Features Of Acute Coronary Syndrome Research Articles

Features of acute coronary syndrome in migrant workers

Cardiovascular diseases of migrant workers are an additional burden on the health care system of many countries in Europe, the United States, and Russia. The prevalence of risk factors among migrants is associated with the country of origin of migrants, the duration of migration, low socioeconomic conditions of residence in the host country, psychological stress, significant physical exertion, violations of work and rest, malnutrition, the spread of harmful factors (smoking, alcohol, narcotic substances), limited access to medical services. The results of the study are presented, indicating that smoking is more common among migrant workers, hypertension levels, total cholesterol, triglycerides, high-density lipoproteins, and low-density lipoproteins are higher in comparison with the indigenous inhabitants of Russia. When performing coronary angiography in patients with acute coronary syndrome in migrant workers, despite their younger age, several vascular lesions are significantly more often detected. The data of the conducted study demonstrate high risks of cardiovascular diseases among migrant workers, which requires organizational measures to prevent them.

Myocardial infarction in patients with HIV infection: incidence, risk factors, pathogenesis, clinical performance and treatment

HIV infection increases the risk of premature myocardial infarction (MI) and other atherosclerotic cardiovascular diseases, which are the main noncommunicable cause of death in HIV-infected patients. The review presents the analysis of recent literature on the incidence, prevalence and risk factors of MI in HIV-infected people. It established that MI is associated with the combined effects of traditional cardiovascular risk factors, HIV infection and the cardiometabolic effects of antiretroviral therapy. Pathogenetic features of acute coronary syndrome in HIV infection under conditions of systemic immune-mediated inflammation, hypercoagulation and direct exposure to the virus are highlighted. The clinical features and coronary damage in MI are described. Methods of treating MI are compared. We concluded that the volume and quality of care for patients with HIV and MI is insufficient. From the perspective of possible drug interactions with antiretroviral therapy, effectiveness and safety of methods for secondary prevention of MI was analyzed.

Takotsubo cardiomyopathy following envenomation: An updated review.

Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation. This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC. In this review, we included all studies on "TTC" and "envenomation "published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation. A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure. Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.

Takotsubo Cardiomyopathy: Narrative Review With Relation to COVID-19

Takotsubo cardiomyopathy (TC) is a unique heart disease which mimics the clinical symptoms and features of acute coronary syndrome (ACS) and is seen more commonly in postmenopausal females. In this condition, abnormal electrocardiographic findings like ST-segment elevation/depression, T wave inversion, and an abnormal/absence of Q wave, along with echocardiographic disturbances like regional wall motion abnormalities and a sudden decrease in the ejection fraction are observed. However, coronary angiography shows no coronary artery obstruction. Interestingly, the left ventricle in TC develops a characteristic appearance similar to that of a “Tako-tsubo” (Japanese pot). Such peculiar observations become important when diagnosing TC in a clinical setting. TC is often caused by a catecholamine surge due to mass sympathetic activation usually preceded by an emotional/physical trigger, however the exact etiology and mechanism of pathophysiology still remain unclear. With growing awareness and prevalence of TC, it becomes crucial for clinicians to differentially diagnose TC from other heart conditions with the help of well-known diagnostic tools. Moreover, amidst the ongoing pandemic, the cytokine storm associated with COVID-19 may be accompanied with a catecholamine surge in the body, which in turn might increase the risk and incidence of TC in patients.

Clinical Features of Acute Coronary Syndrome in Patients with Coronary Heart Disease and Its Correlation with Tumour Necrosis Factor in Cardiology.

