Features of changes in cumulative survival of patients with acute coronary syndrome presenting without elevation of ST segment, who underwent percutaneous coronary interventions at various periods from the onset of symptoms

Abstract

The aim – to evaluate the effect of myocardial revascularization performed on patients with acute coronary syndrome without persistent ST-segment elevation (NSTE-AMI) at different times from the onset of symptoms, on ultrasound of left ventricular contractility (LV) and on the functional class of angina after 12 months of follow-up of these patients.
Materials and methods. Patients with acute myocardial infarction (AMI) without persistent ST-segment elevation (NSTEMI) enrolled in the study (n=128) were divided into groups according to the time of revascularization (urgent or planned revascularization) and the method of revascularization (coronary stenting or shunting) on 5 groups, including the group of NSTEMI patients who did not undergo stenting. Group 1 consisted of patients (n=28) who underwent urgent coronary angiography and ad hoc stenting in the first 72 hours after the onset of symptoms. Group 2 included patients (n=61) who underwent coronary angiography and stenting routinely after 72 hours or more (up to several months of onset of symptoms). Group 3 included patients (n=12) who underwent routine coronary artery bypass grafting. Group 4 consisted of patients (n=27) who did not undergo revascularization after coronary angiography («control group»). And, finally, the 5th group, which consisted of patients of the above groups (n=101), who underwent any revascularization.
Results and discussion. The effectiveness of treatment and the incidence of serious coronary events in NSTEMI patients significantly depend on the availability of percutaneous and surgical revascularization techniques in the treatment program. Supplementation of the revascularization procedure significantly improves the prognosis, significantly reduces the combined rate of MACE during the observation period of patients (up to 48 months) compared with the control group (p=0.000001).
A direct comparison of the group of urgent coronary stenting (within 72 hours from the onset of symptoms) of NSTEMI patients with GRACE Score > 140 points, revealed a significant difference in the number of serious cardiovascular events at 48 months of follow-up (p<0.05), compared with the control group GRACE Score > 140.
Conclusions. Long-term stenting results of NSTEMI patients at high risk of complications (emergency stenting group) did not take precedence over the results of treatment of stable NSTEMI patients (planned stenting group) after their effective stabilization on the background of optimal drug therapy. When comparing the MACE of these two groups, a weakly significant advantage (p<0.05) was found in the group of stabilized patients, which fully confirms the strategy of stratification of patients with unstable coronary blood flow to groups at risk of complications. However, urgent interventions are absolutely indicated for patients at high risk of complications in the first days after the onset of destabilization symptoms.