Method for treating acute myocardial infarction cases

FIELD: medicine.

SUBSTANCE: method involves applying intracoronary phosphocreatine introduction into infarction-responsible artery when carrying out coronary angioplasty. Phosphocreatine solution is injected after reperfusing the infarction-responsible artery at constant volume rate of 0.1-4 ml/s with introduced phosphocreatine dose being equal to 0.5-4 g.

EFFECT: reduced myocardium necrosis zone; prevented cardiac insufficiency and cardiac rhythm disorders.

4 cl

 

The invention relates to medicine, namely to cardiology. The invention can be used in the treatment of acute myocardial infarction.

There is a method of treatment of acute myocardial infarction (SU 1722498 And 61 To 31/21, published 30.03.1992), including traditional therapy and the introduction of additional phosphocreatine (creatine phosphate) in the blood intravenously for 3 days at a daily dose of 0.5-1.0 g/kg of the Known method is used for the prevention of cardiac rupture in patients with acute myocardial infarction and to reduce mortality.

The closest adopted for the prototype for the invention is a method of treatment of acute myocardial infarction, disclosed in the patent EP 0199117, a 61 K 31/66, published 23.03.1986. The method of treatment of acute myocardial infarction at the specified patent is that, during surgery on the open heart, such as operations, emergency coronary artery bypass surgery, extracorporeal circulation in cardioplegic solution enter phosphocreatine. However, the imposition of a solution of creatine phosphate is carried out in a coronary vessel, which is not the infarct-related.

To achieve the desired technical result in this invention prevents the impossibility of an adequate supply of active substance directly in the area in which arcta infarction, associated with the mechanism of operation and the introduction of the active substance in the infarct-related coronary vessel. In addition, direct surgical intervention on the coronary vessel does not apply to low-impact, organoboranes and saving treatments. When using this method the probability of complications, including fatal to 10-15%. The patient after direct surgical intervention on the coronary vessel required a long rehabilitation period.

The task, which directed the claimed invention to provide a novel method for the treatment of acute myocardial infarction in order to increase the effectiveness of treatment of acute myocardial infarction.

The technical result achieved by carrying out the invention, expressed in increased therapeutic effect by enhancing the efficacy of cardioprotective substances on ishemizirovanne cardiomyocytes in the acute period of myocardial infarction, prevention of reperfusion injury of the myocardium, due to the possibility of penetration of phosphocreatine through the damaged plasma membrane, ensuring that impacts directly on the cellular structure. Additional technical result is expressed in the functional extension applied what I exogenous phosphocreatine in cardiology.

To achieve the above technical result in the treatment of acute myocardial infarction, including the introduction of intracoronary solution of creatine phosphate, a solution of creatine phosphate is injected into the infarct-related artery when performing angioplasty and the insertion dose of phosphocreatine is 0.5-4,

In the particular case of carrying out the invention a solution of creatine phosphate is administered after reperfusion (restoration of blood flow) of the infarct-related coronary artery.

In private cases, the execution of the invention spend transluminal (percutaneous) angioplasty, for example, balloon, laser or ultrasound.

In private cases, the execution of the invention the solution of phosphocreatine is injected with a constant bulk velocity of 0.1-4 ml/sec.

The achievement of the technical result due to the following reasons.

The ability of exogenous phosphocreatine to protect itemizedoverlay myocardium known for more than 20 years. Its main pharmacological effect when myocardial ischemia is to stabilize the sarcolemma of cardiomyocytes, which prevents the development of irreversible morphological changes and functional disorders of the heart muscle. Phosphocreatine enough to easily penetrate through the damaged membrane of cardiomyocytes, the effect on the physiological properties of the cell ELEH the patients blood.

The claimed method of treatment of acute myocardial infarction due to intracoronary administration of the active substance (solution phosphocreatine) in the infarct-related artery immediately after reperfusion, i.e. immediately after restoration of blood flow, allowing direct delivery of higher concentrations of phosphocreatine to itemizedoverlay the myocardium in the shortest time possible. While increasing therapeutic effect of phosphocreatine on ishemizirovanne cardiomyocytes. It is known that reperfusion syndrome can significantly worsen the condition of patients with acute myocardial infarction. The manifestation of this syndrome are maximally expressed at the time of recovery of blood flow in the infarct-related artery. The reduction of the time of receipt of the drug to prevent the development of reperfusion injury of cardiomyocytes and to reduce the consequences of its manifestations. Thus, the result is a synergistic effect of reducing the timing of the existing drug and increase its concentration directly in the field of myocardial infarction. The result is greatly reduced the number of damaged cardiomyocytes and prevents necrosis cardiomyocytes, is the localization of the medicinal product and improves blood flow to the ischemia of the heart muscle. If this is m decreases the area of necrosis of the myocardium, prevents the development of heart failure and cardiac arrhythmias in the prevention and reduction of reperfusion syndrome, also removed ischemic contracture of cardiomyocytes.

