scholarly journals Assessment of the effectiveness of treatment in patients after acute coronary syndrome

2020 ◽  
Vol 25 (2) ◽  
pp. 9-18
Author(s):  
D. A. Shvets ◽  
S. V. Povetkin ◽  
A. Yu. Karasev ◽  
V. I. Vishnevsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Drug Therapy ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Secondary Prevention ◽  
Generic Drugs ◽  
Myocardial Revascularization ◽  
Cardiovascular Complications ◽  
Drug Prevention ◽  
Coronary Syndrome

Aim. To assess the effectiveness of secondary drug prevention and surgical myocardial revascularization in patients with coronary artery disease (CAD) during long-term follow-up after acute coronary syndrome (ACS).Material and methods. The study involved 400 patients with ACS discharged from the hospital in 2012-2016. The diagnosis was verified according to the European Society of Cardiology (ESC) guidelines. There were no exclusion criteria. We analyzed the data of medical records (complaints, medical history, physical examination, laboratory and instrumental data). Repeated data collection was carried out by distance survey and during a face-to-face examination during 2018. According to the clinical course of CAD, all patients were divided into 2 groups. Group 1 consisted of 151 patients with complicated course of CAD, group 2 — 249 patients with stable CAD. We analyzed drug therapy recommended at hospital discharge and taken at the time of the repeated examination. The drug names and daily dosage used for the secondary prevention of CAD were recorded. Assessment of survival without cardiovascular complications was carried out according to the Kaplan-Mayer analysis.Results. Seven-year mortality was 22,5%. The total number of cardiovascular events was 37,7%. The main reason for the frequent complications was the insufficient secondary prevention of CAD after ACS. We found that the drugs and their dosage did not have a significant effect on survival. Statin use is associated with a paradoxical increase in the number of complications. The increased frequency of use and dosage of statins are a consequence of unfavorable course of CAD and do not have the proper preventive effect. For some groups of drugs, we observed irregular intake over the observation period. The low effectiveness of therapy is not only due to insufficient doses, but also in the frequent use of generic drugs. The significant effect of coronary angiography on the probability of cardiovascular complications compared with stenting is due to high proportion of coronary angiography use without revascularization.Conclusion. The combination of following factors of drug therapy can explain the low effectiveness of secondary CAD prevention: low dose (26,1±2,8 mg for atorvastatin), irregular intake and common use of generic drugs (97,6% for statins), present in different ratios. The contribution of surgical treatment to reducing cardiovascular complications is lower, the more significant residual coronary artery stenosis.

scholarly journals Myocarditis Mimicking an Acute Coronary Syndrome: A Case Related toSalmonella enteritis

2009 ◽  
Vol 2009 ◽  
pp. 1-2 ◽  
Author(s):  
B. Rossetti ◽  
G. Nguisseu ◽  
A. Buracci ◽  
L. Migliorini ◽  
G. Zanelli
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Salmonella Enteritidis ◽  
Clinical Laboratory ◽  
Final Diagnosis ◽  
Gastrointestinal Infections ◽  
Coronary Syndrome ◽  
Salmonella Enteritis

Infective myocarditis is most commonly due to a viral infection; occasionally it has been related to bacteria. Gastrointestinal infections associated with myocarditis have only rarely been described in young people, and the pathogenesis is unclear. We report a case of myocarditis mimicking an acute coronary syndrome (ACS) in a patient hospitalized for fever and diarrhoea.Salmonella enteritidiswas isolated from stool, and no other pathogens were found. The coronary angiography was normal, and there were not other coronary artery risk factors, other than hypertension. The patient was treated with ciprofloxacin, acetylsalicylate acid, and ramipril with rapid clinical improvement and normalization of cardiac abnormalities. Final diagnosis ofSalmonella enteritisand related myocarditis was made based on clinical, laboratory, ECG and echocardiographical findings.

scholarly journals Nonalcoholic Fatty Liver Disease and Coronary Artery Disease: Big Brothers in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Mauricio Montemezzo ◽  
Ahmed AlTurki ◽  
Fabio Stahlschmidt ◽  
Marcia Olandoski ◽  
Jean Rodrigo Tafarel ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Liver Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Coronary Syndrome ◽  
Diagnostic Coronary Angiography ◽  
Grade Iii

