CLINICAL “PORTRAIT” OF A PATIENT WITH ACUTE CORONARY SYNDROME IN COMBINATION WITH CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES AS A CRITERION FOR PREDICTING AND CHOOSING TREATMENT TACTICS
DOI:
https://doi.org/10.11603/2414-4533.2021.4.12712Keywords:
acute coronary syndrome, critical ischemia of the lower extremities, diagnosis, clinical manifestations, prognosis, treatmentAbstract
The aim of the work: to determine the influence of atherostenotic lesions of the iliac-femoral arterial segment on the severity of the clinical course, laboratory changes, instrumental parameters and prognosis in patients with ACS (MI) with elevation of the ST segment.
Materials and Methods. We examined 105 patients with ACS (MI) with elevation of the ST segment in combination with critical ischemia of the lowers extremities due to stenotic atherosclerosis of the iliac-femoral arterial segment (III–II HAI) and 38 patients with ACS (MI) with ST segment elevation without critical ischemia of the lower extremities (comparison group). In addition to general clinical, laboratory and instrumental methods, additional ECG, ultrasound of the aorto-iliac and femoral arterial segments, transthoracic echocardiography and CAG were performed to assess the severity of anatomical lesions of the VA. The risk of nosocomial mortality was predicted on the GRACE scale.
Results and Discussion. Middle-aged and elderly men (over 55 years old) predominate over women by gender qualification (10.7:1) and significantly more often has ACS (MI) in combination with critical ischemia of the lower extremities. They are characterized by the presence of comorbid conditions (hypertension, uncompensated type 2 diabetes, metabolic syndrome, chronic obstructive pulmonary disease and such risk factors for coronary heart disease as dyslipidemia, smoking, alcohol abuse and aggravated heredity.
Characteristic features of the clinical "portrait" of a patient with ACS (MI) with critical ischemia of the lower extremities is a severe general condition of the patient, which is due to the presence of combined multivascular coronary artery disease (4.78 times more often than in isolated ACS) and a large amount of myocardial necrosis, signs hypertrophy and remodeling with a significant decrease in systolic (PV less than 50 %) and diastolic functions. Frequent presence of life-threatening complications of the acute period of MI, arrhythmias and conduction and acute heart failure determined the prediction of a high risk of mortality on the GRACE scale (172.7±12.7).
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