scholarly journals Experience in implementing a regional registry of patients with acute coronary syndrome

2020 ◽  
Vol 27 (4) ◽  
pp. 54-61
Author(s):  
L. V. Rasputina ◽  
D. V. Didenko ◽  
A. V. Solomonchuk
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Middle Age ◽  
Artery Bypass ◽  
Inverse Correlation ◽  
Family Doctors ◽  
Coronary Syndrome ◽  
Gender And Age

The aim – to create a regional registry of patients who have suffered an acute myocardial infarction (AMI), to determine the frequency of endpoints: death, recurrent myocardial infarction, recurrent coronary angiography (CA), coronary artery bypass grafting (CABG), acute cerebrovascular accident (ACVA), bleeding, hospitalization after MI.Materials and methods. 33 centers of Vinnytsya and Vinnytsya region were involved in the study. During the period 2017–2018, 2120 patients of middle age 75.9±7.7 years were included in the register. Among them 1361 (64.2 %) men, middle age 67.5±8.4 years and 759 (35.8 %) women, middle age 76.3±8.2 years. There were 1658 patients with Q-MI and 462 (21.8 %) patients with MI without Q-wave.Results and discussion. It was found that after discharge from the hospital 419 people (13.4 %) did not visit family doctors and cardiologists. Among them were 262 (62.5 %) men and 157 (37.5 %) women. These patients did not differ significantly in gender and age structure from those who were under medical supervision. In both groups, men predominated and there were significantly more people over the age of 60. Twelve months after AMI, 37 (1.7 %) cases of CABG were documented among patients who visited doctors, 29 patients (1.4 %) were diagnosed with ACVA, and 101 patients (4.8 %) were hospitalized for recurrent AMI and 156 people (7.4 %) underwent CA. In patients with interventional AMI treatment tactics, there were significantly fewer cases of recurrent MI (p=0.022), hospitalization (p=0.025) and death (р<0,001) within 12 months. In patients with AMI, an inverse correlation was found between age and mortality, hospitalized bleeding, and CA. The connection between the fact of performing prehospital thrombolysis and hospitalization for heart failure during the year after AMI was determined. There is a negative correlation between CA and hospitalization for heart failure, bleeding that required hospitalization, re-CA and ACVA.Conclusions. Among patients treated for acute coronary syndrome, 13.4 % do not seek outpatient medical care after discharge from the hospital. Among them are significantly more men, people over 60 years old, residents of countryside. Twelve months after AMI, 1.7 % of patients undergo CABG, 1.4 % are diagnosed with ACVA, and 1.7 % have bleeding that requires hospitalization. 25.7 % of patients are re-hospitalized during the year, 9.5 % die. Among patients who undergo emergency CA and coronary artery stenting, there are more people who have CABG and who have been diagnosed with bleeding that requires hospitalization. In this group, there is a significant reduction in cases of recurrent MI, hospitalizations and deaths during the year.

scholarly journals Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers

2020 ◽  
Vol 2020 ◽  
pp. 1-21 ◽  
Author(s):  
Alexander E. Berezin ◽  
Alexander A. Berezin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
New Technologies ◽  
Early Period ◽  
Cardiac Remodelling ◽  
Complete Revascularization ◽  
Coronary Syndrome

The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome/AMI and heart failure after AMI, and even fewer have depicted the utility of biomarkers in AMI patients undergoing primary PCI. Although complete revascularization at early period of acute coronary syndrome/AMI is an established factor for improved short-term and long-term prognosis and lowered risk of cardiovascular (CV) complications, late adverse cardiac remodelling may be a major risk factor for one-year mortality and postponded heart failure manifestation after PCI with subsequent blood flow resolving in culprit coronary artery. The aim of the review was to focus an attention on circulating biomarker as a promising tool to stratify AMI patients at high risk of poor cardiac recovery and developing HF after successful PCI. The main consideration affects biomarkers of inflammation, biomechanical myocardial stress, cardiac injury and necrosis, fibrosis, endothelial dysfunction, and vascular reparation. Clinical utilities and predictive modalities of natriuretic peptides, cardiac troponins, galectin 3, soluble suppressor tumorogenicity-2, high-sensitive C-reactive protein, growth differential factor-15, midregional proadrenomedullin, noncoding RNAs, and other biomarkers for adverse cardiac remodelling are discussed in the review.

scholarly journals Complex Percutaneous Coronary Intervention Salvages a Patient with Recurrent Acute Coronary Syndrome and Ischaemic Heart Failure with Multiple Life Threatening Co-morbidities: A Case Report

2021 ◽  
Author(s):  
Brajesh Kunwar ◽  
Farah Ingle ◽  
Atul Ingle ◽  
Chandrasekhar Tulagseri
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Vascular Diseases ◽  
Coronary Intervention ◽  
Middle Income ◽  
Coronary Syndrome ◽  
Artery Disease

