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The frequency of cardiovascular diseases is increasing progressively with age, and the global aging of the population poses the problem of treatment of patients of older age groups in a row with other relevant medical and socio-economic problems.
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The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome witho...
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The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome without ST segment elevation. A distinctive feature of the work is the recruitment of patients in the same medical institution for different periods of time, which makes possible to trace the dynamics of the clinical profile of patients in the population of Dnipro, a large industrial center of Ukraine. The prevalence of arterial hypertension, chronic heart failure and previous myocardial infarction remained at the same level. In the 2017-2020’s group compared with the 2015’s group, electrocardiographic ?manifestations of acute coronary syndrome without ST-segment elevation upon admission were more often detected. Laboratory indicators such as hemoglobin, creatinine and total cholesterol levels remained the same. Another interesting finding is a statistically significant decrease in the number of patients with a reduced glomerular filtration rate according to MDRD (less than 60 ml/min/1.73 m2) in the 2017-2020’s group compared to patients in 2015’s group, although the clinical course of the disease remained practically unchanged. There was a trend towards a worsening of the clinical status and prognosis, namely, increase in the prevalence of atrial fibrillation and diabetes mellitus, increase in the risk of GRACE, as well as increase in the quantity of verified diagnoses of unstable angina, which is most likely associated with the increased use of high-sensitivity troponin. Noteworthy feature is that increase in the quantity of high-risk patients led to an increase in the mean GRACE score.
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Background. The study of predictors that negatively affect the long-term prognosis of patients with an increased risk of coronary syndrome can improve the effectiveness of measures for the secondary prevention of cardiovascular ev...
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Background. The study of predictors that negatively affect the long-term prognosis of patients with an increased risk of coronary syndrome can improve the effectiveness of measures for the secondary prevention of cardiovascular events. Aim. To determine the factors that have a negative impact on 5-year survival in patients with acute coronary syndrome and percutaneous coronary intervention. Material and methods. 135 patients with acute coronary syndrome enrolled in the Register of percutaneous coronary interventions in 20122013 at the Tyumen Cardiology Center, a branch of the Tomsk Research Institute of Cardiology of the Russian Academy of Sciences, were included in the study. After 12 and 60 months, the clinical status of patients and ongoing drug therapy were evaluated, and an examination including echocardiography with an ultrasound scanner, daily monitoring of the electrocardiogram and standard blood pressure measuring was performed. Laboratory studies included general and biochemical blood tests. To calculate the factors associated with poor prognosis, a Cox proportional hazards regression model with stepwise inclusion was used. Survival was assessed by the KaplanMeier method using the Log-rank test (logarithmic test). Results. After 1 year, only three-quarters of patients continued the recommended drug therapy, a similar trend continued after 5 years of follow-up. The number of patients without any antiplatelet therapy increased from 19.9% after 12 months to 29.7% after 60 months. Overall survival after 1 year was 97.1%, after 5 years 86.7%. The risk of death increased in the presence of chronic kidney disease (risk ratio 15.1; 95% confidence interval 4.3052.93; p=0.001); type 2 diabetes mellitus (risk ratio 3.67; 95% confidence interval 1.1811.43; p=0.025), history of stroke (risk ratio 9.07; 95% confidence interval 1.8544.60; p=0.007), in patients with a heart rate 80 beats per minute [risk ratio 4.3; (95% confidence interval 1.5112.26; p=0.006) and at pulse pressure 60 mm Hg (risk ratio 4.68; 95% confidence interval 1.6013.72; p=0.005)]. Conclusion. The predictors that influenced the 5-year survival of patients after acute coronary syndrome and percutaneous coronary intervention were chronic kidney disease, diabetes mellitus, a history of stroke, high pulse pressure, and increased heart rate of more than 80 beats per minute.
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Aim. To study retrospectively the treatment preceding acute coronary syndrome (ACS) in patients with atrial fibrillation (AF) in real-life outpatient practice on the territory of Kirov Region. Materials and methods. The registry i...
