EFFICIENCY OF RETROPERFUSION SUPPORT OF CORONARY BLOOD FLOW DURING ENDOVASCULAR CORRECTION OF COMPLEX ANTERIOR CORONARY BED IMPAIRMENT FORMS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

The most adverse outcomes of PCI in patients with ACS-STE occurs during prolonged endovascular correction of complex coronary impairment forms in the absence of coronary arterial flow support. The aim of this study was to assess the effectiveness of retroperfusion support of coronary blood flow during endovascular correction of complex anterior coronary bed impairment forms in patients with ACS-STE. The results of treatment of 12 patients who underwent endovascular image-guided intervention was analyzed from 26.04.2012 to 10.05.2014. 1st group consisted of 6 (50%) patients who underwent retroperfusion support of coronary circulation. 2^nd group consisted of 6 (50%) patients in whom retroperfusion support have not been performed. In 1st group there there was a significant decrease in ST-segment elevation during retroperfusion after 60 seconds of the absence of antegrade blood flow in the anterior coronary bed compared with patients who underwent angioplasty without the coronary blood flow support (ST in V1-V3 with retroperfusion was 2,2±0,4 mm; ST in V1-V3 without retroperfusion was 2,9±0,4 mm; p=0,027). In 2nd group, in the absence of retroperfusion support in all patients after 60 seconds of antegrade flow overlap there was a significant increase in segment elevation ST (ST in V1-V3 was 2,7±0,3 mm; p = 0,027) compared to the initial ECG pattern. Similar dynamics was observed in blood pressure levels. Thus, selective retroperfusion of great cardiac vein can be used as an intraoperative support of cardiac hemodynamics in patients with ASC-STE.

ЧКВ, ретроперфузионная поддержка, рентгеноэндоваскулярное вмешательство, кардиогемодинамика, PCI, retroperfusion support, endovascular image-guided intervention, cardiac hemodynamics

1. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation/ The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC) // Europ. Heart J.- 2012.- Vol. 33.- Р. 2569-2619.

2. Whitlow P. L. Chronic Total Coronary Occlusion Percutaneous Intervention. The Case for Randomized Trials / P L. Whitlow, K. I. Muhammad // J. Am. Coll Cardiol Intv.- 2011.- Vol. 4 (9).- Р. 962-964.

3. Christofferson R. D. Effect of chronic total coronary occlusion on treatment strategy / R. D. Christofferson, K. G. Lehmann, G. V. Martin et al. // Am. J. Cardiol. - 2005.- Vol. 95.- Р 1088-1091.

4. Кононов А. В. Стентирование ствола левой коронарной артерии у больных с различными формами ишемической болезни сердца: ближайшие и среднеотдаленные результаты / А. В. Кононов, И. Ю. Костянов, И. Э. Кузнецова и др. // Международный журнал интервенционной кардиоангиологии (Москва).- 2013.- №23.- С. 26-33.

5. Hildick-Smith D. Randomized Trial of Simple Versus Complex Drug-Eluting Stenting for Bifurcation Lesions. The British Bifurcation Coronary Study: Old, New, and Evolving Strategies / D. Hildick-Smith, A. J. De Belder, N. Cooter et al. // Circulation.- 2010.- Vol. 121.- Р 1235-1243.

6. Бранд Я. Б. Опыт использования внутриаортальной баллонной контрпульсации при выполнении прямой реваскуляризации миокарда у пациентов с острым коронарным синдромом / Я. Б. Бранд, В. Х. Тимербаев, И. М. Долгов и др. // Ишемическая болезнь сердца (Москва).- 2011.- № 3.- С. 22-26.

7. Santarpino G. Preoperative intraaortic balloon pumping improves outcomes for high risk patients in routine coronary artery bypass graft surgery / G. Santarpino, F. Onorati, A. S. Rubino et al. // Ann. Thorac. Surg.- 2009.- Vol. 87.- Р 481-488.

8. Patel M. R. Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock/The CRISP AMI Randomized Trial / M. R. Patel, R. W. Smalling, H. Thiele et al. // JAMA.- 2011.- Vol. 306, № 12.- Р 1329-1337.

9. Almany S. L. Interventional in patient with LV dysfunction. PI 57 in New manual of interventional radiology by Mark Freed et al. / S. L. Almany.- Birmingham, Michigan: Physicians T. Press, 1997.

10. ACC/AHA Guidelines for Percutaneous Coronary Intervention. PTCA Guidelines // JACC.- 2001.- Vol. 37, № 8.- Р 2239-2306.

11. Кардиология: национальное руководство / под ред. Ю. Н. Беленкова, Р. Г. Оганова.- М.: ГЭОТАР-Медиа, 2008.- 1232 с.

12. Белов Ю. В. Постинфарктное ремоделирование левого желудочка сердца. От концепции к хирургическому лечению / Ю. В. Белов, В. А. Вараксин.- М.: ДеНово, 2002.- С. 55-87.

13. Шиллер Н. Б. Клиническая эхокардиография / Н. Б. Шиллер, М. А. Осипов.- М.: Практика, 2005.- С. 344.

14. Serruys P. W. Assessment of the SYNTAX score in the Syntax study / P W Serruys, Y. Onuma, S. Garg et al. // EuroIntervention.- 2009.- Vol. 5.- Р 50-56.

15. Morrow D. A. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy / D. A. Morrow, E. M. Antman, A. Charlesworth et al. // Circulation.- 2000.- Vol. 102.- Р 2031-2037.

16. Tang E. W. Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome / E. W. Tang, C. K. Wong, P. Herbison // Am. Heart J.- 2007.- Vol. 153 (1).- Р 29-35.

17. Incorvati R. L. Clinical applications of coronary sinus retroperfusion during high risk percutaneous transluminal coronary angioplasty / R. L. Incorvati, S. G. Tauberg, M. G. Pecora et al. // JACC.- 1993.- Vol. 22, № 1.- Р 127-134.

18. Петров В. И. Медицина, основанная на доказательствах: учебное пособие / В. И. Петров, С. В. Недогода.- М.: ГЭОТАР-Медиа, 2009.- 144 с.

19. Ishihara M. Implications of prodromal angina pectoris in anterior wall acute myocardial infarction: acute angiographic findings and long-term prognosis / M. Ishihara, H. Sato, H. Tateishi et al. // J. Am. Coll. Cardiol.- 1997.- Vol. 30.- Р 970-975.

20. Lincoff A. M. Percutaneous Support Devices for High Risk or Complicated Coronary Angioplasty / A. M. Lincoff, J. J. Popma, S. G. Ellis et al. // JACC.- 1991.- Vol. 17, № 3.- Р. 770-780.

21. Gore J. M. Preliminary experience with synchronized coronary sinus retroperfusion in humans / J. M. Gore, B. H. Weiner, J. R. Benotti et al. // Circulation.- 1986.- Vol. 74.- Р 381-388.

22. Leung W. H. Coronary and circulatory support strategies for percutaneous transluminal coronary angioplasty in high-risk patients / WH. Leung // Am. HeartJ.- 1993.- Vol. 125 (6).- Р 1727-1738.

23. Thiele H. Intraaortic balloon support for myocardial infarction with cardiogenic shock / H. Thiele, U. Zeymer, F. J. Neumann et al. // N. Engl. J. Med.- 2013.- Vol. 368.- Р 80-81.