Bitsadze O. Emergency surgical revascularization in patients with acute myocardial infarction

The dissertation is based on long-term prospective observation, and it was set high clinical efficacy of emergency surgical revascularization in acute myocardial infarction - the level of total lethality does not exceed 12.4 %. The causes of early mortality in emergency coronary artery stenosis were acute mitral regurgitation (12.5 %) and acute heart failure (56.2 %) with cardiogenic shock (31.3 %). Factors that increase the risk of early mortality were male sex (p<0.05), heart failure of III-IV functional classes (p <0.05), left ventricular ejection fraction less 30.0 % (p<0.05), pulmonary hypertension > 55 mm Hg, creatinine clearance below 50 ml/min (p<0.05). The additional, non-EuroSCOREII risk factors were hypertension (p<0,05), atrioventricular block (p<0,05), and 3-vascular lesions (p<0,05). In the early postoperative period, in STEMI-type vs. NSTEMI, were set the reliable higher level of prolonged mechanical ventilation (p<0.05), intra-aortic balloon pump (27.1 %, p<0.05), prolonged inotropic support (99.0 %, p<0.05), acute renal failure (p<0.05), acute respiratory failure (p<0.05), and transient atrioventricular blockade (p<0,05). In NSTEMI vs. STEMI, were set the reliable higher level acute encephalopathy (p<0.05) and supraventricular arrhythmia (p<0.05). The prognostic model of early postoperative lethality in emergency coronary bypass is represented by regression: S (survival) = 1 / (1 + 2,718 ^ - ([level of GFR * 0,307] + [FVLH * (- 0,160)] + [Pressure LA * (- 0,251)] + [Type of myocardial injury * 1,653]).