The consequence of this is to prevent prolonged risk following myocardial infarction, reducing the degree of ischemia and the reduction of treatment time. The result of this method of treatment is also a significant improvement in quality of life, disappearance or improvement of the clinical picture of angina in the absence or minimization of medication therapy.

Unlike other medicines of phosphocreatine due to the possibility of penetration through damaged membranes of cardiomyocytes directly affects the cells that can prevent the death of cardiomyocytes caused not only by necrosis, but also other factors. This explains the high efficiency of this method.

Although coronary artery bypass open heart and transluminal coronary angioplasty are quite effective ways of treatment of acute myocardial infarction, however, coronary artery bypass open heart associated with large operating injury and has some contraindications. Compared with coronary artery bypass positive aspects of coronary and gioplasty are low traumatism, high efficiency, no need for multicomponent anesthesia and the potential for re-use. Therefore, the use of coronary angioplasty is preferable to use coronary artery bypass open heart.

The claimed method is as follows.

1 g of dry matter exogenous phosphocreatine is diluted according to the instructions in 40 ml of isotonic 0.9% NaCl.

During transluminal coronary angioplasty special catheter is inserted into a blood vessel in the thigh or arm under local anesthesia and carried to the site of narrowing of the coronary arteries. At the same time carried out x-ray examination allows you to monitor the progress of the catheter. The catheter is equipped with a special device for removing atherosclerotic plaques, such as a balloon, which when extending crushes atherosclerotic plaque, causing the disruption of blood flow. The size of the spray members are selected in accordance with the size of the affected vessel and the length of the narrow section. The catheter is brought to the desired coronary artery and narrowing place inflate it. The vessel is still expanding and the flow is restored. Restoration of normal blood flow (reperfusion of the myocardium) is confirmed by the introduction of a radiopaque substance and repeat the x-rays - control coronary angiography. Immediately after restoration of blood flow reperfusion myocardial responsible artery by the catheter phosphocreatine in physiological solution with a constant bulk velocity of 0.1-4 ml/sec. Introduction of a solution of phosphocreatine with this speed does not cause side effects, considering that the average volumetric blood flow in the normal at rest in the coronary arteries is more than 6 ml/sec. The drug has a high dilution and high therapeutic index over 100. Dose entered phosphocreatine may be from 0.5 to 4 g, the time of the introduction is about 40-180 seconds.

Then the device and the catheter removed. The skin on the thigh or arm suture or dressing.

The intervention must be performed in the presence of angiographic indications and technical capabilities angioplasty.

For evaluation of the results of intracoronary injection of exogenous phosphocreatine when performing angioplasty of the infarct-related coronary artery conducted a study, which involved 20 patients of different age groups (45 to 73 years). Were allocated into two groups of 10 people each. All patients had successful angioplasty of the proximal third of the anterior interventricular branch of the left coronary artery in acute period of development infarc is and attack. The first group of patients in the angioplasty was introduced a solution of phosphocreatine according to the invention. Estimate ischemic and reperfusion damage of cardiomyocytes was performed according to the recommendations [Steawart J.T. et al. Early noninvasiwe indentefication of failed reperfusion after trombolisis in acute MI.J Am Coll Cardiol, 1998; 31, C-1505] by analyzing the concentration of a specific protein damage Troponin I after 12 hours and 24 hours after angioplasty.

12 hours after angioplasty concentration of Troponin I in the first control group consisted of 760·10-9g/ml ± 30 and in the first group - 64·10-9g/ml ± 10. In the first group of patients operated by the claimed method, evidence on the concentration of Troponin I after 12 hours were lower by more than 10 times in comparison with the second control group. Which indicates significantly less necrosis of cardiomyocytes. After 24 hours the concentration of Troponin I in the first and the control group was approximately the same at 60·10-9g/ml ± 10.

