Vol. 10, No 1, 2003 pp. 31 - 35
UC 616.127-005.8:616-089
SURGICAL REVASCULARIZATION AND ITS EFFECT
ON PROGNOSIS
IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION
Mirko N. Burazor, Sonja Šalinger-Martinović, Ivana Burazor, Aleksandar
Stanković
Clinic for Cardiovascular Diseases, Clinical Center, Niš, Serbia
E-mail: burazori@eunet.yu
Summary. The recovery of viable (hibernating) myocardium is possible
only after surgical revascularization, in contrast to stunning myocardium
the recovery of which is spontaneous. The aim of the study was to determine
the effect of therapy (medical or surgical revascularization) on the clinical
course and echocardiographic findings during a one-year follow-up of patients
after acute myocardial infarction. The investigation included 195 patients
hospitalized for acute myocardial infarction. Prior to discharge, all patients
underwent DSE test. During a 12-month follow-up, the patients underwent
3-month coronarography and possible surgical revascularization (ACB) (57
patients), depending on the presence of viable myocardium and/or residual
ischemia. The patients were divided into two groups: the first group underwent
ACB, and the second received medical treatment. Both groups showed significant
dynamics of change in WMSI during the follow-up, but a lower degree of
significance was registered in the group under medical treatment (p<0.02
vs. p<0.01). Neither group showed statistically significant dynamics
of change in EF and QRSS values. The dynamics of change in regional motility
between the groups was investigated using Pearson chi-square test. A statistically
significant difference in the dynamics of change in all regional motility
impairments was established, with the significance of difference of p<0.01
for hypokinetic segments, p<0.02 for akinetic, and p<0.001 for dyskinetic
segments. A timely performed surgical revascularization allows for a significantly
faster recovery of segmental contractility and a safer clinical course
during one-year follow-up after AMI.
Key words: AMI, viable (hibernating) myocardium, surgical
revascularization, DSE test
HIRURŠKA REVASKULARIZACIJA I EFEKAT NA
PROGNOZU BOLESNIKA
NAKON AKUTNOG INFARKTA MIOKARDA
Kratak sadržaj: Oporavak vijabilnog hiberniranog miokarda, moguć
je jedino nakon sprovedene hirurške revaskularizacije, za razliku od ošamućenog,
gde je oporavak spontan. Cilj istraživanja bio je procena efekta terapije
(medikamentne ili hirurške revaskularizacije) na klinički tok i ehokardiografski
nalaz tokom jednogodišnjeg praćenja bolesnika nakon akutnog infarkta miokarda.
Ispitivanjem je obuhvaćeno 195 pacijenata hospitalizovanih zbog akutnog
infarkta miokarda.Pre otpusta, pacijenti su podvrgnuti DSE testu. Tokom
perioda praćenja, a u roku od 3 meseca pacijenti su podvrgnuti koronarografiji
i eventualnoj hirurškoj revaskularizaciji (ACB) (57 pacijenta) zavisno
od postojanja vijabilnog miokarda i/ili rezidualne ishemije. Period praćenja
je iznosio 12 meseci. Pacijenti su podeljeni u dve grupe: I-podvrgnuti
ACB-u i II-tretirani medikamentima. Obe ove grupe su pokazale značajnu
dinamiku promene WMSI tokom perioda praćenja, ali sa manjim stepenom značajnosti
u grupi tretiranoj medikamentima (p<0.02 v. p<0.01). Vrednosti EF
i QRSS nisu pokazale statistički značajnu dinamiku promene u obe grupe.
Dinamika promene regionalnog motiliteta izmedju posmatranih grupa ispitivana
je x2 testom. Nadjena je statistički značajna razlika dinamike promene
svih regionalnih poremećaja motiliteta, pri čemu je za hipokinetične segmente
značajnost razlike iznosila p<0.01, za akinetične p<0.02, a za diskinetične
p<0.001. Pravovremeno sprovedena hirurška revaskularizacija, omogućava
značajno brži oporavak segmentne kontraktilnosti, i pruža bezbedniji klinički
tok tokom jednogodišnjeg praćenja nakon AIM.
Ključne reči: AMI, vijabilni miokard, hirurška revaskularizacija, DCE
test
