The aim – to study the risk factors of an unfavorable prognosis and identify patients groups with high risk of complications after acute coronary syndrome (ACS).
Material and methods. A total of 490 patients (pts) hospitalized with ACS without ST-segment elevation (74.49 % men and 25.51 % women, average age 58.78±0.44 yrs) with acute clinical destabilization that occurred no more than 72 hours before admission to the hospital were examined. The diagnosis of acute myocardial infarction (MI) or unstable angina pectoris was established according to the ESC guidelines. The anamnestic and clinical factors affecting the course of the hospital period were identified. The end points of the study, in addition to the clinical signs, were additionally formed combined endpoint: MI/cardiovascular death/recurrent angina pectoris (MI/CVD/RAP), MI/CVD/acute heart failure (MI/CVD/AHF), MI/CVD/ AHF/RAP.
Results. Most patients had arterial hypertension (AH) (77.35 %) and ischemic heart disease (IHD) (72.04 %) in the anamnesis, including a previous MI – 43.06 %. There were 34.08 % active smokers and 53.88 % – smokers in the past; overweight was detected in 16.53 %, type II diabetes mellitus (DM) – in 16.12 %. Acute HF, MI and death were detected with similar frequency in men and women. RAP developed in women more often than in men (46.4 % vs 29.3 %, respectively, Р<0.001). Ventricular arrhythmias (VA) were registered more often in men (15.1 % vs 6.4 %, Р<0.05). There were no significant differences in the middle and older groups. AHF, RAP, and MI/CVD/RAP, MI/CVD/AHF and MI/CVD/AHF/RAP have developed or progressed more often in men with DM than in women. In men, the presence of DM in 2 times increases AHF developing risk (Р<0.05) during the hospital period, 4 times the risk of progression AHF (Р<0.01), 2 times the risk of RAP, MI/CVD/RAP, MI/CVD/AHF/RAP (Р<0.05, in all cases) and almost 5 times the risk of MI/CVD/AHF (Р<0.01). Significant differences during the hospital period are observed in pts younger than 55 yrs and older than 65 yrs. There were no differences in middle age pts. The IHD history significantly increased the AHF progression, RAP development and the frequency of combined endpoint: MI/CVD/RAP, MI/CVD/AHF, MI/CVD/AHF/RAP. The previous MI did not affect the development of the hospital period complications of ACS without ST elevation. Chronic heart failure (CHF) in the history significantly increased the risk of AHF development during the hospital period of ACS, as well as the risk of AHF developing on the 1st day of the disease, the development of RAP and combined CT: MI/CVD/RAP, MI/CVD/AHF/RAP. The presence of AH significantly increased RAP development risk by 26 %.
Conclusions. Factors of poor prognosis of the hospital period in patients with ACS without ST segment elevation include DM in men, IHD, CHF and AH in the history. The risk of RAP, MI/CVD/RAP, MI/CVD/AHF/RAP are significantly higher in women than in men, while VA reliable more frequently develop in men. The most important gender differences regarding development of hospital complications are observed in patients younger than 55 yrs.
The aim – to study clinical and functional characteristics of patients with ST-segment elevation myocardial infarction (STEMI), the terms of urgent percutaneous coronary intervention (PCI), the coronary artery lesions, gender and age, the parameters of intracardiac hemodynamics depending on the time to PCI; to assess the end-points at 1 year follow-up.
Material and methods. Between Feb till May 2015 we conducted a single-center prospective study and enrolled 108 patients with STEMI that underwent PCI (coronary angiography with stenting). We analyzed the terms of PCI after acute coronary syndrome symptoms onset, demographic, anamnestic, clinical, echocardiographic, angiographic data, as well as characteristics of interventions. We studied end-points, such as death, recurrent non-fatal MI, unstable angina, at 12 months follow-up after STEMI. Data on clinical outcomes were available in 100 of 108 patients (92.6 %).
