ORIGINAL RESEARCH
Cardiology
doi: 10.25005/2074-0581-2026-28-2-346-355
COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF PERCUTANEOUS CORONARY INTERVENTION AND THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND ATRIAL FIBRILLATION

E.N. TASHKENBAEVA1, Z.A. NASIROVA1, A.O. LAHANOV2

1Department of Internal Diseases and Cardiology No. 2, Samarkand State Medical University, Samarkand, Republic of Uzbekistan
2Rhythm Disorders Department, Samarkand Branch of the Republican Specialized Scientific and Practical Center of Cardiology, Samarkand, Republic of Uzbekistan

Objective: To conduct a comparative analysis of the effectiveness of different revascularization methods – percutaneous coronary intervention (PCI) and thrombolytic therapy (TLT) – regarding clinical, functional, and hemodynamic parameters, as well as disease outcomes, in patients with acute myocardial infarction (AMI) and paroxysmal atrial fibrillation (AF).

Methods: A total of 124 patients with AMI and various forms of AF were examined at the Samarkand Regional Branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology, Samarkand, Uzbekistan. Of these, 92 patients underwent PCI and 32 received TLT. The study was conducted over three years (2021-2023). Treatment effectiveness was assessed based on: restoration and maintenance of sinus rhythm (SR); changes in left ventricular ejection fraction (LVEF); bleeding risk (HAS-BLED scale); thromboembolic risk (CHA₂DS₂-VASc scale); AF symptom severity (modified EHRA scale); quality of life (modified Libis R.A. questionnaire); and the incidence of major adverse cardiovascular events.

Results: Statistically significant differences between the PCI and TLT groups demonstrated the clinical superiority of the invasive approach. Key findings included: higher rates of SR restoration (93.4% vs. 68.7%, p<0.001); superior improvement in LVEF (p=0.03); and lower risks of both bleeding (0.04±0.00 vs. 0.20±0.03, p<0.001) and thromboembolic complications (0.03±0.11 vs. 0.20±0.57, p=0.01). Furthermore, PCI patients showed lower AF symptom severity (EHRA I, p=0.002; EHRA IIb, p=0.003), improved quality of life (specifically regarding low mood, p=0.005; depression, p=0.047; and loss of interest, p=0.049), and a lower incidence of acute heart failure (p=0.023).

Conclusion: PCI demonstrates clear advantages over TLT in patients with AMI and AF. These benefits include higher SR recovery rates, more significant LVEF improvement, reduced risks of bleeding and thromboembolism, milder AF symptoms, better quality of life, and a lower incidence of acute heart failure.

Keywords: Myocardial infarction, atrial fibrillation, revascularization, percutaneous coronary intervention, thrombolytic therapy.

