Aim.To identify the risk factors for bleeding of BARC scale 2-5 types in patients after acute coronary syndrome (ACS).Material and methods.The data of 1502 patients from the open multicenter study, ORACUL II, were used — 894 men (59,5%) and 608 women (40,5%), mean age — 65,7±12,9 years. Five hundred sixty (37,3%) patients had ACS with ST-segment elevation and 942 (62,7%) — ACS without ST-segment elevation. Bleeding was recorded in 164 patients (10,9%), including index admission — in 39 (2,6%) patients, of which severe (types 3-5) — 0,5%, significant — 1,7% (types 2-5).Results.Within a year after discharge, bleeding was observed in 126 (8,4%) patients, large — 0,8%, significant — 2,4%. The development of bleeding type 2-5 was associated with the presence of gastric ulcer and duodenal ulcer, gastrointestinal bleeding in history, decreased creatinine, hemoglobin clearance, age of patients, the use of anticoagulants in the composition of triple or double antithrombotic therapy, conducting of percutaneous interventional procedures, the presence of heart failure 2-4 Killip class at admission. ROC analysis showed that the predictive value of the ORACLE bleeding risk scale is 0,762, sensitivity — 62%, specificity — 78%.Conclusion.Thus, we based on routine clinical practice have created a simple scale for assessing the risk of bleeding in patients with ACS.
Семейная гиперлипидемия (СГ) чаще выявляется у больных, поступивших в стационар с осложнениями атеросклероза. Целью данного исследования был анализ частоты встречаемости и особенностей течения острого коронарного синдрома (ОКС) у молодых больных в зависимости от наличия СГ. Из 1754 больных многоцентрового клинического наблюдательного проекта ОРАКУЛ II было отобрано 322, у которых индексный эпизод обострения ИБС развился в раннем возрасте (мужчины в возрасте ≤55 лет, женщины в возрасте ≤60 лет). Для диагностики СГ была использована шкала Голландских липидных клиник (I) и критерии Simone Broome Register (II). ОКС без подъема сегмента ST наблюдался у 153 (47,5 %), а ОКС с подъемом сегмента ST-у 169 (52,5 %) больных. У всех 6 больных с определенной/возможной СГ (I) ОКС протекал с подъемом сегмента ST, в то время как среди пациентов с вероятной СГ либо без неё такое течение ОКС наблюдалось у 156 (51,6 %) (p=0,03). Cреди пациентов с вероятной СГ (II) у 16 (76,2 %) ОКС протекал с подъемом сегмента ST, а без СГ такое течение ОКС наблюдалось у 153 (50,8 %) (p=0,04). Данные исследования подчеркивают важность раннего выявления СГ в связи с манифестацией ОКС с подъемом сегмента ST, что может обусловливать худший прогноз. Ключевые слова: семейная гиперлипидемия, острый коронарный синдром Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder with an estimated prevalence of 1/200-1/500 in the general population. In order to diagnose this disorder it is very important to examine thoroughly patients who developed early acute coronary syndrome (ACS). The aim of this study was to assess the specific features of ACS in young patients with and without FH. Of 1754 ACS patients from multicenter observational trial ORACUL-II 322 patients with early onset of ACS (≤55 years of age for men and ≤60 years of age for women) were selected. Dutch Lipid Clinic Network (I) and Simone Broome Register (II) criteria were used to diagnose FH. NSTEMI was observed in 153 patients (47.5 %) and STEMI in 169 (52.5 %). All 6 patients with definite/ possible FH (I) developed STEMI, while
Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of <2,45 mmol/l is significantly worse than in patients with an LDL-C level ≥2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<1,4 mmol/l), mortality was 13,04%, which was significantly higher than in patients with LDL-C ≥1,4 mmol/l (6,32%, p=0,047).Conclusion. A decrease in LDL-C in the acute period is significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. Determination of LDL-C can be included in the examination program for patients with COVID-19. However, the predictive value of this parameter requires further study in prospective clinical studies.
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