Background. The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. Methods. We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients’ clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. Results. This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. Conclusions. NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

scholarly journals Evaluation of Drug Therapy and Adherence to It in Patients after Acute Coronary Syndrome in Real Clinical Practice (Results of One Year Observation)

2019 ◽  
Vol 14 (6) ◽  
pp. 852-857
Author(s):  
L. A. Khaisheva ◽  
S. E. Glova ◽  
V. A. Suroedov ◽  
A. S. Samakaev ◽  
S. V. Shlyk
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Drug Therapy ◽  
Angiotensin Receptor Blockers ◽  
Coronary Event ◽  
Cardiovascular Complications ◽  
Lipid Lowering ◽  
Hospital Treatment ◽  
Coronary Syndrome ◽  
Real Clinical Practice

Aim. To study the prescribed drug therapy, as well as adherence to it in patients with acute coronary syndrome (ACS) in real clinical practice within a year after the index event. Material and methods. The study included 327 patients who were in hospital treatment with ACS: 199 patients (60.9%) with unstable angina (UA) and 128 (39.1%) – with acute myocardial infarction (AMI). The prescribed treatment and adherence to therapy were evaluated within 12 months after the coronary event. Therapy prescribed to patients was compared with current clinical guidelines for the treatment of patients with ACS. Results. 67% of patients completed the clinical study Adherence to prescribed medication within 12 months after ACS was maximal for ACE inhibitors/angiotensin receptor blockers (83.6%), dual antiplatelet therapy (79.9%) and β-blockers (78.1%), and minimal for lipid-lowering drugs (statins; 61.6%). A significant decrease in adherence was revealed in 6 and 12 months from the initiation of therapy. Significantly higher level of adherence to DAT was found in patients with AMI compared with patients with UA (p<0.05). When analyzing the frequency of occurrence of endpoints, it was found that patients who did not adhere to treatment significantly more often had hospitalizations due to UA (15.1% vs 7.4%; p<0.05), AMI (16.9% vs 8.1%; p<0.05), death from cardiovascular causes (13% vs 10.4%; p<0.05). Conclusion. Therapy prescribed at the outpatient stage in patients with ACS in the Rostov Region corresponds to the modern clinical recommendations. Six months after hospital discharge adherence to drug therapy in patients is reduced, which requires more careful outpatient monitoring during this period. In patients who are not adherent to treatment, cardiovascular complications are significantly more frequent.

scholarly journals Evaluation of Platelet Parameters in Patients With Coronary Artery Disease

2020 ◽  
Author(s):  
Mahdieh Mehrpouri1 ◽  
Afshin Ahmad Pour ◽  
Esmail Shahabi Satlsar
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Healthy Volunteers ◽  
Ecg Changes ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Artery Disease

Coronary artery disease (CAD) is one of the leading causes of death worldwide; therefore, identifying new risk factors to predict the severity of the disease is thought to be associated with mortality reduction. In an effort to investigate whether platelet parameters are related to the extent of CAD and can be considered as risk factors, we designed experiments to evaluate platelet parameters in these patients. In a cross‐sectional study, sixty-nine patients with CAD (including fifty-two patients with acute coronary syndrome and seventeen patients with stable angina) and sixty-four healthy volunteers were evaluated for platelet count, mean platelet volume (MPV), and platelet distribution width (PDW). Echocardiography, electrocardiogram (ECG), and coronary angiography were conducted as well. Results showed significantly higher values for MPV and PDW in patients with acute coronary syndrome as compared to patients with stable angina and healthy volunteers (P<0.001 and P=0.009, respectively). There was no significant difference in platelet count between patients and healthy volunteers (P=0.379). Our results also revealed a significant difference in the ejection fraction (EF) percentage between the three groups (P=0.008). Investigating the correlation between platelet parameters and EF percentage, ECG changes, and the results of coronary angiography did not show any significant association. The present study showed that the elevated levels of MPV and PDW in patients with CAD are not related to the extent of coronary artery disease, which was estimated by echocardiography, ECG changes, and coronary angiography. Thus, these parameters cannot be considered as risk factors for coronary artery disease.

