Method for treating acute myocardial infarction at st segment lifting

FIELD: medicine, cardiology.

SUBSTANCE: one should introduce the suspension of autologous mononuclear medullary cells without preliminary cultivation in to the mouth of coronary artery nourishing infarction area. Cell suspension should be introduced at the quantity of 100-150 mln. cells immediately after stenting coronary artery due to technique of passive passage. The procedure should be performed on the 14th - 21st d against the onset of the disease mentioned. The method provides efficient counterbalance of cardiomyocytes due to applying valuable stem cells at excluding complications induced by arterial occlusion.

EFFECT: higher efficiency of therapy.

1 ex, 1 tbl

 

The invention relates to medicine, specifically to cardiology, and relates to methods of treatment of acute myocardial infarction with ST-segment elevation.

It is established that the existing methods of emergency revascularization (thrombolysis, emergency balloon angioplasty) has exhausted its potential in relation to the size restrictions of necrosis of the myocardium [1]. At the same time, myocardial infarction occupies the first place among the reasons for the development of chronic heart failure, and the amount of necrosis of the myocardium is directly related to its frequency and severity [2]. In this regard, the actual problem of developing methods for the treatment of myocardial infarction, ensuring replace the lost number of cardiomyocytes.

There is a method of treatment of patients with acute myocardial infarction with ST-segment elevation [3]when in the infarct - related coronary artery impose a suspension of autologous mononuclear bone marrow cells that were pre-cultured for days with autologous blood plasma, on the 7th day from the beginning of the disease during repeated coronary angiography, the introduction of cell suspension takes place during occlusion of the coronary artery lumen.

This method is the closest to the claimed technical essence and the achieved result and selected as a prototype.

The disadvantage of this SPO is both is the need to perform coronary angiography twice and occlusive coronary artery during injection of cell suspensions, that may increase the risk of complications of interventional procedures, cultivation of autologous mononuclear bone marrow cells with autologous blood plasma during the day and early timing of the introduction of cells from the onset.

The purpose of the invention is improving the effectiveness of treatment and reducing the risk of complications due to the exclusion of re-interventions, and exclude additional effects on mononuclear cells in the bone marrow.

This goal is achieved technical solution that represents a method for the treatment of acute myocardial infarction with ST-segment elevation, which consists in the introduction of a suspension of autologous mononuclear bone marrow cells without cultivation in the coronary artery supplying the area of myocardial infarction. The cell suspension is injected in the amount of 100-150 million cells immediately after stenting of the coronary artery. There is no need to create an occlusion of a coronary artery during injection of the cell suspension. The procedure is carried out on 14-21 days from the onset. Aspiration of bone marrow conduct of the iliac crest after the puncture her predavanja barb. Autologous mononuclear bone marrow cells secrete method gradient centrifugation.

New in the proposed method is the introduction of CL is the exact suspension in the amount of 100-150 million cells without cultivation in the mouth of the affected coronary artery by the method of passive passage immediately after stenting space narrowing of the coronary arteries without creating an occlusion therein during the injection of cell suspensions for 14-21 days from the onset.

Mononuclear bone marrow cells are highly plastic material, so it is advisable to avoid additional impacts on them that will preserve their natural ability to secrete various bioactive substances and morphogenetic properties, which in turn will result in a more powerful induction of reparative processes in the damaged myocardium and lead to more effective treatment.

In the pathogenesis of acute myocardial infarction is important inflammatory reaction on the resulting necrosis of the myocardium. The migration of mononuclear bone marrow cells in the early stages of the disease (up to 14 days of myocardial infarction), when the heart tissue is ongoing inflammatory response, may not lead to the desired result, since migrated mononuclear cells from bone marrow could be more involved in the cascade of inflammatory reactions, and not in the formation of new blood vessels and functioning cardiomyocytes.

An important fact is that the majority of cardiologists limited in opportunities issue the log of emergency primary balloon angioplasty and stenting of the coronary artery and therefore reperfusion perform thrombolytic therapy. Coronary angiography and stenting of the affected artery is performed only in the subacute stage (14 th-21 th day of the disease) myocardial infarction. However, these terms have not time to form a complete scar tissue with new vessels, in addition, in the diseased myocardium remains elevated levels of adhesion molecules [4], which provides fixation (adhesion) portable mononuclear bone marrow cells in the myocardium. That is why we proposed a method of free passage cell usesi with the selective introduction into the mouth of the infarct-related coronary artery. Free passage of the cell suspension eliminates the damaging effects dilational cylinder to the wall of the coronary arteries and reduces the risk of thrombosis. The introduction of cell suspension perform immediately after stenting of the coronary artery, which saves the patient from having double intervention, which significantly reduces the risk of possible complications, both during and after the procedure, which generally increases the effectiveness of the treatment.