Also in the first group of in-hospital period noted a higher ejection fraction according to the ECHO KG 61±7% vs. 44±5% in the control group and higher tolerance to physical load of 100 watts to 75 watts in the control group that testimony is t o a more favorable clinical course in the group, where it was held intracoronary injection of phosphocreatine when performing angioplasty of the infarct-related artery in acute myocardial infarction.

The claimed method of treatment of acute myocardial infarction confirmed by the following examples.

Example 1.

Patient N., 56 years old, in the acute period of myocardial infarction in 8 hours after the onset of an attack of angina pain during the procedure coronary balloon angioplasty of the anterior interventricular branch of the left coronary artery, the catheter was introduced 2 g of phosphocreatine in the solution with a constant volumetric flow rate of 2 ml/sec. After transfer of the patient in the ICU postoperative period went smoothly. The patient was in the house, and after treatment the patient was discharged for outpatient treatment. At the control examination after 4 months, the patient complained of angina attacks or their equivalents, according to the data of laboratory and instrumental examination of signs of myocardial ischemia were not identified.

Example 2.

Patient K., 70 years, acute myocardial infarction within 6 hours after the start of the attack angioznyh pain during the procedure coronary balloon angioplasty of the anterior interventricular branch of the left coronary artery, the catheter was introduced 1 g of phosphocreatine in the solution with the quartering is Noah volumetric rate of 0.5 ml/sec. After transfer of the patient in the ICU postoperative period went smoothly. The patient was in the house, and after treatment the patient was discharged for outpatient treatment. At the control examination after 4 months, the patient complained of angina attacks, according to the data of laboratory and instrumental examination of signs of myocardial ischemia were not identified.

Example 3.

Patient M., aged 45, in the acute period of myocardial infarction 10 hours after the start of the attack, angina pain during the procedure coronary balloon angioplasty of the anterior interventricular branch of the left coronary artery, the catheter was introduced 1.5 g of phosphocreatine in physiological solution with a constant volumetric rate of 3 ml/sec.

After transfer of the patient in the ICU postoperative period went smoothly. The patient was in the house, and after treatment the patient was discharged for outpatient treatment. At the control examination after 4 months, the patient complained of angina attacks or their equivalents, according to the data of laboratory and instrumental examination of signs of myocardial ischemia were not identified.

The given examples show that the use of the claimed method and application do not depend on the age of the patients and are effective the cult for all age groups.

Thus, the claimed method of treatment of acute myocardial infarction and the use of phosphocreatine intracoronary administration in the restored blood flow to the infarct-related artery ensure contact of high concentrations of phosphocreatine directly to itemizedoverlay the myocardium, and thus greatly increases therapeutic effect of the medicinal product. From the above examples it is seen that after carrying out the claimed method of treatment and use of the solution phosphocreatine decreased significantly (approximately 10 times) the number of corrupted cardiomyocytes and prevents the development of reperfusion necrosis cardiomyocytes.

In all cases, were not serious complications occurred only a hematoma at the puncture site (2 cases), hemodynamic disturbances, which do not require special treatment (2 cases), pain syndrome (4 cases) during balloon inflation, and in neither case did not require the use of narcotic drugs. Patients after treatment in the ICU did not report discomfort or discomfort in the chest.

The positive clinical effect of treatment of acute myocardial infarction and use of phosphocreatine was estimated as the disappearance of subjective symptoms of angina and improvement in functional class, the strokes, at least two levels (classification I-IV functional class in NY). No recurrence of angina within 6 months confirms a good long-term results and allows you to cancel anticoagulant therapy. The claimed invention allows to reduce the number of complications. In none of the performed interventions were not observed cardiac rhythm or a second heart attack. There was not one death. The method reduces the time of stay of the patient in the intensive care unit up to 3-4 days.

Patients after treatment usually return to normal activities without a long recovery period required after surgery surgical intervention. Thus melodramatically intervention allows the patient not to change things that often very important for him, because it is an important psychological factor in rehabilitation.

1. A method of treating acute myocardial infarction, including the introduction of intracoronary solution phosphocreatine, characterized in that the solution of phosphocreatine injected into the infarct-related artery when performing coronary angioplasty, and injected dose of phosphocreatine is 0.5-4,

2. The method according to claim 1, characterized in that the solution of phosphocreatine is administered after reperfusion of the infarct-related artery.

3. The way is about to claim 1, characterized in that the solution of phosphocreatine is injected with a constant bulk velocity of 0.1-4 ml/s

4. The method according to claim 1, characterized in that conduct transluminal balloon angioplasty.



 

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