scholarly journals Clinical and Functional Dynamics of Physical Working Capacity and Psychological Adaptation in Patients with Acute Coronary Syndrome at the Stages of Rehabilitation

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
Roksolana Nesterak ◽  
Sofia Bardashevska
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

The objective of the research was to analyze the effectiveness of using suggestive therapy in the patients with acute coronary syndrome by assessing the dynamics of the clinical condition and indicators of anxiety. Materials and Methods. There were examined 135 patients with non-ST-segment elevation myocardial infarction, 60 patients with the use of the conservative treatment and 75 patients who underwent percutaneous coronary intervention. The dynamics of objective indices, adaptation changes and anxiety indices in the groups of patients with traditional treatment and in the groups of patients with suggestive therapy in addition to the traditional rehabilitation measures, were analyzed. Results. Analyzing the dynamics of adaptive indices, it was determined that in the group of patients with non-ST-segment elevation myocardial infarction, who were performed conservative therapy, the dynamics was less significant, which is related to the general desadaptative syndrome. Changes in the group of patients undergoing percutaneous coronary intervention and suggestive therapy, with a decrease of blood pressure, heart rate, and a decrease in the index of functional changes from 3.78±0.15 points before the intervention up to 2.92±0.13 points after suggestive therapy (p<0.01) were more significant. In all groups of patients, high levels of reactive anxiety were observed at the beginning of treatment. As a result of treatment, a decrease in anxiety was noted, but more pronounced changes were seen in the group with the use of suggestive therapy (p<0.05). Conclusions. The use of suggestive therapy methods when treating the patients with acute coronary syndrome is an important intervention, that provides a comprehensive approach considering all the components, enhances the patients’ adaptive abilities in the rehabilitation phase, improves the quality and effectiveness of restorative treatment. The use of suggestive therapy at the rehabilitation stage improves the clinical course, reduces anginal manifestations, stabilizes blood pressure and increases exercise tolerance.

scholarly journals Comorbidities and Percutaneous Coronary Intervention in Elderly Patients with Acute Coronary Syndrome

2021 ◽  
Vol 17 (2) ◽  
pp. 221-227
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova ◽  
M. R. Atabegashvili ◽  
T. D. Solntseva ◽  
D. A. Anichkov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Aim. To assess comorbidities in elderly patients with acute coronary syndrome (ACS) and to analyze patient subgroups with different treatment strategies in the Regional Vascular Center (RVC).Material and methods. The prospective study included 205 patients with confirmed ACS 75 years and older, the mean age was 81±4.9 years, and 68% were women. ST segment elevation myocardial infarction (STEMI) was diagnosed in 46 (22.4 %) patients, non-ST segment elevation myocardial infarction (NSTEMI) was diagnosed in 159 (77,6 %) patients. The Charlson Comorbidity Index (CCI) was calculated in every patient. Early outcomes were defined as those assessed during hospital stay. Late outcomes were assessed at 6 months after the discharge using phone calls and/or clinic visits. All patients provided written informed consent.Results. Percutaneous coronary intervention (PCI) was performed in 42% of patients. In patients with STEMI and NSTEMI PCI was performed in 73% and 32%, respectively. Mean CCI score was 7.9 points: 7.6 points in men and 8.04 in women. Patients with STEMI had higher CCI score than NSTEMI patients (p<0.01): 8.1 points and 7.1 points, respectively. Patients who underwent PCI had lower CCI score (7.2 points) than patients in non-PCI group (8.2 points; p<0.05). Patients with STEMI in PCI and non-PCI groups had significant difference in CCI score (p<0.05): 7.4 and 8.4 points, respectively. Mean CCI score in patients who died in hospital was 8.5 while discharged patients had 7.6 points (p<0.01). In 6 months 13 patients (6.3%) died, their mean age was 84.9 years, mean CCI was 9 points, PCI was performed in 3 (23%) patients.Conclusions. Elderly patients with ACS had high comorbidity level assessed by CCI score. Higher CCI score was associated with PCI non-performance in elderly patients. Elderly patients with STEMI had higher CCI score than patients with NSTEMI which was significantly associated with PCI non-performance. Patients who died in hospital or in 6 months after the ACS onset had higher CCI score than other elderly patients with ACS.

scholarly journals Good Practices in the Clinical Management of Patients with Acute Coronary Syndrome: Retrospective Analysis in a Third-Level Hospital in Mexico

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Héctor E. Flores-Salinas ◽  
Fidel Casillas-Muñoz ◽  
Yeminia Valle ◽  
Cesar M. Guzmán-Sánchez ◽  
Jorge Ramon Padilla-Gutiérrez
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Heart Surgery ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Introduction and Objective. In Mexico, there has been an increase in the risk of cardiovascular disease due to rising life expectancy, westernized lifestyle, lack of prevention, and industrialized exposure. This article describes the pharmacological treatment, surgical interventions, and associated clinical complications in patients diagnosed with acute coronary syndrome (ACS) and their impact on in-hospital mortality frequency in a Cardiology Unit in Instituto Mexicano del Seguro Social. Methods. This is a retrospective study including male and female patients aged ≥18 years who were diagnosed with ACS. The collected data included demographic characteristics, risk factors, medications, electrocardiograms, surgical procedures, and in-hospital deaths. Results. There are at least 20% more diagnoses of ST-segment elevation myocardial infarction in this hospital compared to the latest national reports in Mexico. The most common risk factors were type 2 diabetes mellitus, hypertension, smoking, and dyslipidaemia. Diabetic patients with a clinical history of percutaneous coronary intervention had a higher risk of non-ST-segment elevation myocardial infarction than nondiabetics (OR: 2.34; p=0.013), also smoking patients with previous heart surgery than nonsmokers (OR: 7.73; p=0.0007). The average in-hospital mortality was 3.6% for ACS. Conclusions. There is a higher percentage of coronary interventionism and improvement in pharmacological treatment, which is reflected in lower mortality. The substantial burden of T2DM could be related to a higher number of cases of STEMI. Diabetics with precedent percutaneous coronary intervention and smokers with previous heart surgery have an increased risk of subsequent infarction.

scholarly journals Reperfusion Therapy and Predictors of 30-Day Mortality after ST-Segment Elevation Myocardial Infarction in a University Medical Center in Western Iran

2021 ◽  
Vol 24 (11) ◽  
pp. 796-803
Author(s):  
Nahid Salehi ◽  
Sayeh Motevaseli ◽  
Parisa Janjani ◽  
Mostafa Bahremand ◽  
Reza Heidari Moghadam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Filtration Rate ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30- day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran. Methods: In this registry-based cohort study (2016–2019), we investigated reperfusion therapies – primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone – used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. Results: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36–2.97), referral from non-PPCI-capable hospitals (1.73, 1.22–2.46), age (1.03, 1.01–1.04), glomerular filtration rate (0.97, 0.96–0.97), heart rate>100 bpm (1.94, 1.22–3.08), and systolic blood pressure<100 mm Hg (4.92, 3.43–7.04). Mortality was lower with the pharmaco-invasive approach, although statistically non-significant, than other reperfusion therapies. Conclusion: Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco-invasive therapy, is recommended.

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