Anesthesiologic management of elective endovascular stenting of coronary artery

Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO2).Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

Stress echocardiography vs coronary oomputed tomography angiography for the detection of obstructive coronary artery disease in patients aged >70 years with suspected stable coronary artery disease

Aim. To compare stress echocardiography and coronary computed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years.Materials and methods. The study included 390 patients aged >70 years with suspected stable CAD, which underwent elective coronary artery angiography (CAG). Initially, patients for whom stress echocardiography and CCTA is appropriate was determined. After that diagnostic accuracy of both methods in the detection of obstructive CAD was evaluated in patients with atypical angina and non-anginal chest pain.Results. Among 111 patients with atypical angina and non-anginal pain which underwent stress echocardiography and had unequivocal results, 69 (62 %) patients had obstructive CAD. Stress echocardiography has sensitivity of 89%, specificity of 95%, positive likelihood ratio (LR+) of 17,8, and negative likelihood ratio (LR-) of 0,1. Positive result increased probability of obstructive CAD from 62% to 95%, while negative result reduced probability to 16%. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA, 48 (59 %) patients had obstructive CAD. CCTA has sensitivity of 100 %, specificity of 88%, LR+ of 8,3, and LR- of 0,3. Positive result increased post-test probability of obstructive CAD from 59% to 86%, while negative result reduced post-test probability to 0%.Conclusion. Stress echocardiography and CCTA has comparable diagnostic accuracy in the detection of obstructive CAD in patients aged >70 years with atypical angina and non-anginal pain. Stress echocardiography has a greater diagnostic value of positive result; CCTA has a greater diagnostic value of negative result.

The Diagnostic Accuracy of Exercise Treadmill Testing and Stress Echocardiography for the Detection of Obstructive Coronary Artery Disease in Patients Aged ≥ 70 Years

Aim: to compare diagnostic accuracy of exercise treadmill testing and stress echocardiography in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years.Materials and methods. The study included 390 patients aged >70 years with suspected stable ischemic heart disease, who underwent elective coronary artery angiography (CAG). Exercise treadmill testing (ETT) according to the modified Bruce protocol was carried out in 189 patients (48 %), bicycle stress echocardiography - in 179 patients (46 %). Initially we determined the prevalence of angiographically significant CAD according to the gender and chest pain character, and identified persons in whom stress testing was appropriate. After that diagnostic accuracy of both tests was evaluated in patients with atypical angina and non-anginal chest pain.Results. Among 72 patients with atypical angina and non-anginal pain who underwent ETT and had unequivocal results, 38 (53 %) had obstructive CAD. ETT for detection of obstructive CAD had sensitivity 79 %, specificity 82 %, positive likelihood ratio (LR+) 4.4, and negative likelihood ratio (LR-) 0.3. Positive result increased probability of obstructive CAD from 53 % to 83 %, negative result reduced probability of obstructive CAD to 25 %. Among 111 patients with atypical angina and non-anginal pain who underwent stress echocardiography and had unequivocal results, 69 (62 %) had obstructive CAD. Sensitivity, specificity, LR+, and LR- of stress echocardiography were equal to 89 %, 95 %, 17.8, and 0.1, respectively. Positive result increased probability of obstructive CAD from 62 % to 95 %, negative result reduced probability of obstructive CAD to 16 %.Conclusion: bicycle stress echocardiography was found to be more accurate than ETT to rule in or rule out obstructive CAD in patients aged ≥ 70 years with atypical angina and non-anginal pain.

Sex-related differences in characteristics, management and in-hospital outcome in sub-saharan patients with acute coronary syndrome

