Early surgical myocardial revascularization as an effective method of treating patients with acute coronary syndrome

2020 ◽  
Vol 26 (4) ◽  
pp. 120
Author(s):  
Iu. A. Shneĭder ◽  
V. G. Tsoĭ ◽  
M. S. Fomenko
Keyword(s):  
Acute Coronary Syndrome ◽  
Myocardial Revascularization ◽  
Coronary Syndrome

scholarly journals Experience of the use of the PCSK9 inhibitor Alirocumab in patients with extremely high cardiovascular risk

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 71-77
Author(s):  
V. A. Korneva ◽  
T. Yu. Kuznetsova ◽  
I. S. Scopetc ◽  
N. N. Vezikova
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cerebrovascular Disease ◽  
Laboratory Data ◽  
Myocardial Revascularization ◽  
Real Life ◽  
Transient Ischemic Attacks ◽  
High Cardiovascular Risk ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome

Aim To study the efficacy and safety of alirocumab in patients with high and very high cardiovascular risk in the Republic of Karelia and to evaluate their compliance with the alirocumab therapy.Materials and methods Study design: observational, noncomparative. The observation group consisted of 9 patients receiving alirocumab (Praluent®) (mean age, 48.6±4.7 years; 7 men). 7 patients had familial hypercholesterolemia of the type diagnosed by DLCN criteria; five patients had MI. Lipid profile, concentrations of transaminases, creatinine, glucose, and lipoprotein a (LP(a)) were measured at 3, 6, 12, and 18 months. Electrocardiography was performed, and the clinical picture (development of acute coronary syndrome, acute cerebrovascular disease, transient ischemic attacks, myocardial revascularization, and cardiovascular death) was evaluated. Efficacy criteria included the absence of these clinical conditions, the proportion of patients who achieved the LDL CS goal, and the decrease in LP(a). Safety was evaluated by clinical and laboratory data, such as levels of transaminases, total bilirubin, creatinine, and blood glucose. The observation lasted for 6 months to 1.5 years.Results LDL CS goals were achieved in 7 (77.8%) patients receiving alirocumab. The mean level of LP(a) decreased from 0.39 to 0.28 g/l; the degree of decrease ranged from 20 to 33 %. No cases of IHD instability (acute coronary syndrome) or new cases of acute cerebrovascular disease and transient ischemic attacks were observed. None of the patients had to stop the alirocumab treatment; adverse effects, including local ones, were not observed.Conclusion LDL CS goals were achieved in 7 (77.8%) patients. The level of LP(a) decreased by 20-33% in patients receiving the PCSK9 inhibitor. In real-life clinical practice, the alirocumab treatment was characterized with high compliance and good tolerability without side effects, including local ones.

The Reduction of Cardiac Patients in the Coronary Care Unit of the Santa Izabel Hospital During the COVID-19 Pandemic

2021 ◽  
Vol 4 (3/4) ◽  
pp. 131-134
Author(s):  
Gilson Feitosa ◽  
Leandro Cavalcanti ◽  
Amanda Fraga ◽  
Milana Prado ◽  
Gilson Feitosa Filho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Coronary Care Unit ◽  
Myocardial Revascularization ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
The World ◽  
St Elevation ◽  
Coronary Care

The coronary care unit by Santa Izabel Hospital (Salvador, Bahia, Brazil) made a comparison of admitted patients with coronary disease cases admitted between two equivalent periods ranging from April through July in 2019 and 2020. There was a striking reduction in 2020 of cases of ST-elevation myocardial infarction (39%); non-ST elevation myocardial infarction (19%); and unstable angina pectoris (21%). This occurred in parallel with what happened in many parts of the world and hampered offering the best treatment strategy to these patients with an acute coronary syndrome such as invasive stratification and myocardial revascularization.  

