THE PECULIARITIES OF THE POST-INFARCTION PERIOD COURSE IN COMORBIDITY PATIENTS, WHO HAD PERCUTANEOUS CORONARY INTERVENTION
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i2.8955Keywords:
myocardial infarction, percutaneous coronary intervention, comorbidity, diabetes mellitus type 2, arterial hypertension, complications of the myocardial infarction, post-infarction period.Abstract
Diabetes mellitus type 2 (DM) and myocardial infarction (MI) are often combined, but in the time of arterial hypertension (AH) they cause rapid development of kidney, large vessels’, brain and foot vessels’ complications. These patients have worse prognosis usually, and the mortality indexes are higher than the same ones in patients without carbohydrate metabolism disturbances. Even after the excellent provided percutaneous coronary intervention (PCI) the risk of the adverse events is about 10 % during the first year and 5 % every year during the next 4 years.
The aim of the study – to observe the peculiarities of the post-infarction period course in patients with concomitant diabetes mellitus type 2 and arterial hypertension, who had percutaneous coronary treatment.
Material and Methods. 325 patients with acute coronary syndrome combined with DM and AH were observed, aged 37–92 years, average age (66.22±0.53) years, 133 women and 192 men. Accordingly to the method of coronary flow restitution, patients were divided into 2 groups: 1 group – patients, who were provided PCI (n=124), 2 group – patients, without provided invasive intervention (n=201). The analysis and the estimation of the clinical-laboratory and instrumental indexes were provided further for the peculiarities determination.
Results. In patients of both groups other concomitant disease was determined, an extra mass weight, bad habits (smoking), echo-indexes which are subjected for the concentrical micardial hypertrophy. Persons of the 1-st group were legitimacy faster hospitalized in (14.50±2.04) hours, than patients of the 2 group (47.42±5.63) hours (p<0.001). Early post-infarction period characterized reliable less amount of complications, such as acute heart failure III i IV (Killip) – 9 and 5 % in the 1-st group versus 25 and 16 % in the 2-nd group; arrhythmias 13 versus 25 % and blockades 11 versus 20 %. Mechanical and tromboembolic complications in patients with PCI were not detected at all. Intervention restitution of the coronary permeability prevented the early post-infarction angina pectoris development, which happened instead in 11 % in patients without PCI. The mortality in patients of both groups differentiated not much and hadn’t statistical significance (in group 1 – 3.17 %, in group 2– 5.74 %, p>0.05), unlike annual survival (in group 1 – 92.60 %, in group 2 – 85.63 % , p=0.029).
Conclusions. 1. The course of the post-infarction period in patients with a combination of hypertension and diabetes characterized high part of such terrible complications as: cardiogenic shock, heart asthma, acute left ventricular failure, often with the development pulmonary edema. The indicated comorbidity was significantly different from the arrhythmogenic activity of the myocardium and the development of blockade of the heart.
2. Percutaneous coronary intervention in the conditions of comorbidity significantly affected the reduction of complications in the acute period of myocardial infarction: rarely, there were violations of rhythm and conduction, acute cardiac failure of III–IV centuries. (Killip) and mechanical complications. Coronary intervention also prevented the development of early postinfarction angina.
3. Annual patients’ survival after the intervention of the coronary flow restitution is reliable higher than in patients without revascularization.
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