Impact of Late Revascularization on Cardiac Function in Patients With Non-ST-Segment Elevation Myocardial Infarction

Background: In recent years, there has been a clear trend towards an increase in the incidence of acute non-ST-segment elevation myocardial infarction compared to ST-segment elevation myocardial infarction. Accordingly, studies investigating the effect of late revascularization on cardiac function in patients with non-ST-segment elevation myocardial infarction are increasingly relevant. Objective: To analyze the outcomes of surgical and medical treatment in patients with non-ST-segment elevation myocardial infarction during the subacute phase of myocardial necrosis.
Materials and methods: The outcomes of therapy in 77 patients who were examined and treated in the cardiology departments of the Oryol Regional Clinical Hospital and Kursk City Emergency Clinical Hospital were analyzed. All patients were initially admitted to the internal medicine departments of central district hospitals in the Oryol and Kursk regions with non-specific clinical presentations. In these hospitals, the patients underwent a thorough evaluation, were diagnosed with non-ST-segment elevation myocardial infarction, and received comprehensive conservative treatment. Subsequently, all patients were recommended for hospitalization in the cardiology department of the vascular center for elective coronary angiography. Based on the subsequent treatment strategy, the patients were divided into two groups: Group 1 (n = 42) included patients who underwent coronary angiography in the Kursk and Oryol regional vascular centers, Group 2 (n = 35) included patients who received medical therapy only, as they refused hospitalization in the regional vascular center for elective surgical treatment.
Results: Two months after revascularization, analysis of cardiac function indicators showed that the majority of patients in Group 1 had no symptoms of angina and heart failure (52.4% and 59.5%, respectively), whereas in Group 2 these rates were 8.5% and 14.2%. At the same time, a reduction in the functional class of angina pectoris was observed in 76.1% of patients in Group 1 and 44.8% in Group 2, and functional class of heart failure improved in 69.4% and 37.6%, respectively.
Conclusion: Late myocardial revascularization promotes positive changes in left ventricular systolic function in patients with non-ST-segment elevation acute coronary syndrome. The absence of timely revascularization is associated with more pronounced clinical manifestations of both angina and heart failure. These results further confirm that timely restoration of coronary blood flow plays a crucial role in improving patient prognosis and quality of life.

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