGNOSIS OF ST ELEVATION MYOCARDIAL INFARCTION

Aim. Revealing of the relations of primary (mortality, new cardiovascular events) and secondary (life quality) endpoints with the stability of blood flow restoration after thrombolytic therapy (TLT).

Material and methods. Totally, 117 patients included, hospitalized at 1st day of ST elevation myocardial infarction (STEMI) onset, underwent successful by electrocardiographic criteria TLT. At the 3-24 hours interval from the end of TLT, coronary arteriography and angioplastic were done. Patients were selected to two groups: no rethrombosis (ReT-) and rethrombosis (ReT+). Endpoints and life quality were assessed in 1 month (visit M1) and 12 months (M12) after inclusion. For life quality the Seattle questionnaire was used.

Results. At M1 visit, katamnesis was evaluated in 115 (98,3%) patients — n=82 from ReT-, and n=33 from ReT+. Three patients died, with no significant differences between groups. In ReT+ patients there was lower physical activity found, than in ReT- and angina attacks were more often (р=0,04). At M12 visit the results from 101 (86,3%) patients were analyzed: 72 from ReT- and 29 from ReT+ groups. Mortality in ReT+ (13,8%) was higher than in ReT- (1,4%); HR =9,9; CI [1,2; 85,1]. In both groups there was decrease of adherence to treatment (p<0,01) for all drugs classes, except aspirin. In ReT+ patients repeated MI were more often — 16,7% vs 3,3%; HR =5,3; CI [1,1; 25,9]. Patients from ReT- group at M12 evaluated their condition as more stable than at M1 (p<0,01), however there was decreased exercise tolerance (p<0,01) and decreased treatment satisfaction (р<0,01). In ReT+ group satisfaction by treatment declined (p<0,01).

Conclusion. During the year after STEMI, there is decline in treatment adherence and worsening of life quality. In patients after coronary rethrombosis this is associated with increased risk of repeated MI and annual mortality.

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