Tumour necrosis factor (TNF) levels are higher in patients who have experienced an acute ischemic stroke. Greater levels of TNF may not be linked to an increased risk of recurrent coronary events in the stable phase after myocardial ischemia (MI). Coronary atheroma is connected to endothelial and smooth muscle cells, as well as macrophages that emit the multifunctional cytokine tumour necrosis factor (TNF). Transplanted tumours become more vulnerable when TNF-α was first recognized to have a function in hemorrhagic necrosis. TNF-α has been demonstrated to induce heart failure, pulmonary edoema, and cardiomyopathy in people with advanced heart failure when it is elevated in the bloodstream. It has been postulated that prolonged overexpression of TNF-α after ischemia may contribute to poor cardiac outcomes by increasing TNF-α when the myocardium undergoes both temporary ischemia and reperfusion. A rise in TNF levels has been seen after a myocardial infarction, but it is unclear if these higher levels, found months after the initial event, are associated with an increased risk of subsequent heart attacks. We looked at TNF levels in the blood of 270 patients with coronary heart disease in the Chinese Hypertension League's Cholesterol and Recurrent Events (CARE) experiment to see if this notion held true. Recurrent coronary syndrome and coronary mortality were monitored prospectively in the participants. The min max imbalance normalization can be used to assess a patient's baseline characteristics, including hormone and cholesterol test results. Type 2 stimulant connection to aggregate the TNF-signaling qualities and fuzzy techniques was applied. There may now be enough preliminary evidence from the crucial bundle neural network analysis to identify the risk of coronary heart disease associated with TNF pregeneration studies. The tests were assessed using a variety of methods and performance metrics in a Matlab environment.

Regional, Ethnic and Age-Sexual Features of Acute Coronary Syndromes in Fergana Region

Background. Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. The most important behavioral risk factors for heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Exposure to behavioral risk factors can manifest in humans as high blood pressure, high blood glucose, high blood lipids, and overweight and obesity. Methods. The research was conducted on hospitalized male and female patients aged from 26 to 88 years with suspicion of the acute coronary syndrome (ACS) at the time of admission to the hospital in the Andijan and Fergana Valley. Overall, 653 patients were examined. The study included a retrospective and prospective part with the inclusion of patients with ACS. Findings. Fairly wide prevalence of ACS was revealed in terms of their epidemiological characteristics in both gender groups, as well as in different age groups. It is necessary to improve the work on "life-saving prevention" among the population in relation to an adequate assessment of the symptoms of CVD in patients and the implementation of medical recommendations for optimizing prevention, early detection and treatment of ACS.

Distinct pathological mechanisms distinguish acute coronary syndrome caused by plaque erosion from plaque rupture.

The current systematic review aims to provide novel insights into the distinct pathological features of acute coronary syndrome (ACS) with intact fibrous cap, also known as 'plaque erosion'. A more detailed understanding of its underlying pathomechanisms provides the basis for future personalized therapeutic approaches to ACS. In the past years, a mounting proportion of evidence point towards the concept of plaque erosion being responsible for more than one-third of all cases of ACS and representing an autonomous ACS-causing entity driven by biomechanical forces, immunological alternations and systemic elevation of inflammatory mediators. First pilot studies proved a therapeutic paradigm shift from primary PCI at the ACS-causing culprit lesion to systemic therapies in patients with ACS caused by plaque erosion. This review provides the current status of the broad basic and clinical studies focused to the topic of plaque erosion: a new ACS-causing pathophysiology with different pathological aspects providing appropriate implications for personalized therapies in ACS.

Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

Relevance. The presence of oncological diseases, high polymorbidity in elderly and senile patients can lead to a complicated course of acute coronary syndrome, including the development of acute kidney injury and/or chronic kidney disease, which contributes to a deterioration of the immediate and long-term prognosis and an increase in mortality.The research purposes. To study the course of acute coronary syndrome depending on the presence or absence of oncological diseases in elderly and senile people and to identify clinical and laboratory-instrumental features.Materials and methods. The study included 200 patients (men — n=122 (61 %), women — n=78 (39 %), Me age — 69 (65;77) years). The patients were divided into two groups: 1) the main group — acute coronary syndrome in combination with oncological diseases (n=100) (men — n=61 (61 %), women — n=39 (39 %), Me age — 69 (65;77) years); 2) the comparison group — acute coronary syndrome without oncological diseases (n=100). The groups were formed by the copy-pair method in a ratio of 1:1 by gender and age. All patients were evaluated for anamnesis parameters, the total number of diseases, the Charlson comorbidity index, the main clinical and laboratory-instrumental parameters and the development of complications. We collected an average portion of morning urine on the first day of hospitalization to determine the content of KIM-1 (pg/ml) in 40 patients of the main group and 47 from the comparison group. We collected daily urine on the 2nd day of hospital treatment to determine the level of K+, Na+, Cl-, uric acid and albumin.The results. Patients of the main group, according to the anamnesis, were more often diagnosed with stable angina (p = 0.042), diabetic kidney disease (p = 0.017), chronic kidney disease (p = 0.013) and anemia (p = 0.008). In addition, these patients had a higher Charleson comorbidity index [8 (6; 9) and 5 (4; 6) points; p <0.001] and a total number of diseases [6 (5; 7) and 4 (3; 5); p <0.001]. Patients with oncological diseases with the development of acute coronary syndrome more often complained of shortness of breath (p=0.008) and heart rhythm disturbance (p=0.004). In patients of the main group a lower left ventricular ejection fraction was diagnosed [51.0 (44; 55) and 54 (48; 57), p=0.013]. Acute kidney injury was more frequently diagnosed in the study group than in the comparison group (p <0.001), including acute kidney injury by “basal” creatinine (p=0.005), acute kidney injury by creatinine dynamics (p=0.047), and acute kidney injury by chronic kidney disease (p=0.003). The KIM-1 leel in patients of the main group was higher [921.0 (425.1; 1314.8) and 658.0 (345.6; 921.4) pg/ml; p=0.011]. In patients with acute kidney injury, in contrast to patients without acute kidney injury, a higher level of KIM-1 was detected [999.2 (480.8;1314.1) and 663.1 (360.5;905.2) pg/ml; p=0.008]. Patients with acute coronary syndrome and oncological diseases in the hospital were more likely to develop urgent complications (p=0.005), including death (p=0.024) and acute heart failure (p <0.001). They also had a higher incidence of early post-infarction angina (p=0.018) and anemia (p=0.005).Conclusions. Our study found that patients in the main group had a higher Charlson comorbidity index, a greater number of diseases, including stable angina, diabetic kidney disease, chronic kidney disease, and anemia. These patients with the development of acute coronary syndrome more often complained of shortness of breath and heart rhythm disturbance. Patients with oncological diseases were more often diagnosed with acute kidney damage, including “basal” creatinine, creatinine dynamics, and chronic kidney disease. The level of KIM-1 in the urine was higher in this group of patients. Patients of the main group in the hospital were more likely to develop urgent complications, including acute heart failure and death. There was also a high incidence of early post-infarction angina and anemia.

The Management of Coronary Artery Disease in Ethiopia: Emphasis on Revascularization.

Cardiovascular diseases are number one cause of death worldwide. Over half of the cardiovascular diseases, 51%, are due to coronary artery disease. Coronary artery disease is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial coronary arteries. Rupture of the fibrous cap of the plaque causes the majority of the deaths due to myocardial infarction. Angina pectoris is a discomfort in the chest or adjacent areas caused by myocardial ischemia usually precipitated by exertion. In acute coronary syndrome, the chest discomfort is either of low threshold or appears at rest and when it evolves on the background of established angina pectoris, the discomfort becomes more frequent and prolonged. Exercise electrocardiography which has been the most frequently used non-invasive test to diagnose obstructive coronary artery disease is currently shown to have inferior diagnostic performance compared with diagnostic imaging tests. The pivotal tests in patients presenting with clinical features of acute coronary syndrome are electrocardiography and determination of serum troponin I and/or T. Revascularization is the mainstay of treatment in patients with acute coronary syndrome. In chronic coronary syndrome, on top of optimal medical treatment, revascularization reduces mortality in:- 1) left main stenosis, 2) three-vessel coronary artery disease, particularly with ejection fraction of less than 40%, 3) two vessel disease with more than 75% stenosis of the proximal left anterior descending coronary artery disease.

Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism

Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were <45 years old, p<0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p<0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p<0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p<0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p<0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p<0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p<0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Funding Acknowledgement Type of funding source: None

Acute Coronary Syndrome with Non-ruptured Plaques (NONRUPLA): Novel Ideas and Perspectives.

In this review article, we focus on the mechanisms and features of acute coronary syndromes (ACS) with no ruptured plaque (NONRUPLA) highlighting the uncertainties over diagnostic evaluation and treatment. The most common cause of ACS is obstruction due to atherosclerotic plaque ruptured or erosion. In 14% of patients who present in the Emergency Department as myocardial infarction, the final diagnosis is ACS with NONRUPLA. Although the clinical presentation of NONRUPLA may mimic myocardial infarction, the underlying pathogenesis is different, and it may guide therapeutic approaches and overall prognosis that vary according to etiology. The possible mechanisms of ACS with NONRUPLA are coronary embolism, acute dissection of the aorta or coronary artery, vasospasm, microvascular dysfunction, the imbalance between oxygen demand and supply, coronary trauma and stent complications, direct cellular toxicity and damage, Takotsubo syndrome, and myocardial infarction with non-obstructive coronary arteries (MINOCA).

