ENDOVASCULAR INTERVENTION EFFECTS ON POST-INFARCTION CLINICAL COURSE IN PATIENTS UNDER 60 YEARS

Aim. One of the major issues in modern cardiology is the treatment and prevention of complications in younger patients (under 60 years) after myocardial infarction with ST segment elevation (STEMI). According to the available evidence, in female patients, endovascular interventions are less common, and coronary artery bypass graft surgery is more common than in male patients. Material and methods. The study included 102 male and female patients aged under 60 years and diagnosed with STEMI. In all participants, coronary angiography was performed within first 6 hours, followed by infarct-related artery revascularisation via balloon angioplasty and stenting. At Days 10–15, as well as 6 and 12 months later, clinical examination (presence of angina, heart failure, or arrhythmias), Holter ECG monitoring, and treadmill test were performed. Results. The results of the one-year follow-up suggested that in female patients, heart failure developed earlier, ejection fraction was significantly lower, and Functional Class II angina was more prevalent than in their male peers. Moreover, female patients more often demonstrated clinically significant cardiac arrhythmias, reduced exercise capacity, and decreased heart rate variability. Conclusion. Post-infarction clinical course in women under 60 years was characterised by earlier development of heart failure, which justifies adequate control of its clinical manifestations and more aggressive therapy. The prevalence of effort angina or supraventricular extrasystolia was higher in women, which requires the antianginal therapy correction, via increasing the doses of β-adrenoblockers or calcium channel blockers. In men, ventricular arrhythmias were more prevalent, which might require antiarrhythmic drug therapy.

Myocardial infarction, coronary heart disease, coronary angiography, chronic heart failure

1. Diagnosis and treatment of patients with acute myocardial infarction with ST-segment elevation electrocardiogram. Russian guidelines.M., 2007:66. Russian (Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST электрокардиограммы. Российские рекомендации.М., 2007:66).

2. Shabrov A.V., Arharov I.V., Boldueva S.A. et. al. Acute coronary syndrome: the problem state. Medical academic journal. 2010; 3:52–58. Russian (Шабров А.В., Архаров И.В., Болдуева С.А. и соавт. Острый коронарный синдром: состояние проблемы. Медицинский академический журнал. 2010; 3:52–58).

3. Arhipova L.V., Gurevich M.A. Features of coronary heart disease in the female population. Diseases of the heart and blood vessels. 2011; 1:55–57. Russian. (Архипова Л.В., Гуревич М.А. Особенности ишемической болезни сердца в женской популяции. Болезни сердца и сосудов. 2011; 1:55–57).

4. Skibickij V.V., Medvedeva Ju.N., Shuhardina E.L. et. al. The risk factors and structure of cardiovascular pathology in women with menopause of various origins. Problems of women’s health. 2007; 3 (2):21–28. Russian. (Скибицкий В.В., Медведева Ю.Н., Шухардина Е.Л. и др. Факторы риска и структура кардиоваскулярной патологии у женщин в климаксе различного генеза. Проблемы женского здоровья. 2007; 3 (2):21–28).

5. Kornetov N.A., Lebedeva E.V. Depressive disorders in patients, who had a myocardial infarction. Psychiatry and psychotherapy. 2003; 5:10–15. Russian. (Корнетов Н. А. Лебедева Е.В. Депрессивные расстройства у пациентов, перенесших инфаркт мио- карда. Психиатрия и психотерапия. 2003; 5:10–15).

6. Anikin V.V., Romanova T.O. Pecularities of twenty-four-hours heart rythm variability in myocardialinfarctionin women. Materials of 2nd Russian Congress «Clinical electrocardiology», Suzdal. May, 14–15th, 2008; 55–56. Russian. (Аникин В.В., Романова Т.О. Особенности суточной вариабельности сердечного ритма при инфаркте миокарда у женщин. Мат 2-го Российского конгресса «Клиническая электрокардиология». Суздаль, 14–15 мая 2008; 55–56).

7. Ivanov A.P, Jel’gardt I.A. Heart rhythm variability and cardiovascular system state in patients, who had myocardial infarction. Arythmology bulletin. 2000; 17:33–47. Russian. (Иванов А.П., Эльгардт И.А. Вариабельность сердечного ритма и состояние сердечно-сосудистой системы у больных, перенесших инфаркт миокарда. Вестник аритмологии. 2000; 17:33–47).

8. ACCF/SCAI/STS/AATS/AHA/ASNC. J Am Coll Cardiol. 2009. Appropriateness Criteria for Coronary Revascularisation. 2009;53 (6):530–553.

9. Brodie B.R., Stuckey T.D., Wall T.C. et al. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 1998; 32:1312–1319.

10. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology. Ryan T.J., Faxon D.D., Gunnar R.M. J Am Coll Cardiol. 1988;12:529.

11. Сhiamvimonvat V., Sternberg L. Coronary artery disease in women. Can. Fam. Physician. 1998;44:2709–2717.

12. Heart diseases and stroke statistics –2008 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:25–146.

13. Sadowski M., Gasior M., Gierlotka M et al. Gender-related differences in mortality after ST-segment elevation myocardial infarction: a large multicentre national registry. EuroIntervention. 2011;6 (9):1068–1072.

14. Weaver W., Whiate H., Wilcox R. et al. Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. JAMA 1996;275:777–782.

15. Ani C., Pan D., Martins D., Ovbiagele B. Age- and sex-specific in-hospital mortality after myocardial infarction in routine clinical practice. Cardiol Res Pract. 2010;12:752–765.

16. Hailer B., Naber C., Koslowski B. et al. Gender-related differences in patients with ST-elevation myocardial infarction: results from the registry study of the ST-elevation myocardial infarction Network Essen. Clin Card. 2011;34 (5):294–301.

17. Mercuro G., Deidda M., Bina A. et al. Gender-specific aspects in primary and secondary prevention of cardiovascular disease. Curr Pharm Des. 2011;17:1082–1089

18. Yu H., Kim K., Bang W. et al. Gender-based differences in the management and prognosis оf acute coronary syndrome in Korea. Yonsei Med J. 2011;52:562–568.

19. Wenger N.K. Clinical characteristics of coronary heart disease in women, emphasis on gender differences. Cardiovasc.Res. 2002;53:558–567.