Effectiveness of complete and incomplete myocardial revascularization in the long-term period of acute coronary syndrome with ST segment elevation

Objective. To assess the functional adequacy of emergency X-ray endovascular myocardial revascularization (RERM) in the late period of acute coronary syndrome. To determine clinical, biochemical and microcirculatory markers of high cardiovascular risk during 6 months of observation.
Materials and methods. A total of 54 patients were examined in 6 months after primary percutaneous coronary intervention for acute coronary syndrome (ACS): 24 with complete myocardial revascularization and 30 with incomplete myocardial revascularization. The study methods included: assessment of the dynamics of biomarkers associated with high cardiovascular risk (enzyme-linked immunosorbent assays); monitoring of the effectiveness of dual antithrombotic therapy (Multiplate); a 6-minute walk test; ejection fraction (EF); a study of the state of microcirculation by computer conjunctival biomicroscopy (CBM); oxygen utilization and transport by noninvasive oximetry;
Results. All patients examined with standard DAPT achieved an adequate antiplatelet effect. In the group of patients with complete RERM, there was a significant improvement in all the studied parameters. Analysis of the dynamics of the studied parameters and the clinical status in the group of patients with incomplete ERRM showed that after 6 months of observation the effectiveness of the technology can be assessed as functionally adequate in 73.3% of patients. Incomplete functionally inadequate RERM was associated with a significant decrease in the number of functioning capillaries (FC) according to the GBM data; a decrease in the partial pressure of oxygen in the tissue (PO2), the rate of utilization (V1), the rate of oxygen tension recovery (V2) and, accordingly, lower capillary blood flow (LP), according to non-invasive oximetry, which corresponded to the clinical criteria of low quality of life (need for nitrates, low tolerance to physical activity). As a result of the study, we determined biochemical (CRP > 10 mg/l; ST2 > 35 ng/ml; NTproBNP > 200 pg/ml; TIMP-1 > 388 ng/ml) and microcirculatory (FC > 3 points; LP > 0.75 mmHg/sec) markers of high cardiovascular risk.
Conclusion. The functional adequacy of incomplete revascularization in the late period of ACS is due to the presence of viable myocardium in the zone of chronic occlusion and the formation of effective retrograde reperfusion. It was found that after 6 months of observation 73.3% of patients with ACS had effective restoration of blood supply, confirmed by a reliable improvement in clinical status, dynamics of biomarker levels, microcirculation parameters and oxygen kinetics parameters. The totality of the markers of cardiovascular risk presented in the results of the study in patients with ACS in the long-term period requires prompt resolution of the issue of surgical correction of the coronary bed if aortocoronary bypass grafting is technically possible.

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