Results. According to the study results, half of STEMI patients underwent PCI within 3.5 hours; only 20.4 % patients – within the optimal time window (up to 2 hours); 60 % of patients – from 2 to 6 hours. Only 47 % of patients underwent complete revascularization. However, stenotic lesions ≥ 70 % were identified in 40 % of patients. Severe coronary lesions, suitable for CABG, were detected in 14 % of cases. Large LV aneurysm with intramural thrombus formation was diagnosed in 4 % of patients. Females, compared to males, were older, with the more prevalent concomitant hypertension and diabetes mellitus. Only 33 % of patients were judged as low-risk patients, according to the PAMI-II criteria. At 1 year follow-up, 3 % patients died from recurrent MI. These patients had single- or two-vessel disease, with stenting of the culprit artery. Among patients suitable for CABG, surgical revascularization was performed only in 1/3 cases.
Conclusions. The registry data allow to assess the profile of STEMI patients undergoing PCI, as well as short-term (at discharge) and long-term (at 1 year follow-up) outcomes.
The aim – to compare the clinical, anamnestic characteristics and course of in-hospital period in patients of different age groups with ST-elevation acute coronary syndrome.
Material and methods. Were analyzed the data of 835 patients with ST-elevation acute coronary syndrome admitted to the emergency departments from January 2000 to December 2015. Patients were divided into two groups: I group – < 45 years of age (n=189), II group ≥ 45 years (n=646).
Results. The average age of patients in the I group was (37.8±6.5) years, in the II group – 59.3±8.1 years (Р<0.0001). Among the patients in group I there were more men (Р<0.0001). The mean body mass index (BMI) in young patients was 28.7±4.6 kg/m2 compared to 27.8±4.2 kg/m2 in group II (Р<0.021). The frequency of diabetes mellitus in patients of the I group was 4.2 %, arterial hypertension – 41.8 %. Young patients were much less likely to have a history of myocardial infarction or stroke and concomitant heart failure. The anterior localization of myocardial infarction in group I patients was registered in 59.8 % cases vs 51.9 % in the II group, Р=0.045; there were no significant differences regarding frequency of posterior and lateral infarctions. The average time from the development of symptoms to hospitalization in the I group was 9.7±7.6 hours, and in group II – 4.5±5.3 hours (Р<0.001).
Conclusions. Patients under 45 years of age with ST-elevation acute coronary syndrome are heterogeneous. The most important risk factors for the development of AMI in these patients are smoking, overweight and heredity. Hypertension and diabetes mellitus in young patients were much less frequent than in the older age group. In-hospital course of AMI in young patients was more favorable with fewer complications.
Material and methods. The study involved 91 male patients aged 33-68 (average age (52.3±1.5) years with Q-wave MI. In the first hours after MI onset, all patients had urgent coronary angiography, a stent was inserted into the culprit coronary artery and drug therapy was administered in accordance to the current protocols and guidelines. Depending on the amount of physical rehabilitation, the patients were divided into two groups: group 1 included 47 patients who underwent physical cycling course training (three times a week, a total of 30 sessions), group 2 consisted of 44 patients whose rehabilitation consisted in distance walking and remedial exercises. The examinations were carried out at discharge from the inpatient department (12–15 days). Both clinical, instrumental and biochemical tests were performed after 4, 6 and 12 months following MI.
Results. At the initial stage, the patients of either group didn’t demonstrate differences in clinical indicators or medical history data. At the first survey, the threshold power level and the cost of the work performed according to the indicator of the ratio of dual product to the level of performed work (DP/A) didn’t differ significantly. After 30 training sessions, the threshold power increased significantly (125.0 (125.0–140.0) W in group 1 at the value of DP/A 0.92 (0.76–1.17) units). In group 2, the threshold power increased to 100.0 (75.0–100.0) W, but at the level of DP/A (1.73±0.18) units. One year after MI the level of threshold power increased to 140,0 (125.0–150.0) W at low cost (1.17 (0.98–1.32) units) in group 1, while in group 2 the level of threshold power decreased and approached the data of the first survey (75,0 (75.0–100.0) W) with a significant increase of the cost of work (2.41 (1.73–3.36) units). Such dynamics of the indicators of exercise tolerance was accompanied by changes of hemodynamic indices.
