Prognosis Innovative Approaches in Relation to Results and Complications of Coronary Remedial Surgical Procedure in Case of Acute Coronary Syndrome

Abstract

In modern cardio surgery, it has become possible to predict not only the outcome of surgical interference
in order to save life, but also its effectiveness in terms of the quality of life improvement. It is proved that
coronaro correcting technologies can not only soften the clinical picture of chronic coronary insufficiency,
but also increase the contractility of the ischemic myocardium, as well as significantly improve the patient’s
quality of life, if the myocardial ischemia has the character of hibernation, and not stanning. The ability to
determine which variant of the ischemic syndrome occurs in the patient before surgery helps to predict the
interference effectiveness. The method used for this purpose (radioisotope scintigraphy, positron emission
tomography, MRI, pharmacological stress echotests) are technically or economically inaccessible, difficult
to apply in the perioperative period, and sometimes dangerous.
The purpose of the research: to offer an informative, accessible and safe method of preoperative identification
of the hibernating myocardium among patients with IHD for successful prediction of the interference
effectiveness.
Materials and Method: 83 patients with acute and chronic forms of IHD were under study. In the first group
(49 people), there was a coronary stenting (CS). In the second group (34 patients), there was a heart bypass
surgery (HB). There was the comparative assessment analysis in regard to variant of ischemic syndrome
and the effectiveness of both operations by means of precardial ECG mapping and stress echotest with
dipyridamole.
Results: In case of IHD acute forms (acute coronary syndrome, acute myocardial infarction) CS and HB
operations had significant positive dynamics in regard to indicators of coronary blood flow within the
course of ischemia and myocardial contractility in accordance with precordial mapping (area reduction
of ischemia - AST and the decrease of the ischemia degree - ?ST) and stress echotest with dipyridamole
(increased contractility of EF indicator and a reduction of ESV, increase in the number of eukinetic segments
of the myocardium and decrease of hypokinetic segments). We observed the same dynamics, but much less
pronounced, in accordance with ECG mapping and stress echotest data after both operations within the
group with chronic forms of ischemia.
Conclusion: The precardial ECG mapping is informative and available for use in regional cardiosurgical
clinics as a method of the hibernating myocardium identification, which is a more perspective variant of
ischemia in case of IHD in terms of left ventricular contractility increase.