MEDICAMENTAL PREVENTION OF CONGESTIVE HEART FAILURE IN PATIENTS AFTER MYOCARDIAL INFARCTION IN A STATE OF COMORBIDITIES

Abstract

Summary. Over the past decades the main etiology of the congestive heart disease (CHD) is an ischemic heart disease (IHD). IHD, according to statistical data, dominates and ranks first in the structure of mortality in Ukraine. One of the most dangerous clinical manifestations of IHD is acute myocardial infarction (MI), the main complication of which is the development of heart failure. Despite the development of modern technologies for the treatment of myocardial infarction, including the use of invasive reperfusion technologies, the proportion of patients with heart failure in the long-term period of observation is steadily increasing. One of the provoking factors for the development and progression of heart failure is the presence of concomitant pathology in the majority of patients with MI. Comorbidity with arterial hypertension and diabetes mellitus is often a triggering factor in the development of MI [2]. That is why the search for the most suitable ways of treating myocardial infarction, its complications and minimizing pathological post-infarction cardiac remodeling, preventing the development of heart failure is an urgent problem.

The aim of the study – improvement of a complex drug therapy in the acute period of myocardial infarction to prevent the development of heart failure in patients with comorbid pathology.

Materials and Methods. Our study included 455 patients with an acute myocardial infarction with ST segment elevation at the age of (62.7±1.07) years, among them 342 (75.16 %) men, and 113 (24.84 %) women who approximately was the same age, the average age of women were (61±0.83) years, men – (63.05±0.98) years.

The diagnosis of MI was verified according to the local protocols [3] and ESC (2017). Clinical, laboratory and instrumental research methods were used. Intracardiac hemodynamics was assessed using echocardiography; post-infarction remodeling was analyzed in follow-up investigation during two years. All patients received statins, β-blockers, and angiotensin-converting enzyme (ACE) inhibitors. The patients were divided into 3 groups. Group 1 (n = 232) (51 %) took ramipril at a dose of 2.5–5.0 mg, group 2 (n = 171) (38 %) – perindopril 2.0–4.0 mg, group 3 (n = 52) (11 %) –zofenopril at a starting dose of 7.5 mg twice a day. The prescription of ramipril and zofenopril was carried out in turn as patients entered the clinic. So far, the set was not amounted to 50 people in each group (zofenopril n = 52). Perindopril was indicated for older patients. Statistical processing was performed using the SPSS®v.21.0 software package and an Excel spreadsheet editor. Statistical analysis of the results was carried out using the SPSS v.21.0 program.

Results. In general, the study groups did not differ in concomitant pathology and the Charlson comorbidity index, which made it possible to adequately assess the effectiveness of differentiated treatment. The use of an ACE inhibitor in the postinfarction period from the point of view of pathophysiology has a great influence on the development and formation of postinfarction heart failure [4]. To predict the development of HF over 3 months after MI, the Nt-proBNP levels were studied in dynamics [5] using different ACE inhibitors in the treatment of patients with MI. The results obtained confirmed the benefits of the use of zofenopril in patients who suffered from MI in the background of comorbidity with the goal to prevent the development of HF.

Conclusions. According to the obtained results of the study of the level of Nt-proBNP dynamics, it was concluded that the effect of different ACE inhibitors on the neurohumoral systems of the human body is not the same. And po­sitive hemodynamic and morphofunctional factors make it possible to confidently prescribe this pharmacological group of drugs for the treatment and improvement of prognosis in comorbid patients with MI.