Conclusions. Exercise training program increased physical tolerance with better parameters of bicycle ergometry after its interruption and preserving of the effect during one year after MI. This was accompanied by optimization of the remodeling and restoration of wall kinesis. The exercise training program contributed to improving the physical fitness in patients with late opening of the infarction-related coronary artery disease and incomplete revascularization. The effect of exercise training was short-lived and limited in multifocal lesions.
Material and methods. A retrospective observational single-center study included 576 consecutive pts with stable CAD (mean age 61±9 years, 491 (85.2 %) males, 85 (14.8 %) females), undergoing isolated CABG. We analyzed demographic, clinical, laboratory, echocardiographic, coronary angiographic, intra- and postoperative data, and assessed health-related quality of life. In total, EPOC were registered in 112 (19.4 %) cases. Acute kidney injury (n=55) and acute heart failure (n=49) were the most frequent major EPOC (9.5 % and 8.5 %, respectively). Two patients (0.4 %) died early after CABG.
Results. At univariate analysis, EPOC were related to the following baseline parameters: age; body mass index (BMI); heart failure NYHA class; permanent AF; severe diabetes mellitus (DM); poor kidney function (by estimated glomerular filtration rate (eGFR)); left atrium and left ventricular (LV) end-diastolic volume index; LV systolic dysfunction; LV hypertrophy; aortic and mitral valve regurgitation; three-vessel CAD. At multivariate analysis, the independent predictors of EPOC were as follows: BMI (per 5 kg/m2 increase vs < 25.0 kg/m2 as reference (r): OR 1.38 (95 % CI 1.06–1.79); Р=0.017); DM severity (per each severity category increase vs no DM (r): OR 1.75 (95 % CI 1.47–2.10); Р<0.001); eGFR (per each 30 ml/min/1.73 m2 decrease vs ≥ 90 ml/min/1.73 m2 (r): OR 2.29 (95 % CI 1.58–3.31); Р<0.001); and LV ejection fraction (EF) (< 40 % vs. 40–49 % vs. ≥ 50 % (r): OR 1.92 (95 % CI 1.49–2.49); Р<0.001).
Conclusions. Multiple characteristics related to EPOC reflected comorbidity burden in the study cohort. Independent predictive value of baseline BMI, DM severity, eGFR and LV EF should be taken into account for risk stratification before CABG.
The aim – to determine the impact of the «no-reflow» phenomenon (NRP) after percutaneous coronary intervention (PCI) upon long-term prognosis in patients with ST elevation myocardial infarction (STEMI) and the effect of NRP on the incidence of complications of acute myocardial infarction during the acute period.
Material and methods. 105 patients with STEMI aged 36 to 85 years were studied, the mean age was 60.40±2.03 years. PCI was performed immediately after the diagnosis of STEMI, an average of 7.6±1.2 hours after the onset of the first symptoms. No-reflow was determined after the recanalization of the infarct-related artery (IRA) as the absence of optimal myocardial perfusion using the MBG (Myocardial blush grade, MBG ≤ 2) scale. Patients in whom NRP was fixed were assigned to the main group, n=18 (17.1 %), patients whose angiographic data met the criteria for successful PCI were appropriately allocated to the control group, n=87 (82.9 %). The final combined point was nonfatal repeated myocardial infarction, nonfatal stroke, cardiovascular death (CVD), and repeated hospitalization for the recurrence of the angina pectoris within one year after intervention.
Results. In the main group, postinfarction angina (OR 3.79, 95 % CI 1.08–13.42, Р<0.05), acute left and/or right ventricular failure was significantly more frequent (OR 7.98; 95 % CI 1.89–33.65, Р<0.05) and there were more cases of ventricular fibrillation (OR 12.14, 95 % CI 2.03–72.67, Р<0.05). At the end of 10.9±1.6 months it was found that the incidence of the combined endpoint in the patients of the main group is significantly higher than in the control group (OR 3.89, 95 % CI 1.36–11.24, Р<0.05). The greatest contribution to the difference between the groups at the combined endpoint was made by the discrepancy between the study groups for CVD (OR 10.38, 95 % CI 2.55–42.18, Р<0.05)
Conclusions. NRP in patients STEMI after PCI is related to the development of postinfarction angina, acute left and/or right ventricular failure, ventricular fibrillation. The strongest link was established between the development of NRP and cardiovascular mortality during the first 30 days in patients after intervention. It was not possible to establish connection between NRP and re-hospitalization for the resumption of angina pectoris, the incidence of non-fatal recurrent myocardial infarctions and non-fatal strokes.
