Sychenko Y. Reperfusion therapy in various categories of patients with acute coronary syndrome with ST elevation and final stratification of risk

The dissertation is dedicated to improving the treatment of acute coronary syndrome with ST elevation by optimizing the approaches in choosing the strategy of reperfusion therapy in various categories of patients based on identification and comparison of clinical significance of myocardial reperfusion evaluation in regard to the short-term and long-term prognosis, to ST-segment resolution and its independent predictors. It is proved in the dissertation, that in order to optimize risk stratification of severe cardiovascular «cases» in a short-term and long-term periods for the patients with ACS with ST-segment elevation receiving reperfusion therapy it is reasonable to evaluate its effectiveness in regard to reperfusion by defining the resolution of ST segment as >=70 % in 30 minutes after the primary PCI and as >=50 % at 90 minutes and 180 minutes after thrombolytic therapy. For patients with ACS with ST elevation receiving thrombolytic therapy in streptokinasum the evaluation of reperfusion effectiveness in regard to the risk of acute left ventricular failure is reasonably to define by ST resolution ST>=50 % after 180 minutes. Even in the situations of limited resources, it is advisable to prefer the primary PCI over thrombolytic therapy for all patients with ACS with ST-segment elevation regardless of risk by TIMI and time of ischemia, since in the cases of high risk its use is associated with improved prognosis in hospital period and in low risk cases its use is associated with reduction of severe cardiovascular «cases» over the next 3 years/