Сравнительный анализ различных методов реперфузионной терапии у пациентов с острым коронарным синдромом с подъемом сегмента ST: систематический обзор литературы
Аннотация
Цель. Провести систематический анализ и сравнение эффективности различных методов реперфузионной терапии у пациентов с острым коронарным синдромом с подъёмом сегмента ST (ОКС-ПST), включая первичное чрезкожное коронарное вмешательство (ПЧКВ) и тромболитическую терапию (ТЛТ), с учётом временного фактора и влияния пандемии COVID-19.
Материалы и методы. Проведён систематический обзор проспективных рандомизированных и наблюдательных исследований, сравнивающих эффективность ПЧКВ и ТЛТ у пациентов с ОКС-ПST. Проанализированы данные крупных международных исследований, включая DANAMI-2 (1572 пациента), PRAGUE-2, STAT, GISSI, ISACS-STEMI COVID-19, а также метаанализы 23 исследований и современные диагностические методы оценки глобальной продольной деформации левого желудочка.
Результаты. Метаанализ 23 рандомизированных исследований показал статистически значимые преимущества ПЧКВ по сравнению с ТЛТ: 30-дневная летальность составила 8,0% против 13,7% (p=0,0003), повторный инфаркт миокарда — 3,8% против 7,0% (p<0,05), необходимость повторной реваскуляризации — 5,7% против 25,2% (p<0,001). Подтверждена концепция «золотого часа». Пандемия COVID-19 снизила обращаемость пациентов с ОКС-ПST на 19–30,5% и ухудшила прогноз.
Вывод. ПЧКВ демонстрирует статистически значимые преимущества по сравнению с ТЛТ, однако при выборе метода необходимо учитывать временной фактор и техническую доступность. Современные методы оценки глобальной продольной деформации левого желудочка повышают точность прогноза исходов.
Об авторах
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