Background: Coronary heart disease remains the leading cause of morbidity and mortality in both men and women worldwide. Cardiovascular disease (CVD) is on the rise in sub-saharan countries that are currently undergoing rapid urbanization, industrialization, and lifestyle changes. Recently, knowledge regarding sex differences in CVD has evolved. Although, data on the incidence of acute coronary syndrome (ACS) in sub-saharan are not rare, few focused closely on sex differences. The purpose of this study was to examine sex-related differences in characteristics, management and inhospital outcome in sub-saharan with acute coronary syndrome. Methods: This was a retrospective study conducted at the cardiology department of Principal Hospital of Dakar over a period of 60 months (January 1st 2010 to December 31st 2014), in Dakar, Senegal. Two hundred and seven medical records of patients admitted for ACS based on anginal pain at rest, suggestive electrocardiographic changes and elevated troponin I levels, were included. We studied data on age, risk factors, symptoms, the time delay before admission, the management given, the vital parameters as as well as evolution during hospitalization. Medical records were then stratified into two categories (males and females) to study diferences. The studied parameters were entered into an electronic questionnaire using Epi Info version 3.3.5 of the World Health Organization. Results: Hospital prevalence of ACS was 6.09% with a sex ration M/F of 1.62(159/98). there was an overall rates increase of admissions for ACS in both men and women . The mean age of patients was 67.5 ± 10.1 years with a range of 44 and 93 years. Females were older than males ( p=0.08) with a greatest incidence of ACS in those aged 60 to 69 years. Women had a higher prevalence of risks, such as diabetes, hypertension, dyslipidemia, and obesity than men. In addition, there are sex differences in an order of importance related to risk factors for ACS. Hypertension, diabetes, and obesity are the most important risk factors in women, whereas current smoking, hypertension and diabetes are the important risk factors in men. Chest pain was present in 249 patients (97%). Typical anginal pain was more common in men than women (76.1% vs 52.1%), this difference was statistically significant (p=0.000). The average time delay before medical care was given was 29.09 ± 8.5 hours. This time delay was higher in women than men ( 53.9 ± 18 hours vs 26.4 ± 12.3 hours; p= 0.005) Mean troponin I level found was 1.9 ± 2.8 ng/ml, Creatine phosphokinase and Creatine phosphokinase-MB measured 824 ± 909.7 UI/l and 141.3 ± 245.9 UI/l respectively. Troponin I level was higher in men than women. Mean total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol and, triglyceride were 2.06 ± 0.25 g/l, 0.90 ± 0.2g/l, 0.90 ± 0.20 g/l, and 1.44 ± 0.20 g/l respectively. LDL cholesterol was higher in women than in men. Electrocardiogram revealed an ACS with persistent ST-elevation in 143 patients (90 males vs 53 females) and non ST-elevation ACS in 114 patients (69 males vs 45 females). Concerning treatment, thrombolysis using streptokinase was performed in 33 patients, accounting for 12.8% of patients with ST-elevation. Thrombolysis was performed in 10.2% of females compared to 14.5% of males (p=0.32). Six deaths (6.1%) were recorded in women and 10 (6.3% ) in men. Complications was dominated by pulmonary oedema. Conclusion: Our study confirms that acute coronary syndrome is not a “man’s only” disease in sub-sahara. Although in our study there was no difference in mortality, atypical presentation and low elevations in biomarker were responsible of long time delay before medical care in women.

PECULIARITIES OF THE CORRELATIONSHIP BETWEEN SOMATOGENIC AND PSYCHOGENIC COMPONENTS IN THE CHRONIC PAIN STRUCTURE (ON THE EXAMPLE OF THE ISCHEMIC HEART DISEASE AND SOMATOFORM DISORDERS)

The results of the research of the chronic pain structure of somatogenic and psychogenic origin were presented in this article. Psychogenic component was revealed in the structure of the anginal pain of chronic character in patients with coronary heart disease (CHD). The content of a psychogenic component was expectedly lower in CHD patients than in patients with chronic pain of the psychogenic origin. At the same time, somatogenic component was discovered in patients with psychogenic pain that could confirm the mixed nature of chronic pain of the psychogenic origin. The determination of the chronic pain structure allows to understand mechanisms of its formation better and to find more effective methods of its management.

Type 1 Kounis Syndrome in Patient with Idiopathic Anaphylaxis

Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactic reactions. It can be associated with normal coronary angiogram or preexistent coronary pathology. Idiopathic anaphylaxis is defined as anaphylaxis without any identifiable precipitating agent or event. We present a case of male who experienced attacks of dyspnoea, hypoxemia, hypotension, purple-red skin, and chest pain over several years. He was diagnosed with idiopathic anaphylaxis. Based on the pattern of chest pain of ischemic origin during the attacks he was retrospectively diagnosed with Kounis syndrome.