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References
  1. Zhirov IV, Safronova NV, Osmolovskaya YuF, Tereshchenko SN. Prognosticheskoe znachenie fibrillyatsii predserdiy u patsientov s serdechnoy nedostatochnostyu s raznoy fraktsiey vybrosa levogo zheludochka: rezul’taty mnogotsentrovogo registra RIF-KhSN [Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: Results of the multicenter RIF-CHF registry]. Rossiyskiy kardiologicheskiy zhurnal. 2021;26(1):4200. https:// doi.org/10.15829/1560-4071-2021-4200
  2. Tatarintseva ZG, Kosmachyova ED, Porkhanov VA, Kruchinova SV. Ekhokardiogra- ficheskie dannye pri fibrillyatsii predserdiy v sochetanii s ostrym koronarnym sin- dromom v real’noy klinicheskoy praktike po dannym total’nogo registra ostrogo koronarnogo sindroma po Krasnodarskomu krayu [Echocardiographic data in atrial fibrillation combined with acute coronary syndrome in real clinical practice accord- ing to the Krasnodar regional registry]. Kardiovaskulyarnaya terapiya i profilaktika. 2019;18(2):20-5. https://doi.org/10.15829/1728-8800-2019-2-20-25
  3. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in pa- tients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119-77. https://doi.org/10.1093/eurheartj/ehx393
  4. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients pre- senting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289- 367. https://doi.org/10.1093/eurheartj/ehaa575
  5. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the Europe- an Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the di- agnosis and management of atrial fibrillation of the European Society of Car- diology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. https:// doi.org/10.1093/eurheartj/ehaa612. Erratum in: Eur Heart J. 2021;42(5):507. https://doi.org/10.1093/eurheartj/ehaa798. Erratum in: Eur Heart J. 2021;42(5):546-7. https://doi.org/10.1093/eurheartj/ehaa945. Erratum in: Eur Heart J. 2021;42(40):4194. https://doi.org/10.1093/eurheartj/ehab648
  6. Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217- 21. https://doi.org/10.1177/1747493019897870
  7. Lopes RD, Hong H, Harskamp RE, Bhatt DL, Mehran R, Cannon CP, et al. Optimal antithrombotic regimens for patients with atrial fibrillation undergoing PCI: an updated network meta-analysis. JAMA Cardiology. 2020;5(5):582-9. https://doi. org/10.1001/jamacardio.2019.6175
  8. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A , et al. 2018 ESC/ EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87- 165. https://doi.org/10.1093/eurheartj/ehy394
  9. Cannon CP, Bhatt DL, Oldgren J, Lip GYH, Ellis SG, Kimura T, et al. Dual anti- thrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377(16):1513-1524. https://doi.org/10.1056/NEJMoa1708454
  10. Kim JH, Martinez MW, Guseh JS, Chung EH, Finocchiaro G, Harmon KG, et al. A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes. The Lancet. 2024;404(10468):2209-22. https://doi. org/10.1016/S0140-6736(24)02086-5.
  11. Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, et al. Ti- cagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med. 2019;381(21):2032-2042. https://doi.org/10.1056/NEJMoa1908419
  12. Lopes RD, Hong H, Harskamp RE, Bhatt DL, Mehran R, Cannon CP, et al. Optimal antithrombotic regimens for patients with atrial fibrillation undergoing PCI: An updated network meta-analysis. JAMA Cardiology. 2020;5(5):582-9. https://doi. org/10.1001/jamacardio.2019.6175
  13. Gargiulo G, Goette A, Tijssen J, Eckardt L, Lewalter T, Vranckx P, et al. Safety and efficacy of early aspirin discontinuation in patients with atrial fibrillation under- going PCI. Circulation. 2019;139(5):604-16. https://doi.org/10.1161/CIRCULA- TIONAHA.118.036004
  14. Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Nakamura M, et al. Antithrom- botic therapy for atrial fibrillation with stable coronary disease. N Engl J Med. 2019;381(12):1103-13. https://doi.org/10.1056/NEJMoa1904143
  15. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM; Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS Guideline for the Di- agnosis and Management of Atrial Fibrillation: A Report of the American Col- lege of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1-e156. https://doi.org/10.1161/ CIR.0000000000001193. Erratum in: Circulation. 2024;149(1):e167. https://doi. org/10.1161/CIR.0000000000001207. Erratum in: Circulation. 2024;149(9):e936. https://doi.org/10.1161/CIR.0000000000001218. Erratum in: Circulation. 2024;149(24):e1413. https://doi.org/10.1161/CIR.0000000000001263
  16. Matsuoka Y, Minamiguchi H, Sakamoto D, Sunaga A, Okada K, Nakatani D, et al. Add-on antiplatelet therapy in anticoagulated patients with atrial fibrilla- tion. IJC Heart & Vasculature. 2026;64:101907. https://doi.org/10.1016/j.ij- cha.2026.101907

Authors' information:

Tashkenbaeva Eleonora Negmatovna,
Doctor of Medical Sciences, Full Professor, Head of the Department of Internal Diseases and Cardiology No. 2, Samarkand State Medical University
ORCID ID: 0000-0002-9942-2910
E-mail: Eleonora_88@mail.ru

Nasirova Zarina Akbarovna,
Doctor of Medical Sciences, Acting Associate Professor, Department of Internal Diseases and Cardiology No. 2, Samarkand State Medical University
ORCID ID: 0000-0002-8722-0393
E-mail: zarina.nasirova91@mail.ru

Lahanov Asror Olimkulovich,
Interventional Cardiologist, Rhythm Disorders Department, Samarkand Branch of the Republican Specialized Scientific and Practical Center of Cardiology
ORCID ID: 0009-0008-1560-4612
E-mail: Asrorjon.laxanov@mail.ru

Information about support in the form of grants, equipment, medications

This study was conducted at the Samarkand Branch of the Republican Research Center of Emergency Medicine and the Samarkand Branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology. This work was supported by the applied grant PZ-20170927280: "Development of molecular genetic methods for predicting unstable angina variants and a personalized approach to their therapy". The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Nasirova Zarina Akbarovna
Doctor of Medical Sciences, Acting Associate Professor, Department of Internal Diseases and Cardiology No. 2, Samarkand State Medical University

140100, Republic of Uzbekistan, Samarkand, Amir Temur str., 18

Tel.: +998 (902) 768950

E-mail: zarina.nasirova91@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

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