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To evaluate the incidence of new onset heart failure (HF) in patients with myocardial infarction type 2 who underwent percutaneous coronary intervention (PCI) and compare it with the patients without revascularization during 6 months after discharge.
1240 patients with acute coronary syndrome (ACS) were examined. Myocardial infarction type 1 (T1MI) was identified in 63.9% patients, myocardial infarction type 2 (T2MI) came up in 23.9% cases. Patients with T2MI were older (71,2±10,5 vs 60,15±11,9 P<0.001) and predominantly women (52.8% vs 42% P<0.001) as compared to T1MI patients. Those patients who had not undergone coronary angiography procedure and patients with non-obstructive coronary atherosclerosis were excluded from the 6 months survey that followed.
Factors which caused disequilibrium in the myocardial balance between oxygen supply and its demand in patients with T2MI were distinguished. The dominant one was arterial hypertension (systolic blood pressure > 180 mm Hg) combined with left ventricular hypertrophy identified by echocardiogram (41.6%), tachy- and bradyarrhythmia (heart rate more than 130 and less than 40 bpm) came up in 26.0% cases, severe anemia (Hemoglobin < 5.5 mmol/l for men and < 5.0 mmol/l for women) – in 21.8%, severe respiratory failure (arterial oxygen tension less than 8 kPa) – in 6.4% patients. Two or more factors were detected in 5.2% cases. No other causes were identified. 74.4% patients with T2MI underwent diagnostic coronary angiography. PCI was performed in 39.7% cases. One coronary vessel obstruction was found in 11.4% patients, two vessels obstruction came up in 7.3%, three and more vessels were affected in 47.9%. In 33.4% cases patients demonstrated non-obstructive coronary atherosclerosis. 6 months survey that followed has shown a significant difference in heart failure manifestation between T1MI and T2MI patients (14% vs 21% respectively, P=0.02). Permanent diuretic requirement was found in 10.2% T1MI vs 31.3% T2MI patients (P=0.009). In PCI T2MI group new onset heart failure symptoms were found in 40% patients vs 44% patients in no-PCI T2MI group (P>0.05). Furthermore, there was no significant difference in III-IV NYHA discovered in these two groups (47.1% vs 53.1% respectively, P>0.05).
Six months survey showed no significant difference in new onset HF symptoms between PCI and no-PCI patients with T2MI.