More than 422 million people are suffering from Diabetes Mellitus (DM) worldwide. Majority of the affected population resides in lower and middle income countries. This chronic, metabolic disease gradually does serious damage to heart, blood vessels, eyes, kidneys and nerves; eventually causing cardiovascular diseases, peripheral vascular diseases, retinopathy, nephropathy and neuropathy. Here, a rare case of a 58-year-old male was present who had history of uncontrolled DM with dry gangrene in right forefoot, acute kidney injury and Coronary Artery Disease (CAD) involving Left Main (LM) bifurcation presented with recurrent acute coronary syndrome with heart failure. Patient in view of multiple co-morbidities was unfit for Coronary Artery Bypass Grafting (CABG) was managed successfully with complex coronary intervention involving LM bifurcation.

scholarly journals N-Terminal Pro Brain Natriuretic Peptide in Assessment of Severity of Coronary Artery Disease in Patients with Non ST Elevation Acute Coronary Syndrome

2020 ◽  
Author(s):  
Hesham Mohammed El Ashmawy ◽  
Mohammed Ahmed Sadaka ◽  
Gehan Magdy Youssef ◽  
Abdulkarem Saeed Hassan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Syntax Score ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
St Elevation ◽  
The Mean ◽  
Artery Disease

Introduction: N-Terminal pro Brain Natriuretic Peptide (NT-pro BNP) is an important biomarker in the management of patients with heart failure. Several studies reported its importance as a predictor of morbidity and mortality in Acute Coronary Syndrome (ACS) patients. Aim: To compare serum NT-proBNP levels in Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients and controls and to assess the relation between Nt-proBNP and the severity of Coronary Artery Disease (CAD) in patients with NSTE-ACS including unstable Angina (UA) and Non ST Elevation Myocardial Infarction (NSTEMI). Materials and Methods: Sixty NSTE-ACS patients and 20 matched control without significant obstructive CAD were included in the study. Cardiac enzymes, blood urea, serum creatinine, serum NT-proBNP were measured in all patients immediately before coronary angiography. Gensini score and Syntax score were calculated for all study patients. The NSTE-ACS patients were followed-up for six months for Major Adverse Cardiovascular Events (MACE) including mortality, myocardial infarction, heart failure, stroke, revascularisation by primary percutaneous coronary intervention or Coronary Artery Bypass Grafting (CABG). Results: The mean serum NT-proBNP in NSTE-ACS (UA and NSTEMI) patients was significantly higher (662.7±635.2) pg/mL than that in the control (102.3±96.4) pg/mL, p<0.001. The effective cut-off value for the diagnosis of CAD was 139 pg/mL, Area Under Curve (AUC)=0.950, 95% CI: 0.890-1.00). The serum NT-proBNP was correlated with the severity and complexity of CAD as measured by Gensini score (r=0.496, p<0.001) and Syntax score (r=0.443, p<0.001). The mean value of NT-proBNP in patients with six months MACE was insignificantly higher than in patients without six months MACE with Interquartile Range (IQR) of 418.5 (139-2037) vs. 366 (175-3237) pg/mL, p=0.970. Conclusion: NT-proBNP was correlated with the severity and complexity of CAD in NSTE-ACS with preserved left ventricular systolic function, but it has no impact on six months MACE.

scholarly journals Clinical and functional features of patients with acute coronary syndrome and history of coronary artery bypass grafting

2020 ◽  
Vol 27 (4) ◽  
pp. 18-24
Author(s):  
V. V. Matiy ◽  
M. V. Rishko ◽  
O. O. Kutsin
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome ◽  
History Of

The aim – to investigate the clinical and functional parameters features in acute coronary syndrome and coronary artery bypass grafting history patients.Materials and methods. 68 patients with acute coronary syndrome (ACS) were examined according to the current protocols, in 30 of them there was a history of coronary artery bypass grafting (ACS and CABG group) and 38 patients who didn’t undergo CABG (ACS without CABG group). Physical and laboratory-instrumental methods of investigation, including ECG, echocardiography, coronary ventriculography, coronary artery bypass graft angiography and methods of variation statistics were used in the work.Results and discussion. Among patients with ACS and CABG, a history of a higher incidence and duration of stable angina pectoris, arterial hypertension, diabetes mellitus, and multiple concomitant pathology had been found in comparison with the ACS without CABG group. History of ACS and CABG patients comprised a higher incidence of ACS without ST segment elevation in comparison with ACS without CABG group, repeated ACS, heart failure progression and those patients needed significantly longer stay in ICU than ACS without CABG group. Electrocardiograms of patients with ACS and CABG vs ACS without CABG group were characterized by a significantly higher incidence of pathological Q, atrial and ventricular fibrillation, as well as a combined disturbances of rhythm and conduction. Echocardiography revealed a significantly lower ejection fraction, increase in left atrium size and an E/A ratio in the ACS and CABG group, indicating worse heart failure compensation as well as systolic and diastolic dysfunction with dysfunctional of left ventricular than in ACS without CABG patients.Conclusions. Acute coronary syndrome with coronary artery bypass grafting history patients are characterized by a complicated history and clinical course with more significant electrocardiogram and echocardiography changes in comparison to the group of acute coronary syndrome patients without prior coronary artery bypass grafting history.

