Aim. To perform a comparative assessment of the clinical and demographic characteristics of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and health care quality during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. Data obtained from medical records were used. Statistical processing was performed using the Statistica 10.0 software package. The analysis included patients with NSTE-ACS treated in 2020 (n=524) and 2019 (n=395). The group for further analysis consisted of patients with non-ST elevation myocardial infarction treated in 2020 (n=233) compared to 2019 (n=221).Results. An increase in the relative number of patients with unstable angina in the NSTE-ACS group was revealed. COVID-19 was verified in 5,5% of patients with NSTE-ACS. Of these, pneumonia was diagnosed in 10 (34,5%) patients, while 11 (37,9%) patients were transferred to pulmonary hospitals. The remaining 18 (62,1%) patients were discharged for outpatient treatment. Infected patients had a higher risk of in-hospital mortality according to the Global Registry of Acute Coronary Events (GRACE) score relative to general cohort of patients — 2,0 (1,0; 9,0) vs 1,0 (0,8; 3,0) (p=0,04). In addition, 215 (92,3%) patients underwent invasive coronary angiography, which is higher than in 2019 (78,7%) (p<0,001). An increase in revascularization prevalence in patients ≥75 years old was found (p=0,01).Conclusion. COVID-19 pandemic has led to a change in the clinical characteristics of patients, while not having a significant impact on the scope of endovascular interventions and health care quality for patients with NSTE-ACS in the emergency cardiology department.
Aim:to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis.Materials and methods.We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II–III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated.Results.Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis – in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (<50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed.Conclusion.These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.
This article presents a clinical case of a 40-year-old woman with fulminant myocarditis which progressed rapidly to the development of cardiogenic shock resistant to standard intensive care, but with a positive response to extracorporeal membrane oxygenation.
A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.
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