Clinical and angiographic features of acute coronary syndrome in young adults: A Tunisian Cohort

Acute coronary syndrome (ACS) in young adults seems to be not as low as expected. It presents one of the highly debated issues in cardiology according to the increasing number of those patients. The aim of our study was to describe the clinical and angiographic profile in young patient ≤ 40 years diagnosed with ACS. We performed a retrospective study including 74 patients younger than 40 years of age with clinical and electrocardiographic evidence of ACS, hospitalized in our cardiology department from January 2016 to Mach 2019. All patients underwent a coronary angiography. We analyzed the risk factors, clinical profile, type of ACS and angiographic features of these patients. Mean age was 33 ± 7 years old [26-40] and 94% of them were males (five women versus 70 men). All men were smokers, including four man addicted on cannabis, and only two women were non-smokers. The most common risk factors were diabetes mellitus (14 patients; 19%), systemic hypertension (10 patients; 13.5%), dyslipidemia (7 patients; 9.4%), obesity (7 patients; 9.4%) and a family history of premature coronary artery disease (5 patients; 6.7%). Ten patients (13.5%) were having ST segment elevation myocardial infraction, 13 patients (17.5%) were hospitalized for a non-ST segment elevation and 51 patients (69%) have a history of an unstable angina. The most common abnormal arteriography findings were the involvement of one vessel (23 patients; 31%), followed by double-vessel disease noticed in two cases (2.7%). There was one patient of our population with three-vessel disease (1.3%). The most common vessel to be involved was the left anterior descending (12 cases; 16%). Normal coronary angiography was noticed in 37 patients (50%). ACS in young patients has a huge impact on the patient, the society and the economic burden. It presents a real challenge that the cardiologist must be aware of in order to set on the ideal therapeutic strategy including the perfect clinical management and an early prevention program to control the cardiovascular risk factors.

Vitamin D binding protein polymorphysm in patients with acute coronary syndrome in kaliningrad region

BACKGROUND: Vitamin D binding protein is a main vitamin D carrier in serum. It also has an impact on macrophagial function. Role of vitamin D and macrophages in the pathogenesis of atherosclerosis is scientifically proven but there is lack of data on vitamin D binding protein in this regard.
 AIMS: To evaluate the vitamin D binding protein polymorphism in patients with acute coronary syndrome without diabetes mellitus, autoimmune diseases and malignant tumors. Determine correlation, if there is, between vitamin D binding protein allele and features of acute coronary syndrome among this patient group.
 MATERIALS AND METHODS: It is a cross-sectional observational study. Study subjects are patients with acute coronary syndrome. Exclusion criteria are the presence of diabetes mellitus, autoimmune diseases and malignant tumors. In all participants were evaluated: predisposing factors for heart diseases, CBC, biochemical blood test, troponin, coronarography, echocardiography. The study lasted for 5 months from November 2017 until March 2018. Primary end point assessment of vitamin D binding protein polymorphysm in this group of patients with acute coronary syndrome by means of vitamin D binding protein gene sequencing. 50 patients were enrolled into this study who were urgently admitted to hospital and diagnosed with acute coronary syndrome. Among them 36 males and 14 females. Mean age was 60 (55;66) years. All participants were sequenced for single nucleotide polymorphysm in VDBP p.T436K (rs4588) and P.432E (rs7041).
 RESULTS: Gene polymorphysms of interest were found in 43 patients among 50 enrolled. Haplotype Gc1s/2 (rs7041G-rs4588A) was found in 7 (14%) patients, Gc2 (rs7041T-rs4588A) in 9 (18%) patients, Gc1s (rs7041G-rs4588C) in 20 (40%) patients, Gc1f (rs7041T-rs4588C) in 14 (28%). Coronarography showed that coronary artery occlusions obstructing more than 50% of vessel lumen was found in 16 patients; obstruction greater than 90% was seen in 8 patients; total occlusion in 4 patients.
 CONCLUSIONS: In patient group with acute coronary syndrome prevalence of vitamin D binding protein gene polymorphysm was high in 86% of participants. The features of Gc2 haplotype were higher frequency of recurrent myocardial infarction and total coronary artery occlusion, as well as tendency to decreased serum vitamin D3 (25(OH)D) levels.

