Treatment of Patients with Acute Coronary Syndrome with ST Segment Elevation in Clinical Practice of the Republic of Karelia: the Results of 10-year Register

Aim. To study the clinical course, treatment, and outcomes in the patients with ST segment elevation acute coronary syndrome (STeACS) in real clinical practice

Material and methods. Our study is based on data of 5694 patients who were sequentially hospitalized in the Regional Vascular Center from 01.01.2009 to 01.01.2019 due to STeACS and included in the Federal Hospital Register. Men prevailed (65.8%); the average age was 68 years old. 14.1% of the patients had the history of myocardial infarction (MI) before this hospitalization. The reperfusion strategy, drug therapy, as well as the risks of complications and outcomes in real clinical practice of the Republic of Karelia were analyzed. Descriptive statistics methods were used to evaluate the results.

Results. In the study group a high frequency of reperfusion interventions (83.5%) with a predominance of percutaneous coronary intervention (PCI; 76.2%) was revealed, as well as optimal drug therapy in most patients. Thus, 99.4% of patients took aspirin, 82.8% – clopidogrel, 91.1% – anticoagulants, 91.6% – beta-blockers, 95.6% – statins, 94.2% – angiotensin-converting-enzyme inhibitors/angiotensin II receptors blockers. A risk assessment of hospital and 6-month mortality was performed using GRACE score. The distribution of the hospital risk mortality were the following: 25.7% of patients had a low (49-125 points), 33.7% an average (126-154 points), and 40.6% of patients had a high risk (more than 154 points). At the same time, the risk of 6-month mortality in a half of the patients (51.6%) was low (27-99 points), the average risk (100-127 points) was determined in 23.0% of patients and the high risk (more than 127 points) – in 25.5% of patients. Life threatening complications developed in 38.1% of patients and the most frequent ones were arrhythmias (31.5%). The outcomes at the discharge from the hospital were as follows: 1432 patients (63.5%) had Q MI, 390 (17.3%) – non Q MI, 76 (3.4%) – unstable angina, 21 (0.9%) – MI of unspecified localization and 317 patients (14.1%) – repeated myocardial infarction.

Conclusion. According to the results of a 10-year hospital registry of patients with STeACS, a high frequency of reperfusion interventions and an optimal drug therapy in most patients was revealed. However, to increase the effectiveness of treatment, it is necessary to minimize temporary losses both at the prehospital treatment and during reperfusion.

1. Federal states statistics service. The demographic yearbook of Russia. Statistical handbook. Moscow: Rosstat; 2017. (In Russ.)

2. Boytsov S.A., Demkina A.E., Oshchepkova E.V., et al. Progress and Problems of Practical Cardiology in Russia at the Present Stage. Kardiologiia. 2019;59(3):53-9 (In Russ.) DOI:10.18087/cardio.2019.3.10242.

3. Makki N., Brennan T.M., Girotra S. Acute coronary syndrome. Intensive Care Med. 2015;30(4):186- 200. DOI:10.1177/0885066613503294.

4. Gach O., El H.Z., Lancellotti P. Acute coronary syndrome. Rev Med Liege. 2018;73(5-6):243-250.

5. Radecki R.P., Foley K.F., Elzinga T.S., et al. Pilot of urgent care center evaluation for acute coronary syndrome. Am J Manag Care. 2019;25(5):e160-e164.

6. Ibanez B., James S., Agewall S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. DOI:10.1093/eurheartj/ehx393.

7. Fox K.A., Dabbous O.H., Goldberg R.J., et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333(7578):1091. DOI:10.1136/bmj.38985.646481.55.

8. Reed G.W., Rossi J.E., Cannon C.P., et al. Acute myocardial infarction. Lancet. 2017;389(10065):197- 210. DOI:10.1016/S0140-6736(16)30677-8.

