Прогнозирование эффективности тромболитической терапии у больных с острым инфарктом миокарда с подъемом сегмента ST с помощью теста эндотелийзависимой вазодилатации плечевой артерии

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Abstract

Because thrombolytic therapy has proved to be effective only in 50-60% of patients with ST-elevation myocardial infarction, its application is significantly limited. The purpose of this work was to evaluate the predictors of efficiency of thrombolytic therapy. We included 78 patients hospitalized with ST-elevation myocardial infarction, who underwent thrombolytic therapy. We assessed endothelial function using the brachial artery flow mediated dilation (FMD) test, administered to patients on admission to the clinic. The efficiency of thrombolytic therapy was estimated according to standard ECG criteria. According to the results of thrombolytic therapy, the patients were divided into two groups. Group 1 (n=43) consisted of patients with successful fibrinolysis. Group 2 (n=35) consisted of patients with failed fibrinolytic therapy. We found that the percentage of brachial artery dilation registered with the FMD test was significantly higher in group 1 than in group 2 (11.87 vs. 3.34%, respectively; p<0.001). We also determined that thrombolytic therapy was successful in 15.1% of patients whose FMD test results were less than 5%. At the same time, fibrinolysis was effective in 80. 9% of patients with FMD test results in the 5-10% range. Finally, thrombolysis was successful in 87.5% of patients with FMD test results greater than 10%. The results obtained provide sufficient evidence that endothelial function assessed by means of the FMD test predicts the success of the thrombolytic therapy.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery