Optimization of the treatment of elderly patients with myocardial infarction by revascularization in combination with inotropic stimulation and myocardial unloading
Aim. To study effect of coronary revascularization in combination with inotropic stimulation and myocardial unloading on prognosis in elderly patients with myocardial infarction (MI) complicated with heart failure (HF). Material and methods. 149 elderly patients with ECG picture of acute MI with ST segment elevation and HF symptoms were included into the study. All patients received standard therapy. According to the additional therapeutic maneuvers patients were split into four groups: 18 patients treated with percutaneous transluminal coronary angioplasty (PTCA) combined with inotropic levosimendan (LS) therapy; 20 patients with PTCA only; 22 patients treated with levosimendan (LS) only; control group - 89 patients with standard therapy without PTCA or LS. Results. Combination of PTCA and LS in elderly patients with acute MI complicated by HF had advantages in comparison with PTCA or LS applied separately or not applied at all. Combined therapy with PTCA and LS resulted in more prominent improvement of left ventricle systolic function, increase in exercise tolerance and more effective prevention of cardiac remodeling and was safe. Conclusion. Combined therapy with PTCA and LS is more effective than separate usage of these methods in elderly patients with MI complicated with HF.