9. Vogel B., Claessen B.E., Arnold S.V. ST-segment elevation myocardial infarction. Nat Rev Dis Primers. 2019;5(1):39. DOI:10.1038/s41572-019-0090-3

10. Neumann F.J., Sousa-Uva M., Ahlsson A., et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. DOI:10.1093/eurheartj/ehy394.

11. Switaj T.L., Christensen S.R., Brewer D.M. Acute Coronary Syndrome: Current Treatment. Am Fam Physician. 2017;95(4):232-40.

12. Rentrop K.P., Feit F. Reperfusion therapy for acute myocardial infarction: Concepts and controversies from inception to acceptance Am Heart J. 2015;170(5):971-80. DOI:10.1016/j.ahj.2015.08.005.

13. Hao W., Lu S., Guo R. Risk factors for cardiac rupture complicating myocardial infarction: a PRISMA meta-analysis and systematic review. J Investig Med. 2019;67(4):720-8. DOI:10.1136/jim-2018-000841.

14. Erlikh A.D. How “Real Life” Treatment of Patients With ST-Elevation Acute Coronary Syndrome Has Changed During Recent Several Years (Data From a Series of the Russian RECORD Registries). Kardiologiia. 2018;58(7):23-31 (In Russ.) DOI:10.18087/cardio.2018.7.10140.

15. Kontsevaya A.V., Bates K., Goryachkin E.A., et al. Hospital Stage of Myocardial Infarction Treatment in 13 Regions of Russian Federation by Results of the International Research. Rational Pharmacotherapy in Cardiology. 2018;14(4):474-87 (In Russ.) DOI:10.20996/1819-6446-2018-14-4-474-487.

16. Malay N., Solokhina L.V., Bukhonkina Y.M. Characteristic features, treatment and hospital outcomes in patients with acute myocardial infarction: Khabarovsk Register data. Part I. Rational Pharmacotherapy in Cardiology. 2016;12(1):56-62 (In Russ.) DOI:10.20996/1819-6446-2016-12-1-56-62.

17. Erlikh A.D. Twelve month outcomes in patients with acute coronary syndrome, by the national registry RECORD-3. Russian Journal of Cardiology. 2018;(3):23-30 (In Russ.) DOI:10.15829/1560-4071-2018-3-23-30.

18. Liu Y., Yao Y., Tang X.F., et al. Evaluation of a novel score for predicting two-year outcomes in patients with acute coronary syndrome after percutaneous coronary intervention. J Chin Med Assoc. 2019;82(8):616-22. DOI:10.1097/JCMA.0000000000000124.

19. Piironen M., Ukkola O., Huikuri H., et al. Trends in long-term prognosis after acute coronary syndrome. Eur J Prev Cardiol. 2017;24(3):274-80. DOI:10.1177/2047487316679522.

20. Shavadia J.S., Chen A.Y., Fanaroff A.C., et al. Intensive Care Utilization in Stable Patients With ST-Segment Elevation Myocardial Infarction Treated With Rapid Reperfusion. JACC Cardiovasc Interv. 2019;12(8):709-17. DOI:10.1016/j.jcin.2019.01.230.

21. Park J., Choi K.H., Lee J.M. Prognostic Implications of Door-to-Balloon Time and Onset-to-Door Time on Mortality in Patients with ST -Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Heart Assoc. 2019;8(9):e012188. DOI:10.1161/JAHA.119.012188.

22. Orenes-Piñero E., Esteve-Pastor M.A., Ruiz-Nodar J.M., et al. Under-prescription of novel antiplatelet drugs in patients with acute coronary syndrome and previous cardiovascular disease. Minerva Med. 2019;110(5):410-8. DOI: 10.23736/S0026-4806.19.05859-2.

23. Paravattil B., Elewa H. Strategies to Optimize Dual Antiplatelet Therapy After Coronary Artery Stenting in Acute Coronary Syndrome J CardiovascPharmacolTher. 2017;22(4):347-55. DOI:10.1177/1074248416683048.