Skopets Inga1, Vezikova Natalia1, Malygin Alexander2
1Petrozavodsk State University, Petrozavodsk, Russia, 2Republic hospital n.a. V.A. Baranov, Petrozavodsk, Russia
To evaluate the clinical features and treatment of Acute coronary syndrome (ACS) in clinical practice in the Republic of Karelia, Russia
The prospective study included 5924 patients successively hospitalized in the Regional Vascular Center (Petrozavodsk, Russia) due to ACS in 2010-2019. The rate of clinical complications, reperfusion strategy, drug therapy and hospital mortality were assessed.
5924 patients with ACS were included to the Russian Federal registry of ACS, men prevailed (59.4%). 2381 (40.2%) patients had ST-elevation Myocardial Infarction (STEMI) and 3543 (59.8%) – ACS without ST elevation (nonSTE-ACS).
In STEMI group the most often kind of reperfusion was PCI (79.5%). The average time from symptoms onset to primary PCI was 240 min and 81.8% patients exposed primary PCI within 90 min from STEMI presenting.
Fibrinolytic therapy applied in 5.8% cases of STEMI, in 16 cases (0.8%) rescue PCI was used.
In 71.2% of cases fibrinolysis was carried out within 30 min from STEMI diagnosis.
The drug therapy of ACS in the hospital was following: 98.8% of patients took aspirin; clopidogrel – 88.2%, anticoagulants – 92.0%, beta-blockers – 92.3%, statins – 97.4% ACE-inhibitors (or AT2-recepcor blockers) – 95.0%.
The outcomes of ACS during the hospital discharge were following: Q wave myocardial infarction (MI) was diagnosed in 2026 (38.3%) cases, non-Q-wave MI – in 1534 (29.0%), unstable angina – in 1214 (22.9%), repeated MI – in 1010 (19.1%) and 140 patients (2.6%) had other diagnosis.
The analysis of the clinical features of ACS shows that significant number of patients (27.7%) had severe complications. So, ventricle arrhythmias were diagnosed in 19.3% of cases, acute left ventricle insufficiency – in 8.5%, cardiogenic shock –in 3.3%, cardiac arrest – in 4.8%, myocardial rupture – in 0.4%. The hospital mortality rate reached 3.98% (5.62% in STEMI group and 2.71% in nonSTE-ACS group).
The 10-years registry shows ACS treatment in real clinical practice in the Republic of Karelia. The study assessed that despite of the reperfusion and drug therapy according the guidelines of patients with ACS management the frequency of severe complications is high.