Young male with heart failure and negative angiogram

A young previously well male presented with features of acute coronary syndrome and heart failure. ECG showed inferior ST elevations but his cardiac markers and angiogram was negative. He was found to have a large abdominal paraganglioma with normal adrenal glands. He had a successful excision of the tumor and is now under life- long surveillance. He is awaiting genetic testing.

Particularités des syndromes coronariens aigus chez la femme en Afrique subsaharienne

IntroductionAcute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar. MethodologyThis was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar. ResultsThe prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P=0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer (=0.005). Therapeutically, medical care was almost identical regardless of gender. ConclusionIn Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign.

Correlation between malnutrition and acute coronary syndrome in the elderly with comprehensive geriatric assessment

Objective To analyze the influence of malnutrition in the elderly patients with acute coronary syndrome on related factors and short-term prognosis. Methods 415 elderly patients with acute coronary syndrome were selected.Comprehensive geriatric assessment was used to investigate the risk of acute coronary syndrome by examining coexisting diseases and using the NRS2000 score.The mortality and emergency visits were followed up. Results The patients were divided into two groups according to NRS2000 score: malnutrition group (n=179) and non-malnutrition group (n=236). (1) In malnutrition group, the proportions of female, over 85 years old, more than 3 kinds of coexisting diseases were 47.5%(85/179), 11.7%(21/179), 62.6%(112/179), respectively, which were higher than those of the non-malnutrition group[36.9%(87/236), 4.7%(11/236), 41.9%(99/236)](χ2=4.732, 7.152, 17.318, all P<0.05). (2) In malnutrition group, the incidence rates of geriatric syndromes such as uracratia, falls, visual disorder, hearing disorder, constipation, sleep disorders, oral problems were 47.5%(85/179), 30.2%(54/179), 40.2%(72/179), 41.9%(75/179), 54.7%(98/179), 52.0%(93/179), 76.5%(137/179), respectively, which were higher than those of the non-malnutrition group[31.4%(74/236), 14%(33/236), 29.2% (69/236), 29.7% (70/236), 30.5%(72/236), 36.0%(85/236), 53.0%(125/236)](χ2=11.206, 16.092, 5.477, 6.707, 24.732, 10.577, 24.297, all P<0.05). (3) In malnutrition group, the incidence rates of coexisting chronic diseases such as hypertension, chronic obstructive pulmonary disease, heart failure, severe renal insufficiency, cerebrovascular disease, dementia, anemia, osteoporosis were 77.1%(138/179), 16.2% (29/179), 22.9%(41/179), 17.9%(32/179), 46.9%(84/179), 6.7%(12/179), 27.4%(49/179), 26.8%(48/179), respectively, which were higher than those of the non-malnutrition group[61.9%(146/236), 7.6%(18/236), 14.4%(34/236), 7.2%(17/236), 32.2%(76/236), 1.3%(3/236), 13.1%(31/236), 17.4%(41/236)](χ2=10.931, 7.451, 4.965, 11.137, 9.315, 8.624, 13.262, 5.388, all P<0.05). (4)Cox regression analysis showed that malnutrition risk score was the independent risk predictor for all-cause mortality (HR=0.034, 95% CI: 0.072-0.904) and emergency department visits (HR=0.328, 95% CI: 0.197-0.548) in elderly patients with acute coronary syndrome. Conclusion Comprehensive geriatric assessment and nutritional assessment are useful to evaluate the clinical features of acute coronary syndrome in elderly patients.Malnutrition risk score is an independent predictor of all-cause mortality and emergency treatment in elderly patients with acute coronary syndrome. Key words: Coronary disease; Comprehensive geriatric assessment; Aged; Malnutrition

Clinical and epidemiological features of acute coronary syndrome in the city of Kemerovo

Clinical and epidemiological features of acute coronary syndrome in the city of Kemerovo

