The choice of treatment for myocardial infarction based on individual cardiovascular risk and symptoms of coronary heart disease

According to the data of hospital mortality of patients of the Shymkent cardiological center, the most frequent case of the indicator at the stationary stage in patients with myocardial infarction occurs when the class of acute heart failure according to Killip II-IV is determined in patients, the level of blood glucose is more than 8.0 mmol/l, the level of blood creatinine is more than 123.8 mmol/l and the absence of arterial hypertension when entering the clinic. The main causes of mortality among such elderly and senile patients were Killip class II-IV, blood glucose level of more than 7.30 mmol/l, blood creatinine level of more than 141.4 mmol/l, belonging to the female sex and the absence of hypertension on admission. Implementation of coronary artery stenting taking into account risk factors affecting mortality in hospital in patients with acute myocardial infarction leads to a decrease in hospital mortality and long-term mortality, compared with conservative treatment. Implantation of drug-coated stents and uncoated metal stents equally reduced the mortality rate of myocardial infarction in patients. In elderly and senile patients with myocardial infarction in combination with diabetes mellitus after coronary artery stenting there is a deterioration in long-term survival. Long-term survival at the end of 2010-2018 was 83.67%, while in patients with concomitant diabetes mellitus - only 40.03%, p=0.045 (Log-rank test). Thrombolytic therapy did not improve survival in hospital and long-term patients in the elderly and senile age group. Implementation of thrombolysis in elderly and senile patients hospitalized up to 1.5 hours from the onset of symptoms of myocardial infarct, leads to an unreliable reduction in mortality (p=0.085), hospitalized later than 1.5 hours - there is an increase in mortality compared with patients without thrombolysis(p=0.848). Coronary stenting in acute myocardial infarction reduced mortality in elderly and senile patients regardless of the time between the onset of symptoms of myocardial infarction and hospitalization (p=0.486 and p=0.004).