Results of Treatment of Acute St-Segment Elevation Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: Data of a Retrospective, Single-Center Study (In-Hospital Period)

Abstract

Myocardial infarction significantly contributes to mortality rates in patients with chronic obstructive pulmonary disease (COPD). The influence of COPD on the course of acute ST-segment elevation myocardial infarction (STEMI) is controversial. Aim. To evaluate characteristics of coronary artery lesions and cardiovascular complications in STEMI patients with and without COPD depending on a reperfusion treatment method during in-hospital stay. Material and methods. A total of 1112 cases of STEMI treatment within the first 6 hours of the symptoms onset were analyzed. All of these patients have undergone reperfusion treatment: primary percutaneous coronary intervention (PPCI) or pharmacoinvasive strategy (PIS) methods. All the patients were divided into two groups: patients without COPD (952 persons; 83.2%) and those with COPD (160 patients; 16.8%). COPD impact on in-hospital course of STEMI was assessed.Results. The presence of COPD had no influence on STEMI in-hospital mortality. Mortality rates in patients with COPD (12 subjects; 7.5%) and without COPD (83 subjects; 8.7%) did not differ significantly (p=0.2). The study has demonstrated the significant influence of COPD on the patients' baseline characteristics and treatment results, which can have an impact on long-term prognosis. According to our data COPD presence was associated with more severe coronary artery lesions in both PPCI and PIS subgroups (p<0.001). This has determined more frequent transmural myocardial damage in STEMI patients with COPD regardless of reperfusion strategy and time factor (79% in patients with COPD and 50% in those without one, p<0.001). The incidence of hemorrhagic complications also didn't depend on COPD presence and remained low in all groups. Conclusion. At COPD presence STEMI was associated with more severe coronary artery lesions and increased frequency of transmural myocardial damage and residual stenosis after thrombolytic therapy. COPD did not lead to the increase in in-hospital mortality rates in STEMI patients undergoing reperfusion treatment. Keywords: thrombolytic therapy, acute ST-segment elevation myocardial infarction, percutaneous coronary intervention, pharmacoinvasive strategy, chronic obstructive pulmonary disease. Инфаркт миокарда вносит существенный вклад в смертность пациентов с хронической обструктивной болезнью легких (ХОБЛ). Влияние ХОБЛ на течение острого инфаркта миокар-да с подъемом сегмента ST (ИМпST) носит противоречивый характер. Цель. Изучить особенности поражения коронарного русла, сердечно-сосудистые осложнения при ИМпST у больных ХОБЛ и без таковой на госпитальном этапе в зависимости от ме-тода реперфузионной терапии. Материал и методы. Проанализировано 1112 случаев лечения пациентов с ИМпST в первые 6 ч от начала симптоматики. Всем этим больным была проведена реперфузионная те-рапия с помощью первичного чрескожного коронарного вмешательства (пЧКВ) или фармакоинвазивной стратегии (ФИС). Из общего числа больных была выделена группа пациен-тов без ХОБЛ (952 пациента; 83,2%) и с ХОБЛ (160 пациентов; 1...