Aim. To assess clinical and medical history data of patients with acute myocardial infarction (AMI) admitted to the hospital with a possibility of primary percutaneous coronary intervention (PCI), according to the AMI Register in Khabarovsk. Material and methods. The AMI Register includes data on all patients consecutively admitted to the Khabarovsk Regional Vascular Center from 01.01.2014 till 31.03.2014. 321 AMI patients were included into the study. Result. 177 patients with ST-segment elevation AMI (55.14%) were enrolled into the Register as well as 135 patients with non-ST-segment elevation AMI (42.05%) and 9 patients with early recurrent myocardial infarction and early postinfarction stenocardia (2.8%). 54.19% of patients with a reference AMI admitted to the vascular center in the first 6 hours, and 65.39% of patients – in the first 12 hours. The systemic thrombolysis was carried out in 20 patients (6.2%). PCI with coronary stenting was carried out successfully in 122 patients (68.92%) with ST-segment elevation AMI and in 25 (18.5%) patients with non-ST elevation AMI. The average hospital stay was 8.6 days and total mortality – 9% (n=29). Conclusion. The present treatment of AMI patients (modern pharmacotherapy, primary PCI) is associated with a low lethality. The late admitting of patients and as a result – admitting of 29.59% of AMI-patients in a day after AMI onset is a point for the improvement of AMI management as well as low rate of the interhospital transfers (4.36%).
Clinical cases of long-term use of rosuvastatin are presented with an estimation of its effect on the soft end (lipid profile) and hard end (number of heart attacks, strokes, heart failure, hospitalization for cardiovascular causes) points are given. The results of studies on rosuvastatin (ASTEROID, CORONA, METEOR, ORION, COSMOS) are presented. Clinical guidelines on the management of patients with stable ischemic heart disease are considered on the example of COURAGE trial.
Aim. To study a treatment of patients with acute myocardial infarction (AMI) before and during hospitalization in a Khabarovsk hospital, which has an opportunity of primary percutaneous coronary intervention (PCI), as well as hospital outcomes according to the AMI Register. Material and methods. 321 patients consecutively hospitalized in the Khabarovsk Regional Vascular Center were included into AMI Register: 177 patients with ST-segment elevation AMI (STEMI; 55.1%); 135 patients non-ST-segment elevation AMI (non-STEMI; 42.1%); 9 patients with early recurrence of AMI and early post-infarction stenocardia (2.8%). Results. Before reference AMI a frequency of administration of statins was 13.7%, angiotensin-renin blockers – 29.3%, acetylsalicylic acid – 28.7%, beta-blocker – 25%. Among patients with atrial fibrillation only 7 ones (17%) were treated with oral anticoagulants. 141 patients (79.6%) with STEMI underwent PCI procedure: primary PCI – 82.3% and delayed PCI – 17.7%. PCI with coronary stenting was performed in 86.5% of patients with STEMI. Frequency of PCI in non-STEMI patients was 42%: primary PCI – 43.9%, delayed PCI – 56.1%, PCI with coronary stenting – 43.9%. Gender and age of the patients did not influence the choice of tactics of revascularization in STEMI and non-STEMI (PCI(+), PCI(-), PCI with coronary stenting) (p<0.05). Medication in hospital: double antithrombotic therapy (DATT) was prescribed in 86.9% of patients; direct anticoagulants – in 91.2%, statins – in 97.2%, beta-blockers – in 88.5%; renin-angiotensin-aldosterone system inhibitors – in 90.6%. A total lethality in STEMI was 15.2%, and in non-STEMI – 1.5%. Lethality in PCI-negative patients with STEMI was higher than this in patients with non-STEMI (p<0.001). In STEMI patients lethality was 3.3 times lower in PCI-positive patients in comparison with PCI-negative patients. Conclusion. AMI Register demonstrated that before reference AMI very few patients were covered with modern medicines influencing prognosis. AMI hospital treatment in Khabarovsk Regional Vascular Center was characterized by a high rate of primary PCI, DATT, enoxaparin, and high-dose statin therapy.
Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) slow down progression of cardiovascular diseases and reduce risk of mortality and life threatening complications. What it is better to prescribe for patient in a concrete clinical case – ACE inhibitors or ARB? Authors compare these drug classes (mechanism of action, indications, evidense base of clinical trails, treatment costs and safety). The place of ACE inhibitors and ARB in modern therapy of cardiovascular diseases is defined. Results of the recent trails (ONTARGET, TRANCEND, PRoFESS, I-PRESERVE) are discussed.
Objective . To evaluate the long-term outcomes and medical treatment in patients during 2.5 years after reference acute myocardial infarction (AMI), to study adherent to medical treatment and the role of various factors affecting the long-term prognosis. Materials and methods . The AMI Register included data about all patients, whom are consistently hospitalized in the regional vascular center (RVC) of Khabarovsk during the period from 01.01.14 till 31.03.14. The 2.5 years outcomes and adherence to treatment were evaluated by using phone interview. Results . According to prospective part of the AMI Register of 292 patients discharged from the regional vascular center (RVC), the vital status in 2.5 years managed to be established at 274 (93.8 %) from which died 45 (16.42 %, or 15.40 % from all discharged patients). In structure of a mortality the proportion of dead from cardiovascular disease (СVD) patients made 86.6 %. The long-term mortality of patients with myocardial infarction with ST-segment elevation was 19.3 %, the myocardial infarction non-ST-segment elevation – 13.2 %; р = 0.632. The new predictors of death 2.5 years after the onset of AMI were cerebrovascular diseases, the absence of the antihypertensive drugs and β-blockers before reference AMI, not prescribing antiplatelet drugs in loading doses in the early hours of the disease. Frequency of real reception of statins was 65.1 %, angiotensin-renin blockers –76.0 %, β-blocker – 73.8 % of patients after AMI. Only 55.9 % patients Received double antithrombocytic therapy (DATT) during a year. By the Moriscors–Green test adherent were only 109 (47.6 %). 79 (34.5 %) know their values cholesterol, blood pressure and blood glucose. Conclusions . Indicators of the remote lethality among patients authentically didn't differ with a myocardial infarction with ST-segment elevation in AMI and a myocardial infarction non-ST-segment elevation in AMI in the remote period. The register AMI taped failure predictors, showed the insufficient frequency of reception of recommended medicinal drugs in secondary prophylaxis after a referent AMI, especially concerning statines and DATT. The commitment of patients of long medicamental therapy, and also awareness on indicators of quality of treatment (level of a cholesterin, blood pressure) in real clinical practice according to the register were low.
Statins, the most common drugs for reduction in lipid levels, are “strategic” medicinal products for the treatment and prevention of cardiovascular diseases caused by atherosclerosis. The milestones of lipid-lowering therapy history are presented as well as its contemporary aims and their implementation with focus on rosuvastatin. Data of recent metaanalysis regarding statins efficacy in primary and secondary prevention of cardiovascular complications, good safety and tolerability profile were presented. Treatment of patients with acute coronary syndrome with modern statins in high doses is discussed specially. Clinical case study of long-term treatment with rosuvastatin 20 mg/day is described. Frequency of statin prescriptions and achievements of target lipid levels in real medical practice among population of Russian patients is evaluated according to results of LIS study and PROFILE registry. Results of Russian studies of therapeutic equivalence of generic drug with original rosuvastatin are presented.
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