scholarly journals Multivessel spontaneous coronary artery dissection in a patient after mild COVID-19: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2097598
Author(s):  
Konstantin Kireev ◽  
Vadim Genkel ◽  
Alla Kuznetsova ◽  
Rifat Sadykov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Vascular Wall ◽  
Cardiovascular Complications ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Distal Branch

Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity of possible cardiovascular manifestations. Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, the development of which in patients with COVID-19 has been described and studied insufficiently. A 35-year-old male patient presented to our hospital with an acute coronary syndrome a few weeks after mild COVID-19. According to coronary angiography, a dissection of ramus intermedius was detected. Successful stenting was performed. Subsequently, the patient had relapses of chest pain, which led to two repeated coronary angiographies. The patient had been diagnosed with consecutive dissections of right coronary artery and distal branch of ramus intermedius. Repeated stenting of dissected segments of right coronary artery and ramus intermedius was not performed. Afterward, the patient’s condition remained stable and he was successfully discharged. One of the main pathophysiological mechanisms of cardiovascular complications in COVID-19 is probably the virus-triggered hyperinflammation and massive release of cytokines. A systemic inflammatory response may initiate inflammation of the vascular wall and other target tissues. The results of histological studies confirm the direct infection of endothelial cells 2019-nCoV with the development of diffuse endothelial inflammation (endotheliitis). It is possible that in patients with a genetic predisposition to artery dissection, COVID-19 may be a trigger of spontaneous coronary artery dissection.

scholarly journals THE RESULTS OF STEP-BY-STEP MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH ACUTE CORONARY SYNDROME AND MULTIVESSEL CORONARY ARTERY DISEASE: EARLY PERFORMING CORONARY ARTERY BYPASS SURGERY AFTER STENTING USING BARE-METAL STENTS

2019 ◽  
Vol 34 (2) ◽  
pp. 84-88
Author(s):  
A. V. Bocharov ◽  
L. V. Popov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Coronary Syndrome

Objective: To compare the long-term results of coronary artery bypass grafting performed in the early period after stenting for acute coronary syndrome by bare-metal stents with the results of coronary artery bypass grafting in patients with coronary heart disease.Material and Methods. The results of 24-month follow-up of step-by-step treatment of patients with acute coronary syndrome and multivessel lesion who received stenting of clinical-dependent artery with bare-metal stents as the first step and, then, underwent functional myocardial revascularization by aortocoronary bypass surgery within 90 days were analyzed. Results are presented as mean value and standard deviation (M±SD) in case of normal distribution and median with interquartile range in the form of 25 and 75 percentiles in case of non-normal distribution. The type of distribution of quantitative variables was assessed by the Lilliefors-corrected Kolmogorov–Smirnov test. Efficacy and safety assessments were carried out according to the criteria of non-inferiority in comparison with the literature data of myocardial revascularization by stenting. The differences were estimated using a two-way 95% confidence interval of the difference in adverse events based on the selected noninferiority design.Results. Surgical revascularization of the coronary bed in the early period after stenting of the clinically dependent artery using bare-metal stents in patients with acute coronary syndrome and multivessel lesion was equivalent to coronary artery bypass grafting, except for the rate of repeated revascularization.

scholarly journals Acute coronary syndrome with elevation of ST associated with ergotamine abuse

2019 ◽  
Vol 57 (1) ◽  
pp. 69-71 ◽  
Author(s):  
Gabriel E. Pérez Baztarrica ◽  
Leonardo P. Armijos Carrion ◽  
Juan H. Abarca Real ◽  
William A. Paredes Lima ◽  
Otto P. Giler Saltos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Aortic Dissection ◽  
Case Reports ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract There are few case reports of cases of carotid and aortic dissection related to the ergotamine abuse, but the cases that affect the coronary arteries is a very rare coronary. We present a patient of a 48-year-old female with an ST-segment elevation myocardial infarction attributable to chronic ergotamine use. The coronary angiography showed dissection of right coronary artery proximal.

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