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Aim. To study retrospectively the treatment preceding acute coronary syndrome (ACS) in patients with atrial fibrillation (AF) in real-life outpatient practice on the territory of Kirov Region. Materials and methods. The registry included 163 patients with AF who were undergoing rehabilitation following ACS (ACS occurred <1 month ago) in the hospital of Kirov State Medical University. Mean age of patients was 64.9 +/- 9.7; 55.8% were men. Results. 92.6% of patients were assigned to group 4 of cardiovascular risk (CVR). Only 26.4% of all patients received hypolipidemic therapy (HLT); only 21.9% of CVR group 4 patients, 66.7% of CVR group 3 patients, and all patients of group 2 achieved the total cholesterol goal. Only 10.6% of group 4 patients, 55.6% of group 3 patients, and 33.3% of group 2 patients achieved the LDL-C goal. Assessment of antithrombotic therapy (ATT) in AF patients showed that 34.3% of patients received oral anticoagulants (OACs) (vitamin K antagonists (VKAs) - 30.5% and new generation OAKs (NOACs) - 3.8%); 21.5% of patients not taking VKAs monitored their international normalized ratio (MNR) on a regular basis and 9.4% of patients had a target MNR during admission; and 13.3% of patients at high risk of stroke according to the CHA(2)DS(2)-VASc scale had thromboembolic complications (TEC). 83.6% of patients received a therapy for IHD; 21.88% received a therapy completely consistent with clinical guidelines. 78.2% of patients received a therapy for CHF; 30.08% received a therapy completely consistent with clinical guidelines. Analysis of antihypertensive therapy (AHT) in AF patients showed that 39.3% of patients received a rational combination AHT; 34% received probably rational (considering concurrent conditions) therapy; and 0.7% received a non-rational therapy. 17.33% of AH patients achieved the BP goal; fixed-combination AHTs were administered extremely rarely (4%). Conclusion. The retrospective analysis of treatment quality in patients with AF showed that HLT, ATT, and AHT for IHD and CHF were of very low quality, which suggested that efficacy and safety control for the treatment of major cardiovascular diseases (CVD) administered to this patient cohort before ACS was virtually absent. Generally, approximately the same situation was described in similar registries of Europe, China and Russia.
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Aims The aim of this article is to assess initiation and discontinuation of preventive medication and use of non-pharmacological prevention interventions after acute coronary syndrome (ACS) among migrants to Denmark compared to th...
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Aims The aim of this article is to assess initiation and discontinuation of preventive medication and use of non-pharmacological prevention interventions after acute coronary syndrome (ACS) among migrants to Denmark compared to the local-born Danish population, taking differences in comorbidity and sociodemographic factors into account.
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С ноября 2000 г. по июль 2001 г. в 59 лечебных учреждений различных городов России госпитализировано 1412 больных 18 лет и старше с симп...
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С ноября 2000 г. по июль 2001 г. в 59 лечебных учреждений различных городов России госпитализировано 1412 больных 18 лет и старше с симптомами, предположительно связанными с острой ишемией миокарда, которые возникли в предшествующие 24 ч и сопровождались подъемами сегмента ST на ЭКГ или блокадой левой ножки пучка Гиса. Оценивались демографические данные, данные анамнеза, особенности текущего обострения ИБС, лечение, обследование и исходы за время пребывания в стационаре, а также диагнозы при поступлении и окончании госпитализации. Маркеры некроза миокарда определены в 61 % случаев. Частота использования вмешательств, способных благоприятно повлиять на исходы при этой форме острого коронарного синдрома, оказалась достаточно низкой. Аспирин с ранних сроков заболевания назначен у 79% больных (противопоказания отмечены у 6,2%). В первые 12 ч после появления симптомов тромболитическая терапия проведена у 12,9% больных, коронарная ангиопластика- у 1,2%. Среди больных, поступивших в стационар в пределах 12 ч после появления симптомов, тромболитическая терапия проведена в 21,3% случаев, ангиопластика- в 1,9%. р-Блокаторы назначались не более чем в 60% случаев (первое введение внутривенно у 4,3%), гиполипидемические средства при выписке рекомендованы 12,3% больных (у 21,1% с известной гиперлипидемией). Ингибиторы ангиотензинпреврашающего фермента в стационаре получали 68,1% больных. За оставшееся время госпитализации коронарная ангиопластика была выполнена у 5 больных, коронарное шунтирование- у 1. Вместе с тем госпитальная летальность оказалась сравнительно невысокой и составляла в целом 8,5%, среди больных с несомненным острым инфарктом миокарда при поступлении в стационар - 10,1%. Частоту инфаркта миокарда, развившегося после госпитализации, по имеющимся данным трудно оценить; стенокардия отмечена у каждого пятого больного.
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Background: Patients with acute coronary syndrome complicated with high degree atrioventricular block still have a high mortality. A low percentage of these patients need a permanent pacemaker (PPM) but mortality and associated fa...
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Background: Patients with acute coronary syndrome complicated with high degree atrioventricular block still have a high mortality. A low percentage of these patients need a permanent pacemaker (PPM) but mortality and associated factors with the PPM implant in acute coronary syndrome patients are not known. We assess whether PPM implant is an independent variable in the mortality of acute coronary syndrome patients. Also, we explored the variables that remain independently associated with PPM implantation. Methods: This was an observational study on the Spanish ARIAM register. The inclusion period was from January 2001 to December 201 I. This registry included all Andalusian acute coronary syndrome patients. Follow-up for global mortality was until November 2013.
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The aim of this work was a retrospective assessment of the quality of treatment, depending on the severity of polymorbidity (PM) in patients with atrial fibrillation (AF) before admission to acute coronary syndrome (ACS). Material...
