Kovalchuk R. A. Features of the course of acute myocardial infarction with ST-segment elevation in the presence of arterial hypertension. Dissertation for the degree of Doctor of Philosophy in specialty 222 - Medicine (22 - Health care). - Danylo Halytsky Lviv National Medical University, Ministry of Health of Ukraine, Lviv, 2025.
Coronary heart disease is one of the most challenging healthcare issues today: more than 7 million people die of the disease every year. The risk of death is particularly high in the event of acute coronary events, in particular, myocardial infarction (MI) due to total occlusion of the coronary artery - ST-elevation myocardial infarction (STEMI).
The successful introduction of reperfusion therapy in recent years has significantly reduced in-hospital mortality in acute MI, which currently stands at 4-6%. Nevertheless, there are numerous challenges that must be addressed to enhance the management strategy for these patients.
The aim of the study is to optimise the diagnostic and therapeutic tactics of management of patients with STEMI in the presence of arterial hypertension (AH) who underwent primary percutaneous coronary intervention (PCI) with stenting of the infarct-related coronary artery (IRCA), based on the identification of features (in comparison with other risk factors (RF) - diabetes mellitus (DM), diabetes mellitus (DM), COVID-19, and obesity) of cardiac rhythm and conduction disorders, myocardial remodelling, manifestations of heart failure (HF) (according to the blood levels of brain natriuretic peptide, NT-proBNP), and systemic inflammation (according to the blood levels of C-reactive protein, CRP), and determining their role in the formation of short- and long-term prognosis.
Objectives of the study: to establish the nature of cardiac rhythm and conduction disorders in patients with STEMI and concomitant hypertension (compared with other risk factors - diabetes mellitus, COVID-19 and obesity); to identify the features of myocardial remodelling in patients with STEMI in the presence of hypertension (compared with other risk factors); to determine the dynamics of NT-proBNP, a marker of heart failure, and CRP, a marker of systemic inflammation in the peripheral blood of the study patients (compared with other risk factors); to determine the features of the clinical course of STEMI in the presence of hypertension; to determine the criteria for an unfavourable prognosis in patients with STEMI and concomitant hypertension.
Subjects: acute myocardial infarction with ST-segment elevation in patients with arterial hypertension.
Subjects of the study: clinical and anamnestic data; cardiac rhythm and conduction disorders according to the results of daily monitoring (DM) of the electrocardiogram (ECG); structural and functional state of the myocardium according to echocardiography (Echocardiography); peripheral blood levels of NT-proBNP (a marker of HF) and CRP (a marker of systemic inflammation); complications that occurred in the study patients at the inpatient stage and during 6 months of outpatient follow-up.
According to the inclusion and exclusion criteria, 126 patients were included in the study. The main group (group I) consisted of 95 patients with STEMI and hypertension, and the comparison group (group II) consisted of 31 patients with STEMI without hypertension. Important inclusion criteria for patients in the study were primary (without prior thrombolysis) percutaneous coronary intervention with IRCA stenting within 24 hours of symptom onset, as well as complete restoration of blood flow in the IRCA (TIMI-3). The exclusion criteria include the presence of acute left ventricular failure of class III or IV (according to T. Killip) after stenting of the IRCA.
The course of the disease was assessed in the presence of hypertension in comparison with such risk factors as diabetes mellitus, COVID-19 and obesity, in an attempt to find out how significant the contribution of hypertension, compared with each of these factors, is in the formation of clinical features of STEMI.
The study was conducted at the Department of Family Medicine, Faculty of Postgraduate Education, Danylo Halytskyi Lviv National Medical University in 2021-2024. The patients who took part in the study were undergoing inpatient treatment for STEMI at the Department of Cardiology and Reperfusion Therapy of the Heart and Vascular Centre of St. Panteleimon Hospital, Municipal Non-Commercial Enterprise ‘1st Territorial Medical Association of Lviv’, as well as at the infarction and cardiology departments of the Lviv Regional Clinical Diagnostic and Treatment Cardiology Centre.
The following research methods were used in the dissertation: informational and analytical; clinical and anamnestic; clinical and laboratory, in particular, determination of NT-proBNP and CRP in peripheral blood; instrumental: ECG, echocardiography, coronary angiography, DM ECG; mathematical and statistical.