The method is as follows: on the 14th-21st days of acute myocardial infarction under local anesthesia with 10%lidocaine solution the dotted line the crest of the Ilium in the field of predavanja spine, aspirinum 100-120 ml of bone marrow in two 60-ml syringe with 5 ml gaari is a, method gradient centrifugation allocate mononuclear cells in the bone marrow. Prepare a suspension of mononuclear bone marrow cells with a concentration of from 2 to 5×106cells. Perform coronary angiography and stentoreus the affected artery, then install the catheter at the mouth of the affected coronary artery and perform slow introduction suspensions of mononuclear bone marrow cells.

Example. Patient G., 59 years old, was admitted to the emergency Department of cardiology after 3 hours from the beginning of angina status with signs of myocardial ischemic injury in the area of anterolateral wall of the left ventricle and acute heart failure II FC .Killip. The patient performed a systemic thrombolytic therapy kabikinase 750000 UNITS, effective on circumstantial evidence of myocardial reperfusion after 5 hours from the onset. According to the stress perfusion scintigraphy of the myocardium with thallium 199 reveal stable 45% passing 15% defects in myocardial perfusion. In addition, establish a reduced ejection fraction of the left ventricle to 50%. On the 16th day of the disease under local anesthesia with 10%lidocaine solution the dotted line the crest of the Ilium in the field of predavanja spine, aspirinum 100 ml of bone marrow, the method of gradient centrifugation produce autologous mononuclear cells from bone mo is ha perform coronary angiography and stentoreus affected coronary artery with optimal result, kateteriziruyut the mouth of the affected coronary artery, the method of passive passage impose a suspension of mononuclear bone marrow cells in the amount of 90 million cells. All these interventions the patient tolerates well, not registered any complications. Before the introduction of autologous mononuclear bone marrow cells mark the radiopharmaceutical 99 NMRA (Ceretectmo). Reveal that 30 min after injection of the cell suspension in the myocardium rendered about 2.5% of the cells after 3 h of 1.8%, after 24 h of 1.6% of the cells. After treatment, the patient is followed over 6 months and state the positive results of the treatment, which is manifested by the absence of increase of left ventricular volumes (end-diastolic volume 123 against 102 ml, end-systolic volume 51 against 40 ml) increased the ejection fraction of the left ventricle by 10%, decrease magnitude stable perfusion defect by 8% (45% vs. 37%). During the observation period do not exhibit clinical signs of chronic heart failure.

The proposed method for the treatment of acute myocardial infarction with ST-segment elevation applied in 12 patients (table. 1).

Table 1
Basic data clinical and instrumental examination
IndicatorsBefore the treatmentAfter 6 months of treatmentP
Age, years57,7±9,4
The time of reperfusion5,2±1,4
MLC mlof 124.7±26,7to 140.5±46,5NS
CSR ml74,7±22,569,5±28,4NS
PV %40,7±10,751,5±4,50,07
Stable perfusion defect, %33±12,521,2±13,90,04
Transient perfusion defect, %15,5±11,618±4,8NS
The accumulation of 99 m mibi prior to operation 24 hours after the administration2%
NS - no differences BWW - end-diastolic volume of the left ventricle, CSR-systolic volume of the left ventricle, EF - ejection fraction of the left ventricle.

As can be seen from the table, the proposed method of treatment has allowed to ensure delivery of autologous mononuclear bone marrow cells in MIC the rd, to reduce the severity of processes postinfarction remodeling of the left ventricle, improving contractile function and myocardial perfusion.

The proposed method allows the authors to improve the efficiency of treatment of patients with acute myocardial infarction with ST-segment elevation and reduce the number of complications of interventional procedures.

References

1. Topol E.J. Current status and future prospects for acute myocardial infarction therapy. Circulation 2003; 108(suppl III): III-6 III-13.

2. Braunwald E. Myocardial reperfusion, limitation of infarct dementia size, reduction of left ventricular dysfunction, and improved survival. Should the paradigm be expanded. Circulation. - 1989. - Vol.79, N2. - 441-444.

3. B.E. Strauer, Brehm m, Zeus T., et al. Repair of infarcted myocardium by autologous intracoronary mononuclkear bone marrow cell transplantation in humans. Circulation 2002; 106: 1913-1918.

4. Xie Y, Zhou T., Shen, W., et al. Soluble cell adhesion molecules in patients with acute coronary syndrome. Clin Med J. 2000: 113: 286-288.

The method of treatment of acute myocardial infarction with ST-segment elevation, consisting in the delivery zone of necrosis of the myocardium of autologous mononuclear bone marrow cells obtained by the method of gradient centrifugation, by introducing them into the coronary artery supplying the area of myocardial infarction, characterized in that the cell suspension without prior cultivation in the amount of 100-150 million cells injected into the mouth of the affected coronary artery by the method of passive passage immediately after stenting space narrowing of the coronary ar is ' series without creating an occlusion therein during the injection of cell suspensions at 14-21 th days of onset.



 

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