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CNAA / Theses / 2016 / June /

Long term effects of conservativ treatment of acute myocardial infarction versus late revascularization


Author: Lazu Mihaela
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2016
Scientific adviser: Ion Popovici
doctor habilitat, professor
Scientific consultant: Nicolae Ciobanu
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Institution: Medical-Sanitary Public Institution Institute of Cardiology

Status

The thesis was presented on the 17 June, 2016
Approved by NCAA on the 6 October, 2016

Abstract

Adobe PDF document – 1.45 Mb / in romanian

Thesis

CZU 616.127-005.8-073.43-085/-089.844

Adobe PDF document 2.93 Mb / in romanian
150 pages

Keywords

optimal drug therapy, percutaneous coronary angioplasty, regional left ventricular dysfunction

Summary

The thesis is exposed on 150 pages and consists of introduction, four chapters, conclusions, practical recommendations, summarized in Romanian, Russian and English and bibliography with 120 sources. Illustrative material includes 21 tables and 41 figures. The results are published in 11 scientific papers. Field of study:cardiology. Aim: Long term comparative clinic-funcțional evaluation of patients with anterior myocardial infarction with Q wave exposed to conservativ treatment versus late revascularization.

Objectives: ●Clinic and ecocardiografic evaluation of patients with anterior myocardial infarction with Q wave in admission period (1-30 days after infarction). ●Evaluation of the effects of conservative treatment of acute myocardial infarction versus late revascularization on EcoCG and effort indices, as well as regional systolic dysfunction dynamics during post-infract evolution of 18 months. ●Assessment of the predictors of benefic clinic-functional evolution of patients with anterior myocardial infarction with Q wave underwent late revascularization.

Scientific novelty: Evalution of the effects of late revascularization of myocardium in anterior myocardial infarction with Q wave on long term clinic-funcțional dynamics (18 months). Important scientific problem solved in the thesis consist in elucidation of the peculiarities of myocardial remodeling in patients with Q-wave anterior infarction undergoing late revascularization with angioplasty and beneficial factors influencing the dynamics of post-infarction period, which contributes to strengthening the concept of clinical and funcțional development in post-myocardial revascularization myocardium and optimization based on pre-procedure predictors of interventional therapy election.

Theoretical significance: Late revascularization in pacients with anterior myocardial infarction with Q wave influences similarly to conservative treatment the regional systolic dysfunction in fist 6 months, but a superior patern is emphasized in a period >12 months.

The value of work: Late revascularization of pacients with anterior myocardial infarction with Q wave has superior clinic-funcțional benefits during period of 6-18 months compared to conservative treatment if it is applied earlier of 7 days, coronary lesions are monovascular and require a stent with diameter >3,5 mm, and hense, could be an election therapy.

Implementation of scientific results: The findings were approved as scientific value and were implemented in current curative activity at the Institute of Cardiology and Clinical Hospital ”Sfânta Treime”.