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 774 Young adults with acute coronary syndrome: still a long road ahead

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Jessica Ielapi ◽  
Salvatore De Rosa ◽  
Giuseppe Deietti ◽  
Claudia Critelli ◽  
Giuseppe Panuccio ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Young Adults ◽  
Myocardial Revascularization ◽  
Young Patients ◽  
Clinical Profile ◽  
University Hospital ◽  
Complete Revascularization ◽  
Percutaneous Coronary Angioplasty ◽  
Coronary Syndrome ◽  
Magna Graecia

Abstract Aims Acute coronary syndrome (ACS) are a leading cause for mortality and morbility worldwide. Despite ACS usually affects the older population, it also occurs in younger individuals. Young ACS patients (YACS) have a significantly worse prognosis compared to their age-mates in the general population. Despite YACS are characterized by a different risk profiles compared to their older mates, many aspects still remain elusive. Aim of this study was to describe the clinical profile of young adults with Acute Coronary Syndrome. Methods and results Young patients (≤50 years) with the first diagnose of Acute Coronary Syndrome admitted to the Magna Graecia University Hospital were enrolled in the ongoing GENEPAMY registry. Over 7 years, a total of 675 eligible patients with Acute Coronary Syndrome aged 44 ± 8 years were included. Men accounted for 84.9% of all patients. Overall, 11.9% of patients had diabetes, 69.1% hypertension, 17.6% obesity, 93.6% dyslipidemia, while 75.5% were smokers. In the overall cohort, 44.1% were first diagnosed with STEMI, 45.9% with NSTEMI, while the remaining had been admitted for Unstable Angina. Cardiogenic shock was present at admission in 2.7% of cases. Multivessel disease was present in 39% of cases and was significantly less frequent in women (P < 0.001). Thrombolysis was administered as the initial treatment in 15.1% of cases but was ineffective in 66.7% of patients. Percutaneous coronary angioplasty was performed in 79.1% of patients, while 1.9% of patients underwent surgical myocardial revascularization. Spontaneous coronary dissection was present in 0.7% of men and 17.2% of women (P < 0.001). At admission, 98.9% of patients had been treated with ASA, 17.9% with clopidogrel, 49.1% with ticagrelor and 28.4% with prasugrel. A complete revascularization was achieved in 81.6% during the index hospitalization but was significantly more frequent in women compared to men (86.3% vs. 80.8; P < 0.001). Conclusions Our data highlight that YACS present a peculiar clinical profile. In particular, the high cardiovascular risk profile demands attention. Finally, despite most patients were men, young women with ACS present several relevant differences compared to men, needing a more careful clinical management.

scholarly journals Adherence to Medical Treatment in Patients who Have Experienced Acute Coronary Syndrome and Percutaneous Coronary Intervention

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 36-38
Author(s):  
N. M. Kuzmina ◽  
N. I. Maximov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
Adherence To Therapy

Purpose: to study adherence to therapy after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We analyzed retrospectively 127 case histories of patients who underwent PCI for ACS in 2015 (in Udmurtia at that time PCIs were mostly carried out later than 6 hours after onset of symptoms). Inclusion criteria: age 25–75 years; confirmed ACS; stenting of coronary arteries for the first time. Exclusion criteria: pregnancy; prisoners; incompetent persons; history of PCI or coronary artery bypass grafting. In two years after the PCI 95 patients were questioned concerning use of statins (including their doses) and dual antiplatelet therapy (DAPT). Results. In 2 years after index PCI 83% of patients took statins regularly. DAPT for 1 year or more after PCI received 85% of patients. Conclusion. Adherence to therapy with statins and antiplatelet therapy was found to be high. PCI in patients with ACS was mainly delayed (more than 6 hours from the onset of symptoms). It is necessary to further improve the routing of patients to PCI performing centers from Udmurtia regions for the timely myocardial revascularization.

scholarly journals Treatment of patients with acute coronary syndrome in 2019 (data from federal registry of acute coronary syndrome)

2020 ◽  
pp. 37-45
Author(s):  
О.В. Сагайдак ◽  
Е.В. Ощепкова ◽  
Ю.В. Попова ◽  
О.М. Посненкова ◽  
А.Р. Киселев ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Median Time ◽  
Myocardial Revascularization ◽  
Care Quality ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Quality Of Medical Care

