cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2019.4.10246cardio-583Research ArticleОСТРЫЙ КОРОНАРНЫЙ СИНДРОМACUTE CORONARY SYNDROMEСвязь стратегии прямого стентирования инфаркт- связанной артерии со снижением смертности у женщин с острым инфарктом миокарда с подъемом сегмента STAssociation of Strategy of Direct Stenting of Infarct-Related Artery with Reduction of Mortality in Woman with ST-Elevation Myocardial InfarctionБессоновИ. С.BessonovI. S.

MD, PhD

MD, PhD

ivanbessnv@gmail.comКузнецовВ. А.KuznetsovV. A.ЗыряновИ. П.ZiryanovI. P.СапожниковС. С.SapozhnikovS. S.Тюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр РАНРоссияTyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation201916042019594511Copyright © Kardiomag, 20192019KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/583

Цель исследования. Оценка влияния стратегии прямого стентирования при первичных чрескожных коронарных вмешательствах (ЧКВ) на результаты лечения пациентов женского пола с острым инфарктом миокарда с подъемом сегмента ST (ОИМпST). Материалы и методы. Из 1297 больных с ОИМпST, которым в период 2006–2015 гг. были выполнены первичные ЧКВ, в анализ были включены 330 (25,4 %) пациентов женского пола. В основной группе исследования выполнялось прямое стентирование, в нее был включен 161 (48,8 %) пациент. Группу сравнения составили 169 (51,2 %) пациентов, которым выполнялось непрямое стентирование. Баллонную предилатацию и мануальную тромбоаспирацию проводили по решению рентген-эндоваскулярного хирурга. Результаты. Непосредственный ангиографический успех ЧКВ чаще определялся в группе пациентов, у которых выполнялось прямое стентирование (97,5 % против 87,6 %; р<0,001). При этом феномен no-reflow чаще возникал у пациентов, которым выполнялась предилатация, мануальная тромбоаспирация, либо применялось сочетание этих методов (11,2 % против 1,9 %; р=0,005). Смертность (4,3 % против 11,8 %; р=0,013) и частота развития основных кардиальных осложнений – MACE (4,3 % против 13 %; р=0,005) были статистически значимо ниже у пациентов основной группы. При этом по частоте рецидива инфаркта миокарда и развитию осложнений в месте пункции между группами не выявлено статистически значимых различий. Случаев тромбоза стентов в исследуемых группах не регистрировалось. После применения метода случайного отбора подобного по вероятности (propensity score matching) были сформированы 2 группы по 78 пациентов, полностью сопоставимые по клиническим и ангиографическим характеристикам. Было выявлено, что у пациентов группы прямого стентирования смертность (2,6 % против 12,8 %; р=0,016) и частота развития событий MACE (2,6 % против 14,1 %; р=0,009) оставались ниже, чем в группе, в которой выполнялось непрямое стентирование. По результатам бинарной логистической регрессии проведение прямого стентирования было независимо связано со снижением смертности (отношение шансов –ОШ 0,29 при 95 % доверительном интервале – ДИ от 0,09 до 0,97; р=0,04) и развитием событий MACE (ОШ 0,28 при 95 % ДИ от 0,09 до 0,87; р=0,03). Вывод. Прямое стентирование инфаркт-связанной артерии у женщин является эффективным и безопасным методом лечения при ОИМпST.

Aim of this study was to evaluate the impact of direct stenting (DS) strategy on the results of treatment of female patients with STelevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). Materials and methods. Among 1297 patients with STEMI admitted to the coronary care unit and subjected to PCIs from 2006 to 2015 there were 330 women (25.4 %). Data from 161 women (48.8 %) who underwent DS were compared with those from 169 women who underwent indirect stenting (IS). Among patients of IS group in 148 (87.6 %) stenting was performed after predilation, in 7 (4.1 %) after manual thrombus aspiration, and in 14 (8.3 %) after combination of predilation and thrombus aspiration. Results. The rate of angiographic success was higher in the DS group (97.5 vs. 87.6 %, р<0.001). Rates of deaths (4.3 vs. 11.8 %; p=0.013), major adverse cardiac events (MACE)(4.3 vs. 13 %; p=0.005), and no-reflow (1.9 % vs. 11.2 %; p=0.013) were significantly lower in the DS group. There were no differences in rates of recurrent myocardial infarction and access site complications. Following propensity score matching, each group contained 78 patients. Rates of MACE (2.6 vs. 14.1 %; p=0.009) and deaths (2.6 vs. 12.8 %; p=0.016) remained significantly lower in the DS group. After multivariate adjustment, DS strategy was independently associated with lower mortality (odds ratio [OR] 0.29; 95 % confidence interval [CI] 0.09–0.97; p=0.04) and MACE (OR=0.28; 95 %CI 0.09–0.087; p=0.03). Conclusion. DS strategy in STEMI female patients turned out to be safe and effective technique.

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The authors declare that there are no conflicts of interest present.