Еfremova O. Influence of fibrinolysis on function of endothelium, hemostasis, parameters of hemodynamics and structurally functional indexes in the patients with myocardial infarction.

Object of the study: Acute myocardial infarction (AMI). Purpose of the study: Optimization of AMI treatment af-ter fibrinolytic therapy based on profound investigation of the role of functional state of the endothelium, hemostasis, hemodynamic and structural-functional disorders at un-complicated and complicated variants of the course and distinguishing main factors which determine pathogenetic mechanisms of AMI complications after fibrinolysis. Methods of the study: Clinical-instrumental, biochemical, statistical methods (parametric and non-parametric). Practical significance of the obtained results: A method of early prediction of complicated and non-complicated course of AMI after fibrinolytic therapy using non-invasive clinical, structural functional, biochemical, endothelial and coagulation parameters and assessment of AMI treatment efficacy after FLT. It was proven that complicated AMI af-ter FLT is the result of compensation capability failure. The most important pathogenetic factors influencingVRD and PA development were distinguished. The use of com-puter program allowed to reveal the patients with a high risk of post-perfusion complications of AMI immediately after the admission and to control the efficacy of the ad-ministered therapy. The prognostic criteria of quantitative parameters at the moment of admission which determine the risk of complications during the hospital period of treatment as well as prognosis for 3-month follow-up. Main factors which play an important role in forming PA and VRD in hospital period of AMI after fibrinolysis were determined. This allowed scientifically substantiated ap-proach to pathogenetic treatment of these patients. New positive aspects of pathogenetic mechanism of sim-vastatin effect in AMI were revealed. The necessity of wider use of this drag at primary stages of AMI to reduce post-perfusion AMI complications was confirmed. Novelty of the obtained results: For the first time, a fun-damental investigation of clinical, structural-functional, biochemical, endothelial and coagulation parameters in non-complicated and complicated AMI after fibrinolytic therapy was done. It was shown that complicated MI after FLT was associated with marked disturbances of hemosta-sis, endothelium, hemodynamic and structural functional disorders, which frequently causes early postinfarction an-gina and ventricular disorders of the rhythm. The devel-oped mathematical models allow to predict the course of hospital AMI period after fibrinolysis using clinical pa-rameters of each patient. Additional anticoagulation and re-endothelial effects of simvastatin in AMI after fibrinolysis were established.