Особенности перкутанного лечения пациентов с инфарктом миокарда без элевации сегмента ST, поступивших в стационар в разные сроки от начала заболевания
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Анотація
Цель работы – оценить влияние коронарной реваскуляризации (коронарного стентирования, КС) на выживаемость пациентов, перенесших инфаркт миокарда без элевации сегмента ST (non-ST-segment elevation myocardial infarction, NSTEMI), при выполнении вмешательства в разные сроки от начала заболевания.
Материалы и методы. В исследование включен 101 пациент с NSTEMI. Ургентно (от 0 до 72 ч с момента развития заболевания) обследованы 29 больных. Остальные 72 пациента были госпитализированы в плановом порядке, а диагноз NSTEMI был установлен им в период от 4 до 180 суток до момента проведения коронаровентрикулографии или КС.
Результаты и обсуждение. Пациенты после КС лучше переносили физическую нагрузку, у них реже возникали рецидивы стенокардии напряжения и инфаркт миокарда по сравнению с группой контроля, в которой реваскуляризацию не проводили. Общая выживаемость пациентов с NSTEMI за период наблюдения 48 мес была статистически значимо (р<0,0048) выше у больных, которым выполняли КС, чем в группе контроля: соответственно 95 и 80 %. Кумулятивная выживаемость без МАСЕ у ургентных и плановых больных в течение 48 мес наблюдения была статистически значимо (р=0,002) выше у пациентов, которым проводили КС: 78 % по сравнению с 50 % в группе контроля. Также кумулятивная выживаемость без MACE на протяжении 48 мес у пациентов, перенесших NSTEMI в сроки от 4 до 180 суток до госпитализации, которым было проведено КС в плановом порядке, была статистически значимо выше, чем в группе контроля (р<0,0036): соответственно 81 и 50 %. У пациентов после перкутанных вмешательств статистически значимо улучшалась функция левого желудочка, и через 48 мес наблюдения количество больных без нарушений сегментарной сократимости увеличилось с 82,4 до 92,4 %. Пациенты с NSTEMI, у которых была впервые выявлена дисгликемия (без диагностированного сахарного диабета), чаще имели тяжелое многососудистое поражение коронарных артерий по сравнению с больными с нормальным углеводным обменом.
Выводы. Проведение КС у пациентов, перенесших NSTEMI, в разные сроки от начала заболевания, статистически значимо повышало как общую, так и кумулятивную выживаемость больных. При этом отмечено позитивное влияние КС на кумулятивную выживаемость без MACE не только в группе ургентных больных, но и у пациентов, перенесших NSTEMI в сроки от 4 до 180 суток до госпитализации.
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