Введение. Проблема качества оказания медицинской помощи больным с острым коронарным синдромом (ОКС) является одной из наиболее актуальных для нашей страны, так как летальность, особенно при ОКС с подъемом сегмента ST (ОКСсST) остается на высоком уровне. Федеральный регистр больных с ОКС (далее – Регистр) дает возможность выявлять недостатки и разрабатывать подходы к улучшению оказания медицинской помощи больным в реальной клинической практике. Цель исследования: анализ качества оказания медицинской помощи больным с ОКС, прошедших лечение в 2019 году. Материалы и методы. За период с 01.01.2019 по 31.12.2019 в Регистр были внесены данные 27929 больных с ОКС из 138 медицинских организаций 32 субъектов Российской Федерации (средний возраст 65,3±11,7 лет, 62,7% мужчин). Результаты: Из 20757 у 65,9% (n= 13399) диагноз при выписке – острый и повторный инфаркт миокарда, у 32,6% – нестабильная стенокардия. 44,7% (n=9287) составили больные с ОКС с подъемом сегмента ST (ОКСсST), 55,3% (n=11470) – c ОКС без подъема сегмента ST(ОКСбST). Из 9287 больных с ОКСсST75,8% (n=7044) была выполнена реваскуляризация миокарда. Из них у 21,7% (n=1532) использовался фармакоинвазивный подход, у 61,1% (n=4304) больных выполнено только ЧКВ, у 17,0% больных проводили только тромболитичсекую терапию без ЧКВ. Остальным больным реваскуляризация не была проведена и выбрана консервативная тактика лечения. Из 11470 больных с ОКСбST реваскуляризация выполнена лишь у 31,5% (n=3621). У больных с ОКСсSTмедиана времени от момента госпитализации до начала ЧКВ составило 55 [34;106] мин. Медиана времени от начала симптомов заболевания до начала ЧКВ составила 320 [180;807] мин. Среди больных с ОКСбST медиана времени от момента госпитализации до начала ЧКВ составила 195 [75;1025] мин. От начала симптомов заболевания до начала ЧКВ составила 945 [370;2620] мин. Заключение При анализе соответствия клиническим рекомендациям, отмечается, что оказание медицинской помощи больным с ОКС оказывается не в полном объеме, что наиболее выраженно в подгруппе больных с ОКС без подъема сегмента ST. Introduction. The problem of the quality of medical care for patients with acute coronary syndrome (ACS) is one of the most relevant for our country, since mortality, especially for patients with ACS with ST segment elevation (ACSwST) remains high. The Federal Registry of Patients with ACS (hereinafter referred to as the Register) makes it possible to identify gaps in medical care quality and develop approaches for its improvement. Objective: to analyze the quality of medical care for patients with ACS who underwent treatment in 2019. Materials and methods. For the period from January 1, 2019 to December 31, 2019, data from 27029 patients with ACS from 138 medical organizations in 32 regions of the Russian Federation was included in the Registry (average age 65.3 ± 11.7 years, 62.7% of men). Results: Out of 20757, 65.9% (n = 13399) had an acute and repeated myocardial infarction diagnosis at discharge, and 32.6% had unstable angina pectoris. 44.7% (n = 9287) were patients with ACS with ST segment elevation (ACSwST), 55.3% (n = 11470) - with ACS without ST segment elevation (ACSnST). Of 9287 patients with ACSwST, 75.8% (n = 7044) underwent myocardial revascularization. Of these, in 21.7% (n = 1532) the pharmacoinvasive approach was used, in 61.1% (n = 4304) of patients only PCI was performed, in 17.0% of patients only thrombolytic therapy without PCI was performed. The remaining patients did not undergo revascularization and conservative treatment was chosen. Of 11470 patients with ACSnST, revascularization was performed only in 31.5% (n = 3621). In patients with ACSwST, the median time from hospitalization to the onset of PCI was 55 [34; 106] min. The median time from the onset of symptoms to the onset of PCI was 320 [180; 807] min. Among patients with ACSnST, the median time from the time of hospitalization to the onset of PCI was 195 [75; 1025] min. From the onset of symptoms to the onset of PCI, it was 945 [370; 2620] min. Conclusion Analyzing the quality of ACS patients medical care we concluded that ssufficient part of patients with ACS are provided with non-optimal treatment due to clinical guidelines, and the medical care is the it was noted that the provision of medical care to patients with ACS is not in full, which is most pronounced in the subgroup of patients with ACS without raising the ST segment.

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