Early and Postponed Percutaneous Coronary Interventions in Acute Period of Myocardial Infarction

Aim of the study was elaboration of indications to the application of postponed percutaneous coronary interventions (PCI) in acute period of myocardial Infarction (MI) in patients without prior thrombolytic therapy. We fulfilled comparative assessment of efficacy of 3 strategies of treatment of 810 patients admitted to the N.V. Sklifosovsky Institute of Urgent Aid from 2003 to 2007: primary PCI carried out within first 12 hours (n=32), postponed PCI in acute period because of initially elevated risk (n=90), conservative treatment without reperfusion therapy (n=688). Elevated risk of death according to TIMI score was used as the basis for establishment of indications for postponed interventions. Right ventricular involvement and repeat MI were considered as additional predictors. The data obtained indicate that elevated risk of death allows to detect patients with high rate of persisting occlusions and subtotal stenoses in infarct related artery. Reperfusion therapy appears to be the main component of treatment of such patients. Necessity to perform primary PCI within first 12 hours does not exclude possibility of its later use in acute period of MI. Both strategies allow to substantially lower rates of complications and lethal outcomes. Shortening of terms of application of reperfusion therapy gives an opportunity to prevent most of unfavorable outcomes. Success of postponed interventions in acute period of MI opens opportunities of their active use in patients from other hospitals.