VENTRICULAR EXTRASYSTOLY WITH HIGH RISK OF LIFE-THREATENING ARRHYTHMIAS DEVELOPMENT IN ACUTE CORONARY SYNDROME WITHOUT ST ELEVATION: EVALUATION OF REVASCULARIZATION EFFECTIVENESS

Aim. To study the role of early myocardial revascularization in the clinical course of the acute coronary syndrome (NSTEACS) without ST elevation, complicated with ventricular extrasystoly (VE) and high risk of life-threatening ventricular arrhythmias (LVA) development.
Material and methods. Totally 124 patients with NSTEACS with VE II-V Lown and high risk of LVA that was assessed if there are pathologic values of linear shift of preectopic VE interval and LVA index, ≤10 ms and ≤0,5, respectively. To all patients having informed consent during the first 24 h since admittance the evaluation of coronary arteries flow grade was performed and for those having indications — revascularization preformed. In refusion of invasive treatment — in addition to conservative therapy the drugs of III class were used (mostly amiodarone).
Results. The best positive effect of revascularization in NSTEACS with VE and LVA risk was if it had been performed during the first 2 h since hospitalization: fatal ventricular arrhythmias during hospitalization and before were not registered.
Efficacy of fatal arrhythmias prevention in NSTEACS with VE and high risk of LVA during 2-24 h after hospitalization and with revascularization if indicated, was nearly same with the use of additional III class drugs — i.e. amiodarone, and was about 76,19% and 79,41%, resp.
Conclusion. All patients with NSTEACS with VE and high risk of LVA the revascularization is indicated if indicated, in first 2 h after hospitalization.

1. Wijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. The Task Force onMyocardial Revascularization of the European Society of Cardiology (ESC) and the EuropeanAssociation for Cardio-Thoracic Surgery (EACTS). Eur. Heart. J. 2010; 31: 2501-55.

2. Diagnostics and treatment patients with acute myocardial infarction with ST elevationin ECG. National clinical guidelines 2th ed. Moscow.; 2009. pp.165-227. Russian(Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ. Национальные клинические рекомендации. 2-е издание. М.; 2009.с.165-227).

3. Hamm CW, Bassand J-P, Agewall S, et al. ESC Guidelines for the management of acutecoronary syndromes in patients presenting without persistent ST-segment elevation. TheTask Force for the management of acute coronary syndromes (ACS) in patients presentingwithout persistent ST-segment elevation of the European Society of Cardiology (ESC).Europ. Heart J. 2011; 32: 1-56.

4. Olesin AI, Konovalova OA, Koziy AV, et al. Ventricular extrasystoly in patients with nonST elevation acute coronary syndrome: assessing the risk of life-threatening ventriculararrhythmias (clinico-experimental study). Russ J Cardiol 2009; 1: 24-31. Russian(Олесин А. И., Коновалова О. А., Козий А. В. и др.) Желудочковая экстрасистолияу больных острым коронарным синдромом без подъема сегмента ST: оценка рискаразвития жизнеугрожающих желудочковых аритмий (клинико-экспериментальное исследование). Российский кардиологический журнал 2009; 1: 24-31).

5. Braunwald’s Heart Disease. A textbook of cardiovascular medicine. 9th ed. Libby P. et al., Phyladelfhia, W. B. Saunders Company; 2011.

6. Galito L, Badano L, Fox K, et al. The European Association of Echocardiography (EAE) Textbook of Echocardiography. Oxford Academ.; 2011.

7. Olesin AI, Shabrov AV, Koziy AV, et al. Method for prognosis sudden death in patient with Left and Right premature ventricular beat. Patent RU № 2312591, 2007, Russian. (Олесин А. И., Шабров А. В., Козий А. В. и др.) Способ прогнозирования внезапной смерти у больных с лево- и правожелудочковой экстрасистолией — Патент Российской Федерации № 2312591, опубликован 20.12.2007 г., Бюллетень изобретений № 35.).

8. Clinical arrhythmology. Ed. by Ardashev AV. Medpractica-M.; 2009. Russian (Клиническая аритмология. Под ред. Ардашева А. В. Медпрактика-М.; 2009).

9. Olesin AI, Shabrov AV, Sinenko VI, et al. Assessment different treatment ventricular cardiac arrhythmias in compare with its mechanism. Kardiologia. 2005; 5: 75-6. Russian (Олесин А. И., Шабров А. В., Синенко В. И. и соавт. Возможность дифференцированного лечения желудочковых нарушений сердечного ритма в зависимости от механизма их развития. Кардиология. 2005; 5: 75-6.).