Effectiveness of Complex Use of Percutaneous Coronary Intervention and Drug Revascularization in Acute Coronary Syndrome
Purpose. To evaluate the effectiveness of the integrated use of propranolol with heparin and percutaneous coronary intervention (PCI); propranolol with tenecteplase in combination with PCI and separately, only PCI for hemodynamics, cardiohemodynamics, and the clinical course in the acute period, as well as in the observation of MI. The results of complex drug and mechanical revascularization are compared.Materials and methods. 63 patients with acute coronary syndrome (ACS) were examined: anterior myocardial infarction with Q wave and ST segment elevation at the age from 30 to 70 years (56.7±1.20) that were divided into 3 groups of 21 people by randomization. In the 1st group, they were treated with heparin, propranolol, fozinopril, and PCI; in the 2nd group, methylase (tenecteplase) and propranolol were administered, fozinopril was used, and PCI was performed in 24 hours; in the 3rd group, only PCI was performed. Using echocardiography and Doppler echocardiography, there were studied the values of the end systolic volume (ESV), end diastolic volume (EDV), ejection fraction (EF), stroke index (SI), cardiac index (CI), and the index of the disorder of local left ventricular contractility (LVC). There was also revealed the dynamics of systolic and diastolic blood pressure, the clinical course of MI in the observation period.Results and discussion. Administration of tenecteplase, propranolol infusion, fozinopril oral administration, and transdermal coronary intervention (PCI) in 24 hours accelerate stabilization of central hemodynamics. The ESV, EDV, IALC decrease, the left ventricular systolic function improves. There was no restenosis, recurrence of MI, and mortality. In one patient, the DOS was observed in 5 days.During treatment with fozinopril, propranolol with heparin, and PCI, the central hemodynamics was also stabilized. The reduced ESV and EDV, IALC and decreased degree of, improves and LV systolic function (group 1). At the same time, in 2 patients, there was recorded DOS on the 3rd day, in 1 patient - recurrence of MI. When only PCI was performed, 4 patients developed recurrence of MI, 4 patients had restenosis, 2 patients had AHF, and 2 patients died.Conclusions.The result of this work shows that the integrated use of drug therapy with percutaneous coronary intervention lets to get a prognostically positive result in contrast to using only PCI.