COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF PERCUTANEOUS CORONARY INTERVENTION AND THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND ATRIAL FIBRILLATION

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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