Preview

Rational Pharmacotherapy in Cardiology

Advanced search

The Efficacy of Thrombolytic Therapy in Inferior Myocardial Infarction with Damage to the Right Ventricular

https://doi.org/10.20996/1819-6446-2021-04-12

Full Text:

Abstract

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.

Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.

Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p<0.005). ST-segment decrease by 50% or more in 90 minutes from the TLT was found in 35 (71.4%) patients with RVMI and in 49 (71.0%) patients without RVMI (p>0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p <0.005), respectively. There were no false-positive assessments in patients with RVMI when using ST-segment decrease to the isoline.

Conclusion. TLT should be considered effective in patients with inferior myocardial infarction with the right ventricle lesion, if ST-segment decreases to isoline in 90 minutes from the TLT start.

About the Authors

E. S. Mazur
Tver State Medical University
Russian Federation

Evgeniy S. Mazur - eLibrary SPIN 3898-6719

Tver



V. V. Mazur
Tver State Medical University
Russian Federation

Vera V. Mazur - eLibrary SPIN 9798-0540

Tver



N. S. Kuznetsova
Tver State Medical University
Russian Federation

Natal'ya S. Kuznetsova

Tver



R. M. Rabinovich
Tver Regional Hospital
Russian Federation

Robert M. Rabinovich

Tver



K. S. Myasnikov
Tver Regional Hospital
Russian Federation

Konstantin S. Myasnikov

Tver



References

1. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119-77. DOI:10.1093/eurheartj/ehx393.

2. Acute myocardial infarction with ST segment elevation of the electrocardiogram. Clinical guidelines of the Ministry of Health of the Russian Federation (2020). Available from: http://cr.rosminzdrav.ru/re-comend/157_3 (In Russ.)

3. Carrillo X, Fernandez-Nofrerias E, Rodriguez-Leor O, et al. Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres: in situ fibrinolysis vs. percutaneous coronary intervention transfer. Eur Heart J. 2016;37(13):1034-40. DOI:10.1093/eurheartj/ehv.

4. Sim DS, Jeong MH, Ahn Y, et al. Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in Patients With ST-Segment-Elevation Myocardial Infarction: A Propensity Score Matched Analysis. Circ Cardiovasc Interv. 2016;9(9):e003508. DOI:10.1161/CIRCINTERVENTION.115.003508.

5. Kashtalap VV, Zavyrylina IN, Barbarash OL. Endovascular revascularization for ST-elevation acute coronary syndrome in Russia: problems and prospects for the further development. Kreativnaja Kardiologija. 2015;3:5-15 (In Russ.) DOI:10.15275/kreatkard.2015.03.01.

6. Khripun AV, Malevanny MV, Kulikovskikh YV. Pharmacoinvasive reperfusion therapy in treatment of ST-segment elevation myocardial infarction. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2013;14(4):50-9 (In Russ.)

7. Kostogryz VB. Results of Hospital Use of Recombinant Non-Immunogenic Staphylokinase in Patients with ST-Elevated Myocardial Infarction. RationalPharmacotherapyinCardiology 2017;13(1):51-4 (In Russ.) DOI:10.20996/1819-6446-2017-13-1-51-54.

8. Falcao FJ, Alves CM, Barbosa AH, et al. Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment. Clinics. 2013;68(12):1516- 20. DOI:10.6061/clinics/2013(12)07.

9. Mazur ES, Rabinovich RM, Mazur VV, et al. Comparative Results of Recombinant Non-Immunogenic Staphylokinase and Tenecteplase Use in ST-Segment Elevation Myocardial Infarction in Real Clinical Practice. Rational Pharmacotherapy in Cardiology. 2017;13(4):463-8 (In Russ.) DOI:10.20996/1819-6446-2017-13-4-463-468.

10. Naumov SA, Karpunina NS. Some Aspects of Prehospital Thrombolytic Therapy in the Perm Region. Rational Pharmacotherapy in Cardiology. 2018;14(4):494-500 (In Russ.) DOI:10.20996/1819-6446-2018-14-4-494-500.

11. Zeymer U, Neuhaus KL, Wegscheider K, et al. Effects of Thrombolytic Therapy in Acute Inferior Myocardial. J Am Coll Cardiol. 1998;32:876-81. DOI:10.1016/S0735-1097(98)00344-1.

12. De Lemos JA, Antman EM, McCabe CH, et al. ST-segment resolution and infarct related artery patency and flow after thrombolytic therapy. Am J Cardiol. 2000;85:299-304. DOI:10.1016/s0002-9149(99)00736-5.

13. Birnbaum Y, Levine GN, French J, et al. Inferior ST-elevation myocardial infarction presenting when urgent primary percutaneous coronary intervention is unavailable: should we adhere to current guidelines? Cardiovascular Drugs and Therapy. 2020;34:865-70. DOI:10.1007/s10557-020-07039-0.

14. Noguchi M, Sakakura K, Akashi N, et al. The Comparison of Clinical Outcomes Between Inferior ST- Elevation Myocardial Infarction with Right Ventricular Infarction Versus Without Right Ventricular Infarction. Int Heart J. 2019;60:560-8. DOI:10.1536/ihj.18-515.

15. Albulushia A, Giannopoulosb A, Kafkasc N, et al. Acute right ventricular myocardial infarction. Expert Review of Cardiovascular Therapy. 2018;16(7),455-64. DOI:10.1080/14779072.2018.1489234.

16. Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). J Am Coll Cardiol. 1999;33:1756-824. DOI:10.1016/s0735-1097(99)00126-6.

17. The Thrombolysis in Myocardial Infarction (TIMI) trial, phase I findings: TIMI Study Group. N Engl J Med. 1985;312(14):932-6. DOI:10.1056/NEJM198504043121437.

18. Longobardo L, Suma V, Jain R, et al. Role of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters. J Am Soc Echocardiogr. 2017;30:937-46. DOI:10.1016/j.echo.2017.06.016937.

19. Skrypnik DV, Vasil'eva EJu, Shpektor AV. Diagnosis and treatment of myocardial infarction with right ventricular failure. Kreativnaja Kardiologija. 2012;1:14-8 (In Russ.)


For citation:


Mazur E.S., Mazur V.V., Kuznetsova N.S., Rabinovich R.M., Myasnikov K.S. The Efficacy of Thrombolytic Therapy in Inferior Myocardial Infarction with Damage to the Right Ventricular. Rational Pharmacotherapy in Cardiology. 2021;17(2):233-238. (In Russ.) https://doi.org/10.20996/1819-6446-2021-04-12

Views: 296


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)