Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity of possible cardiovascular manifestations. Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, the development of which in patients with COVID-19 has been described and studied insufficiently. A 35-year-old male patient presented to our hospital with an acute coronary syndrome a few weeks after mild COVID-19. According to coronary angiography, a dissection of ramus intermedius was detected. Successful stenting was performed. Subsequently, the patient had relapses of chest pain, which led to two repeated coronary angiographies. The patient had been diagnosed with consecutive dissections of right coronary artery and distal branch of ramus intermedius. Repeated stenting of dissected segments of right coronary artery and ramus intermedius was not performed. Afterward, the patient’s condition remained stable and he was successfully discharged. One of the main pathophysiological mechanisms of cardiovascular complications in COVID-19 is probably the virus-triggered hyperinflammation and massive release of cytokines. A systemic inflammatory response may initiate inflammation of the vascular wall and other target tissues. The results of histological studies confirm the direct infection of endothelial cells 2019-nCoV with the development of diffuse endothelial inflammation (endotheliitis). It is possible that in patients with a genetic predisposition to artery dissection, COVID-19 may be a trigger of spontaneous coronary artery dissection.
Aim.To determine gender differences in immediate outcomes of patients with acute non-ST-elevation myocardial infarction undergoing off-pump coronary artery bypass grafting (CABG).Methods.CABG was indicated to patients with persistent myocardial ischemia (postinfarction angina) who did not meet criteria for percutaneous coronary intervention. Hybrid procedures and CABG aimed at repairing mechanical complications of AMI were not considered. Men (n = 66, 65.3%) were assigned to Group 1, whereas women (n = 35, 34.7%) were assigned to Group 2. Women were older and obese (grades 2-3), had higher GRACE scores, levels of cardiospecific troponin and higher rate of type 2 diabetes (p<0.05). Men and women commonly had three-vessel CAD (3.0; 4.0). The mean SYNTAX score for men and women was 29.0 (24.0; 33.0) and 27.0 (24.0; 28.0), p>0.05.Results.The median preoperative period was 4.0 days (3.8; 5.0) in male patients and 5.0 (4.0; 6.0) days in female patients (p>0.05). The groups did not have any significant differences in technical aspects of CABG (p>0.05). Mortality was 3.0% in men and 2.9% in women (p>0.05). No deaths were recorded from the onset of AMI till the first 72 hours after CABG. Three patients who under CABG died after 72 hours from the onset of MI (p>0.05). The total number of complications was 13 (19.7%) in men and 5 (14.3%) in women (p>0.05). There were no cases of conversion to cardiopulmonary bypass.Conclusion.The immediate outcomes of delayed of-pump CABG in both, men and women with acute non-ST-segment myocardial infarction, were comparable in mortality and complications (p>0.05). The immediate outcomes of CABG performed within 72 hours in both, men and women, were comparable in mortality as compared to surgeries performed after 72 hours from the MI onset. Obtained data demonstrated safety of early open-heart surgeries for acute non-ST-elevation myocardial infarction.
НУЗ "Дорожная клиническая больница на ст. Челябинск ОАО "РЖД". Челябинск; 2 ГБОУ ВПО "Южноуральский государственный медицинский университет" Минздрава России. Челябинск, Россия Цель. Оценить медико-социальный статус, качество жизни, частоту модифицируемых факторов риска (ФР) атеросклероза у пациентов, перенесших острые инфаркты миокарда (ОИМ), а также определить риски сердечно-сосудистых заболеваний у этих больных. Материал и методы. Проведено анкетирование 200 пациентов с заключительным диагнозом ОИМ. Возраст больных 32-65 лет (средний возраст 50,4±1,4). Респонденты-жители г. Челябинска или его ближайшего пригорода. Респондентам предлагались вопросы, касающиеся социального статуса, качества их жизни до ОИМ, частоты модифицируемых ФР атеросклероза. Результаты. Средняя оценка социального благополучия и качества жизни пациента до ОИМ, находилась на удовлетворительном уровне. Исключение составлял доход на одного 1 члена семьи (оценка-ниже среднего). Частота распространения ФР атеросклероза: хронический стресс-72,0%, артериальная гипертензия-67,5%, избыточный вес-55,0%, курение-49,0%, повышенный уровень холестерина-42,5%, гиподинамия-20,5%, гипер-гликемия-18,5%, нерациональное питание-16,5%. Только 26,0% респондентов развитие заболевания (ОИМ) связали с неправильным образом жизни. Заключение. На примере пациентов с ОИМ преимущественно трудоспособного возраста, проживающих в крупном промышленном городе, определены риски сердечно-сосудистой патологии: низкий доход на одного 1 члена семьи (53,5% респондентов), недостаточная информированность о негативных влияниях модифицируемых ФР атеросклероза и их высокая частота. Ключевые слова: специализированная медицинская помощь, острый инфаркт миокарда, качество жизни, социальный статус.
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