Clinical efficacy in correction of vessels' endothelial dysfunction sn the peri- and postoperative period in patients with acute coronary syndrome in combination with obliterating atherosclerosis of the lower extremities
DOI:
https://doi.org/10.11603/2414-4533.2021.1.12016Keywords:
reperfusion complications, arginine-carnitine complexAbstract
The aim of the work: to study the effectiveness of interventional and drug treatment of patients with acute coronary syndrome without ST segment elevation in combination with obliterating atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications at the inpatient stage.
Materials and Methods. The study included 54 patients with acute coronary syndrome without ST elevation in combination with obliterating atherosclerosis stage III–IV of chronic ischemia according to the classification of B. V. Pokrovsky or Fontaine, which corresponds to critical ischemia of the 4th, 5th or 6th categories (grade II–III) according to Rutherford (ESC, 2017). According to the chosen treatment tactics all patients were divided into 2 groups: 34 patients of the main experimental group in addition to standard corticosteroid treatment, received an additional intravenous 4.2 g of L-arginine and 2.0 g of L-carnitine in the form of a solution for infusion of 100 ml once a day for 7 days. One infusion of the drug was performed before the intervention. The control group included 20 patients who also underwent emergency balloon angioplasty and stenting of the infarct-dependent coronary artery, but patients in this group received only standard protocol treatment.
In addition to general clinical, instrumental and laboratory methods (general blood test, MB fraction of creatine phosphokinase (CPK-MB), troponin T, arterial blood oxygen saturation (SpO2), ECG in 12 standard leads, etc.), the functional state of vascular endothelium was determined by endothelin-1 concentration (ET-1) in blood plasma (using an enzyme-linked immunosorbent assay from Amersham Pharmacia Biotech) and the content of stable NO metabolites, which were determined by reaction with Gris reagent.
Results and Discussion. In the initial state in patients with ACS without ST segment elevation in combination with obliterating atherosclerosis of the lower extremity vessels was found the severe disorders of microcirculation and endothelial function and their additional aggravation in the peri- and postoperative periods after percutaneous coronary intervention. It was accompanied by the development of reperfusion syndrome with varying duration and severity of the left ventricular failure and arrhythmias. In patients of the control group under the influence of standard drug treatment was noted the presence of treatment-resistant supraventricular and ventricular extrasystoles. At the same time in patients of the experimental group with ACS without ST segment elevation in combination with obliterating atherosclerosis of the lower extremity vessels under the influence of complex drug treatment with the inclusion of L-arginine and L-carnitine from the second day of observation was a significant decrease of the frequency of rhythm and conduction disorders. At the end of treatment in comorbid patients of the experimental group the frequency of arrhythmias and conduction decreased by 53.1 % and manifestations of acute heart failure – by 44.2 %.
The obtained result substantiates the expediency of introducing the proposed cytoprotective antioxidant therapy in the preoperative period to prevent the manifestations of reperfusion syndrome and its continuation in the postoperative period to stabilize the clinical condition of patients and secondary prevention of complications.
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