Spontaneous reperfusion of infact-related artery in patients with ST elevation myocardial infarction


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Aim. To characterize a clinical course of ST elevation myocardial infarction (STEMI) and spontaneous reperfusion of the coronary arteries (SR) as well as in patients after reperfusion trombolytic therapy (TLT) and/or transluminal ballon coronary angioplasty (TBCA); to compare effectiveness of different approaches to treatment of SR patients: conservative - early medication and active - TBCA on the first postmyocardial 24 hours.
Material and methods. We studied 479 patients admitted to hospital not later than 6 hours since STEMI onset and either having SR (n = 49) or treated using active methods of coronary circulation restoration - prehospital thrombolysis (n = 127), thrombolysis after hospitalization (n = 127), primary TBCA (n = 60) and TBCA after initiation of TLT (n = 116). We made a more detailed analysis on the sample of 149 SR patients.
Results. SR was diagnosed in 10.2% cases with STEMI and occurred much earlier than recovery of coronary circulation due to TLT and/or TBCA. Patients with SR developed Q-MI, right ventricular infarction, cardiac failure and atrioventricular block less frequently. They had the lowest peak activity of creatin phosphokinase and a higher left ventricular ejection fraction versus patients without SR (50.7 ± 6.8 and 45.4 ± 6.6%, respectively; p < 0.05). As showen by coronaroangiography, SR patients had no"no reflow" phenomenon (0% and 17%, respectively). Active policy of SR patients treatment had no significant advantages over conservative treatment.
Conclusion. Early SR had more favourable course of MI, less mass of the affected myocardium and better contractile function of the left ventricle. The conservative policy of STEMI treatment in the presence of SR is more effective than the active one if a due control over the patients' condition is provided.

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