The aim – to study the dynamics of indices of the exercise tolerance and the qualitative status of the main classes of lipoproteins together with activity of corresponding enzymes in patients after acute myocardial infarction (MI) during the first 6 months of follow-up.
Material and methods. 76 patients were included in the study (mean age 52.2±1.2 years). They received basic therapy according to the current guidelines, including emergent stenting. 41 pt (1st gr) in addition to standard medical treatment had the course of 30 cycle ergometer exercise trainings 3 times per week in individual regimen and 35 pts (2nd gr) underwent medical treatment and walking without trainings. All of them were examined on the 14–16th days of myocardial infarction and in dynamics at 2,5; 4 and 6 months. Blood biochemistry assays were performed on the 14–16th days and in 5 months after myocardial infarction.
Results. There was no difference in main clinical and anamnestic indices in patients of both groups at the first examination. Regular cycle ergometer exercise trainings led to the significant increase of the level of work capacity at the 4th month from (60.7±3.0) to (114.0±2,9) kJ (P<0.05) with better economic efficiency of heart work. The level of tolerance to physical load which was achieved by pts in the 1st gr was preserved 2 months at least after physical training stopping (112.0±3.9) kJ (P<0.05). At the same time these indexes in the 2nd gr were (59.1±3.8), (65.8±3.0) and (69.8±4.4) kJ, respectively with worse economic efficiency of heart work. At the 1st exam it was established high level of free radical oxidation of proteins, associated with oxidation of low density lipoproteins (LDL), very low density lipoproteins (VLDL), and high density lipoproteins (HDL) with higher index of their oxidative modification and blood atherogenic potential. The accomplished training program significantly decreased the content of free radical oxidation of proteins in blood serum and lipoproteins (LDL+ VLDL, HDL).
Conclusions. The efficiency of physical training program at the cycle ergometer in early period after myocardial infarction was established during 6-months follow up. Regular activities in individual regimen in addition to standard medical treatment (with emergent stenting) led to significant increasing of the level of the completed work and economic efficiency of heart work. These clinical effects may be explained by the decreasing of intensity of oxidative stress and inflammation, the improvement of qualitative status of lipoproteins. After stopping of physical trainings the achieved tolerance to physical load was preserved at least for two months.
The aim – to study the clinical characteristics of patients with stable coronary heart disease (CHD) and heart failure (HF) with mid-range left ventricular (LV) ejection fraction (EF) (40–49 %; HFmrEF), undergoing the planned coronary artery bypass grafting (CABG) in the real-life clinical practice settings.
Material and methods. We conducted a cross-sectional one-center study and consecutively enrolled 622 patients with stable CHD (mean age 61±9 yr, 526 (84.6 %) males and 96 (15.4 %) females), undergoing planned CABG. We analyzed demographic, clinical, laboratory, echocardiographic and coronary angiographic data. The population of enrolled patients was stratified into three groups according to the LVEF degree: group 1 (LVEF ≥ 50 %; 350 (56.3 %)); group 2 (LVEF 40–49 %; 11 (18.5 %)); and group 3 (LVEF < 40 %; 157 (25.2 %)).
Results. The set of parameters in group 2, having intermediate values when compared to groups 1 and 3, were: the frequency of baseline aldosterone antagonists administration; the frequency of patients without mitral and tricuspid regurgitation; the frequency of patients with moderate or severe mitral regurgitation; mean systolic pulmonary artery pressure; the frequency of patients with LV aneurysm, detected by coronary ventriculography.
Conclusion. The population of patients with CHD and HFmrEF, undergoing CABG in the real-life clinical practice settings, is associated with clinical heterogeneity. Further studies are warranted, aimed to determine the predictors of favorable and unfavorable dynamics of LVEF in this category of patients in the post-CABG period.