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The aim of this work was a retrospective assessment of the quality of treatment, depending on the severity of polymorbidity (PM) in patients with atrial fibrillation (AF) before admission to acute coronary syndrome (ACS). Materials and methods. Retrospectively, 105 patients were included in the analysis (54 men (51,4%), mean age 65,94 +/- 9,34 years) who had AF before hospitalization for ACS. The index of polymorbidity (IPM) was assessed by ME Charlson et al. (1987) in the modification of H. Quan et al. (2005). The M +/-sigma, the Student's coefficient, chi(2) were calculated. Results. Patients were ranked according to the IPM: the moderate degree of PM was revealed in 40%, the severe degree of PM - in 60% of patients. The group with a moderate degree of PM included patients aged 58,91 +/- 6,95 years, in the group with a severe degree of PM age was 70,63 +/- 7,65 years (p<0,001). Men predominated (71 vs 29%, p=0,0001) in the group with a moderate degree of PM, and women predominated (62 vs 38%, p=0,0075) in the group with a severe degree of PM. In the group of patients with a severe degree of PM, the average number of all diseases was 7,97 +/- 2,66. When analyzing the quality of antithrombotic therapy (ATT), lipid-lowering and antihypertensive therapy, it was found that it was of lower quality in patients with a severe degree of PM than in patients with moderate PM. Only 20 (33,33%) patients >= 65 years and 8 (40%) patients >= 7.5 years received ATT drugs of class B of the FORTA (Fit fOR The Aged) list - oral aticoagulants. All other patients of these age categories did not receive any ATT. Conclusion. Patients with AF are characterized by high PM, which is more pronounced in the older age group and in women. Multiple drug therapy is associated with high PM in patients with AF. A retrospective assessment of the quality of treatment, depending on the severity of PM in patients with AF before admission to the ACS, showed the deterioration in the quality of ATT, lipid-lowering and antihypertensive therapy with an increase in IPM.
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Background: A systematic method of symptom assessment in patients with acute coronary syndromes is important for disease recognition and initiation of early treatment. However, such assessment in Chinese people is hindered by the ...
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Background: A systematic method of symptom assessment in patients with acute coronary syndromes is important for disease recognition and initiation of early treatment. However, such assessment in Chinese people is hindered by the lack of a psychometrically sound instrument. Aims: To develop the Chinese version of the Symptoms of Acute Coronary Syndromes Inventory (SACSI-C) and to evaluate its psychometric properties for Chinese patients. Methods: SACSI was translated from English into Chinese according to Brislin's model. Its content validity and face validity were evaluated. A sample of 114 acute coronary syndromes patients was recruited from the cardiac units of two hospitals in Hong Kong. The reliability was assessed by one-day test-retest reliability. The known-groups validity was evaluated by its ability to differentiate patients with typical versus atypical symptom presentation in older (>75 years) and younger (<75 years) groups. Results: The Item-Content Validity Index of the SACSI-C was computed as 0.88-1.00. The Scale-Content Validity Index was computed as 0.99. The intraclass correlation coefficients of all items of the symptom subscale were above 0.75, except for item 16. The kappa values of all items in the symptom location and quality subscales were above 0.663. The test-retest reliability was good. The known-groups validity was evident, as demonstrated by the results of Chi-square test (p=0.007) and logistic regression analysis (odds ratio=2.9, p=0.039), showing that older patients were significantly more likely to have atypical symptom presentation. Conclusion: The psychometric properties of the SACSI-C are satisfactory and could be used to assess acute coronary syndromes symptomatology in Chinese.
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Methods: Two groups according to the presence of fQRS in ECG. Results: fQRS has higher sensitivity for LAD, LCX &RCA, more specific for LAD. Conclusions: fQRS is a good, simple, applicable positive test to predict the presence of significant CAD in acute coronary syndrome (ACS), even without enzyme elevation. Theoretically, fQRS is due to heterogeneous myocardial electrical activation from regional ischemia, myocardial fibrosis or scar. We aimed to detect if the presence of fragmented QRS complex in patient with acute coronary syndrome (ACS) can predict the presence of coronary artery lesion and to which extent in Egyptian patients....
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Methods: Two groups according to the presence of fQRS in ECG. Results: fQRS has higher sensitivity for LAD, LCX &RCA, more specific for LAD. Conclusions: fQRS is a good, simple, applicable positive test to predict the presence of significant CAD in acute coronary syndrome (ACS), even without enzyme elevation. Theoretically, fQRS is due to heterogeneous myocardial electrical activation from regional ischemia, myocardial fibrosis or scar. We aimed to detect if the presence of fragmented QRS complex in patient with acute coronary syndrome (ACS) can predict the presence of coronary artery lesion and to which extent in Egyptian patients.
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