International Medical Journal, Vol. 24., Iss. 3, 2018, P. 14−19.
SUPPLEMENT OF STANDARD THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER PERCUTANEOUS CORONARY INTERVENTION
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
The most effective strategy in treatment of acute myocardial infarction is percutaneous coronary intervention with early restoration of coronary blood flow in the ischemic region of the myocardium. However, this approach does not always lead to reduction in the volume of necrotic myocardium and the earliest possible restoration of the contractility of the left ventricle, that is the patient recovery. Considering the biochemical changes that occur at the cellular level during implementation of the pathological mechanism "ischemia − reperfusion", the search for drug therapy aimed at protecting the myocardium from reperfusion injury is pathogenetically justified. To investigate the efficacy of ranolazine and quercetin in patients with STEMI after percutaneous coronary intervention and their effect on long−term treatment outcomes, 105 patients were inbvestigated. Percutaneous coronary intervention was performed on average 7,6±1,2 hours after the appearance of the first symptoms. Three treatment groups were distinguished: group 1 included the patients who were prescribed quercetin for 5 days immediately after randomisation; group 2 included the patients, who were prescribed ranolazine orally for 30 days; group 3 consisted of patients who received standard treatment before and after percutaneous cotronary intervention. Non−renewable flow was determined after recanalization of the infarct−related artery as a lack of optimal myocardial perfusion using the MBG scale (Myocardial Blush grade, MBG ≤ 2 b). The frequency of development of myocardial infarction complications (postinfarction angina, ventricular and supraventricular arrhythmias, acute aneurysm of the heart) were analyzed. The dynamics of forming heart muscle damage zone was studied on the basis of serial determination of the activity of the MB fraction of serum creatine phosphokinase in peripheral venous blood on the first 3 days after the heart attack. Our study demonstrates that inclusion of quercetin and ranolazine in the pharmacotherapy of patients with STEMI after percutaneous coronary intervention does not affect the restoration of myocardial perfusion but reduces serum activity of MB creatine phosphokinase as a marker of myocardial necrosis and reduces the incidence of postinfarction angina.
Key words: no−reflow phenomenon, percutaneous coronary intervention, acute myocardial infarction with ST elevation, ranolazine, quercetin.