The aim – to evaluate the effect of different regimes of lipid lowering therapy on the effectiveness of urgent myocardial revascularization and the development of cardiac remodeling in patients with acute coronary syndrome with ST segment elevation (STEMI).
Material and methods. The study involved 135 STEMI patients admitted an average of 4.5 hours after symptoms onset and treated with primary percutaneous intervention. Lipid-lowering treatment was prescribed immediately after presentation. Patients were randomly assigned to one of four groups treated by moderate (group I and group II) or high (group III and group IV) intensity lipid-lowering therapy. Group I (26 patients) was assigned to atorvastatin 10 mg / ezetimibe 10 mg combination, group II (24 patients) – to atorvastatin 40 mg, group III (42 patients) – to atorvastatin 40 mg / ezetimibe 10 mg combination, and group IV (43 patients) – to atorvastatin 80 mg. Echocardiography was performed in all the patients during first 24 hours after symptoms onset and 90 days after STEMI development. Left ventricular (LV) dilatation was defined as at least 25 % increase of end-diastolic volume.
Results. Patients from groups III and IV showed a tendency to the reduction of post-MI LV dilatation after 3 month of treatment (Р<0.1). In our study use of high intensity lipid-lowering therapy reduced the risk of LV remodeling by 30 % (p<0.05), that was also associated with significantly higher LDL reduction. Having no initial differences, on the 90th day the average LDL level was 1.63±0.40 in patients with high intensity treatment vs. 2.21±0.30 mmol/l in patient with therapy of moderate intensity (Р<0.01).
Conclusion. The use of high-intensity lipid-lowering therapy with achievement of target LDL levels after STEMI can reduce the incidence of post-MI LV dilatation.
The aim – to estimate the role of geometric parameters of mitral valve deformation and remodeling of the left ventricle (LV) in the formation of mitral insufficiency in patients with systolic dysfunction after myocardial infarction (MI) of different localization.
Material and methods. We assessed 99 patients with left ventricular (LV) systolic dysfiunction after MI with mild to severe mitral insufficiency. We evaluated mitral insufficiency by means of echocardiography through determining EROA (effective regurgitant orifice area), assessed indexes of LV global and local remodeling. mitral insufficiency was moderate and severe in 36 patients with anterior MI (group 1) and in 43 patients with inferior/posterior MI (group 2), the control group consisted of 21 healthy individuals.
Results. In both groups of patients rates of global and local LV remodeling were significantly higher than in the control group (P<0.0001). Sphericity index was significantly higher in group 1, compared to group 2 (P=0.003). The indexes of local remodeling were significantly higher in group 1, especially anterior papillary muscle (PM) tethering distance (Р=0.03), posterior displacement of the anterior PM (Р=0.03), PM height (Р=0.01), interpapillary distance (Р=0.02). Correlation between EROA and sphericity index in group 1 was revealed (Kendall τ 0.46, P<0.0001), in group 2 this correlation was weak (Kendall τ 0.23, Р=0.016). In group 1 correlation of EROA with anterior and posterior PM tethering distance was revealed (Kendall τ 0.41 and 0.52, P<0.0001). In group 2 EROA correlation with posterior PM tethering distance and anteroposterior mitral valve diameter was revealed (Kendall τ 0.36 and 0.48, P<0,0001). Correlation between EROA and inferior apical segment akinesia and WMSI of posterior PM was revealed in group 1 (Kendall τ 0.71 and 0.51, P<0.0001), and relation between mitral insufficiency and obstructive lesion in circumflexus (Cx) and right coronary artery (RCA) (Р=0.0008 та Р=0.002) in this group.
Conclusions. LV spherisation and PM dislocation are more pronounced in ischemic CMP after anterior MI, compared to inferoposterior MI. Apical and posterior PM displacement, akinesia of inferior apical segment, Cx and RCA obstruction are major determinants of ischemic mitral insufficiency after anterior MI, while posterior PM tethering and anteroposterior mitral annular dilatation are determinants of mitral insufficiency after inferoposterior MI. The obtained data might determine surgical approaches in ischemic mitral insufficiency of different mechanisms.