Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion. Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564
The aim of the work was to determine frequency of lupus anticoagulant (LA) detection in patients at various degrees of COVID-19 severity as well as duration of LA circulation after the infectious disease. The study included 103 patients with COVID-19. The patients were observed during the hospital care and in ambulance, if required. The patients were admitted to the departments of infectious diseases arranged at the V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology, and F.I. Inozemtsev City Clinical Hospital. Treatment schedules and stratification of the patients by clinical severity was carried out in accordance with Interim Guidelines issued by the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection (version 9). The following groups were formed: mild (n = 27), moderate (n = 55) and severe (n = 20). The patients were tested for LA positivity in the course of disease: on the day of starting medical care (with outpatient observation), or on the day of hospitalization; repeated tests were made before discharge (inpatients), and later, 1-2 months and 7 months after recovery. Lupus anticoagulant was determined by two independent tests (dRVVT and SCT), i.e., as a screening test and a confirmation test. At initial examination, LA was found in 50 patients (49%). The effect of LA in 98% of cases was observed with dRVVT test, as an increase of normalized ratio (NR). The maximum median value of NR was 1.54 (0.97: 2.1) was revealed in patients with severe course of COVID-19 (p 0.0001) compared with other groups and correlated with severity of the infectious process (r = 0.491, p 0.0001). In mild cases of COVID-19, LA was detected less often (4 cases, 14.8%) than in moderate severity cases (27, 49.1%), and severe patients (19, 95%) (p 0.05). Re-examinations of the patients before discharge from the hospital and 1-2 months later revealed high frequency of LA (p 0.05). However, no LA-positive test was found 7 months after discharge. In patients with COVID-19, high frequency of circulating LA was registered, depending on severity of the infectious process. In addition, we have first shown that persistence of the circulating LA over post-infectious period does not exceed 7 months.
Background: The method of comparative analysis is one of the most common in science where optimal choices are required. Despite the fact the method is empirical, under the conditions of epidemics such as Covid-19, it is one of the most affordable in assessing the effectiveness of the therapy. Patients with diabetes having coronavirus infection are included in the risk group which required steroid therapy. In patients with diabetes, excessive usage of Exogenous corticosteroids creates insulin deficiency which leads to hyperglycemia and the risk of developing coma. Purpose of the study: сompare the effectiveness and safety of using corticosteroids in patients with Covid-19 and diabetes prescribed "by standards" and "method of calculation". Method: Diabetic Patients with novel coronavirus infection were screened (n = 107).All patients were divided into 3 groups.In group 1(n=35) patients received dexamethasone at a dosage of 0.1 mg/kg once a day in the morning intravenously; in group 2(n = 38), patients received dexamethasone 20 mg twice daily intravenously in the morning and evening (more than 0.2 mg/kg/day) and in group 3(n = 34) patients received dexamethasone 0.1 mg /kg once a day in the morning intramuscularly. Comparative analysis were carried out according to the criteria: the period of intoxication, glycemic variability, CRP, leukocyte counts, D-dimer, and transaminases. For analysis STATISTIC 10,0 computer program was used (Matematica®, Matlab®, HarvardGraphics®) StatSoft). Results: In all the groups after therapy it was noted redistributive leukocytosis.In patients receiving high therapeutic dose (group 2) initially suppressed production of leukocytes is activated and reaches the normative indicator (p&lt;0.001) and the indicators are comparable to the data of group 3(p&lt;0.001)in which patients received glucocorticoids at a lower dose (0.1 mg/kg/day) intramuscularly. The most significant decrease in D-dimer levels was in patients with a dosage of dexamethasone at the rate of 0.1 units/kg once a day intravenously by 80.9%(P &lt;0.0001);intramuscularly by 73.2%(P&lt;0.00001)and with intravenously at a dose of more than 0.2 units/kg there was a decrease in the level of D-dimer by 67.9% (P &lt;0.00001). Decrease in CRP (cytokine storm relief rate) did not differ significantly between the groups, which eliminates the role of inexpedient usage of dexamethasone in dosages of more than 0.2 units/kg/day.Fasting blood glucose in patients in group 3 increased by 22% (P&lt;0.0002); in group 1 only by 12% (P &lt;0.05)and in group 2 by 32% (P &lt;0.0001). In all the groups, an increase was observed in postprandial glucose, and in group 2 to the level of developing ketoacidosis and required emergency intervention by increasing the dose of insulin. Conclusion: For patients without diabetes, the dose of dexamethasone is prescribed in accordance with standards (average dose) regardless of body weight and concomitant diseases. In patients with diabetes are required to determine the dose of dexamethasone individually at the rate of 0.1 mg /kg body weight per day. This method reduces the risk of adverse outcomes and ensures the achievement of positive dynamics of clinical and laboratory parameters which ultimately reduces mortality and shortens the recovery time.
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