Abstract 162: Evolution of Acute Coronary Syndrome Treatment During Last Years in Russian Hospitals (Based on Results of RECORDs Registries)

Background and Purpose: The prospective registries are the most powerful evaluation tool to characterize patients and features of acute coronary syndrome (ACS) treatment. There have been a lot of changes in ACS treatment in Russian hospitals in recent 5-7 years. The aim of our study was to evaluate changes in the ACS treatment occurred in Russia during the last few years. Methods: We conducted the series of independent registries of ACS which were organized by the initiative of their participants - RECORD registries. The first regi stry was held in 2007 (18 centers in 13 cities, n=796). The RECORD-2 registry was conducted in 2009-2011 (7 centers in 7 cities, n=1656). In this analysis pooled data of the RECORD and RECORD-2 (“old” registries; n=2452) were compared with data of the RECORD-3 (“new” registry), conducted in March-April 2015 (47 centers in 37 cities, n=2370). Results: In comparison with “old” registries significantly more patients from “new” registry were hospitalized in PCI-capability hospitals (72.5% vs 56.7%; p&lt;0.0001). The rate of troponin detection was also higher in “new” registry (75.7% vs 41.5%; p&lt;0.0001). The rate of primary PCI (pPCI) in ST-elevation myocardial infarction (STEMI ) was 39.0% in “new” and 36.3% in “old” registry (p=0.24). The rate of pPCI in PCI-capability centers wasn’t also significantly higher in “new” registry (47.2% vs 45.8%). The rate of fibrinolysis in STEMI was nearly similar (32.1% vs 32.2%; p=0.98), but the rate of prehospital fibrinolysis and the rate of PCI after fibrinolysis became more frequent in “new” registry (50.9% vs 23.5%; p&lt;0.0001 and 52.4% vs 25.0%; p&lt;0.0001 respectively). In patients with non-ST elevation ACS (NSTEACS) the rate of diagnostic coronarography (CAG) and the rate of PCI within 72 hours after admission weren’t significantly different in “new” and “old” registries (68.2% vs 71.8%; p=0.15 and 26.6% vs 23.6%; p=0.19 respectively). Among discharge medication from “old” to “new” registries decreasing of aspirin and beta-blockers prescription (89.7% and 91.3%; p=0.009 and 86.0% vs 90.2%; p&lt;0.0001 respectively) and increasing of dual antiplatelet therapy and statin prescription (82.6% vs 43.7%; p&lt;0.0001 and 90.9% vs 78.1%; p&lt;0.0001 respectively) were obtained.The duration of in-hospital stay in “new” registry was shorter than in “old” registries (10,2 vs 13.4 days; p&lt;0.0001), the proportion of patients transferred in non-PCI-capability centers to CAG was higher (16.3% vs 2.2%; p&lt;0.0001) and the rate of in-hospital death was lower (5.1% vs 6.6%; p=0.041). Conclusion: A series of prospective independent registries RECORDs showed that in recent years some progress towards better adherence to the guidelines has been made in the treatment of ACS in Russian hospitals participating in those registries. However, there wasn’t a clear increase in the rate of pPCI and fibrinolysis in STEMI and the rate of invasive strategy in NSTEACS.

Multiple right ventricular thrombi formation following acute myocardial infarction: a case report

A 64 year old gentleman presented with features of acute coronary syndrome. Urgent electrocardiogram showed evidence of acute infero-posterior and right ventricular ST segment elevated MI (STEMI). Trans-thoracic echocardiogram (TTE) on admission revealed marked RV and inferior wall hypokinesia with poor RV function. TTE on day three revealed multiple thrombi attached to the RV wall near the ventricular apex. Echocardiogram on the following day revealed coalesced thrombi forming a large mass. This case report illustrates the occurrence of multiple RV thrombi following an episode of acute infero-posterior and right ventricular STEMI. Timely performed TTE can be utilized as a safe, non-invasive and cost-effective diagnostic modality as well as a monitoring tool of the therapeutic outcome of such patients.

Клініко-функціональні особливості гострого коронарного синдрому у пацієнтів із коморбідним цукровим діабетом 2-го типу

Клініко-функціональні особливості гострого коронарного синдрому у пацієнтів із коморбідним цукровим діабетом 2-го типу