scholarly journals Myocardial revascularization in patients with acute coronary syndrome in the context of COVID-19 pandemic: a single-center prospective cohort study

2021 ◽  
Vol 26 (8) ◽  
pp. 4382
Author(s):  
O. V. Kamenskaya ◽  
A. S. Klinkova ◽  
I. Yu. Loginova ◽  
D. V. Habarov ◽  
A. M. Chernyavskiy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Heart Function ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Early Postoperative Period ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Pump Cabg

Aim. To assess the outcomes of myocardial revascularization (MR) and identify risk factors for early postoperative complications in patients with coronary artery disease (CAD) with acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic.Material and methods. The study included 769 patients aged 67,0±4,4 years with CAD with ACS in the period from April to October 2020. In an expedited manner, percutaneous transluminal coronary angioplasty (n=699) and on pump coronary artery bypass grafting (CABG) (n=70) were performed. All patients underwent a COVID-19 rapid tests. After MR, the following outcomes were recorded: adverse cardiovascular events and other complications; various surgical interventions; bilateral COVID-19 pneumonia; death. The follow-up period lasted 30 days.Results. During the hospitalization, COVID-19 was detected in 5,3% of patients (n=41). Among them, bilateral multisegmental pneumonia developed in 48,8%. Among infected patients, COVID-19-related mortality in the early postoperative period was 9,8%. The all-cause mortality rate was 0,7%. On pump CABG significantly increases the risk of developing COVID-19 pneumonia (odds ratio (OR), 23,2; 95% confidence interval (CI) 14,2-35,4; p<0,001). After MR, COVID-19 pneumonia was associated with respiratory (OR, 7,6; 95% CI, 4,3-11,5; p=0,001) and heart failure (OR, 4,2; 95% CI, 2,9-8,6; p=0,001), atrial fibrillation (OR, 8,3; 95% CI, 4,1-13,9; p=0,001), as well as with all-cause mortality (OR, 10,3; 95% CI, 5,2-16,7; p=0,005). Recurrent transmural myocardial infarction in patients with CAD was associated with heart failure after MR (OR, 7,1; 95% CI, 2,4-12,6; p=0,012).Conclusion. Conducting on pump CABG in patients with CAD with ACS is the leading trigger for developing COVID-19 pneumonia, which, during hospitalization after MR, was associated not only with respiratory complications, but also with impaired heart function, which significantly increases the death risk in this category of patients.

ANTIPLATELET THERAPY AND SECONDARY PROPHYLAXIS AFTER CORONARY BYPASS SURGERY IN ACUTE CORONARY SYNDROME

2021 ◽  
pp. 45-51
Author(s):  
Jalilov A.K. ◽  
Ibragimov R.G.
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Antiplatelet Therapy ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome

Antiplatelet therapy with aspirin and clopidogrel has clear advantages in reducing serious adverse cardiovascular events and mortality following acute coronary syndrome. Although these drugs may pose an additional risk of bleeding in the small percentage of acute coronary syndrome patients who will undergo coronary artery bypass grafting, the benefits are vastly superior, and most bleeding can be reduced, if possible, by delaying coronary artery bypass grafting. Short-acting anticoagulants can be administered flexibly, allowing platelet function to be restored after clopidogrel is discontinued. The postoperative bleeding time may clarify the need for platelet transfusion in case of bleeding. Coronary artery bypass grafting without the use of a heart-lung machine may offer some benefits by avoiding heparinization and the inflammatory response associated with bypass surgery. Secondary prophylaxis with antiplatelet therapy, beta-blockers, lipid-lowering therapy, and ACE inhibitors or angiotensin-converting enzyme inhibitors is critical to the long-term success of revascularization. In this regard, it should be borne in mind that regardless of the method of revascularization, patients with acute coronary syndrome are characterized by the clinical benefit of taking antiplatelet agents such as aspirin and clopidogrel, since these drugs reduce the risk of serious adverse events. On the other hand, antiplatelet agents also increase the risk of bleeding in patients who will eventually undergo coronary artery bypass grafting. However, scientists indicate that in most cases, the benefits of early initiation of antiplatelet therapy outweigh the potential risks [1]. In addition, the beneficial effects of aspirin and clopidogrel in acute coronary syndrome are additive. In the study of clopidogrel, indicated for the prevention of recurrence of unstable angina and non-ST-segment elevation myocardial infarction, patients taking both clopidogrel and aspirin were less likely to die of cardiac death, non-fatal myocardial infarction, or stroke at 30 days and 1 year compared with patients who took only aspirin [22]. All these studies confirm that antiplatelet therapy with aspirin and clopidogrel should be carried out in the early stages of acute coronary syndrome. In patients with ST-segment elevation myocardial infarction, clopidogrel improves outcomes in addition to aspirin. In a trial of clopidogrel and metoprolol for myocardial infarction, clopidogrel, in addition to aspirin, was associated with a significant reduction in death, re-heart attack, or stroke compared with aspirin alone [14].

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