DETAILES TO THE PARACLINICAL "PORTRAIT" OF A PATIENT WITH ACUTE CORONARY SYNDROME IN COMBINATION WITH CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES
DOI:
https://doi.org/10.11603/1811-2471.2021.v.i3.12519Keywords:
acute coronary syndrome, critical ischemia of the lower extremities, diagnosis, clinical manifestations, prognosis, treatmentAbstract
The incidence of multifocal atherosclerosis (MFA) varies from 18 to 54 % and significantly complicates the diagnosis, prognosis and choice of volume and treatment methods.
The aim – to determine the influence of critical ischemia of the lower extremities on the severity of changes in laboratory and instrumental parameters and the severity of the clinical course and prognosis in patients with ACS (MI) with elevation of the ST segment.
Material and Methods. We examined 105 patients with ACS (MI) with elevation of the ST segment in combination with critical lower extremity ischemia due to stenotic atherosclerosis of the iliac-femoral arterial segment (III-IV centuries 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 methods, a detailed laboratory and instrumental examination was performed: biochemical analysis of blood, ECG, ultrasound of the aorto-femoral arterial segments, transthoracic echocardiography and CAG to assess the severity of anatomical lesions of VA. The risk of nosocomial mortality was predicted on the GRACE scale.
Results. In addition to the "clinical portrait" of a patient with ACS (MI) in combination with critical lower extremity ischemia, which in 73 % of cases is represented by men over 55 years of age, with existing comorbid conditions (hypertension, uncompensated type 2 diabetes, metabolic syndrome, COPD, thyroid dysfunction) and risk factors for coronary heart disease (dyslipidemia, smoking, alcohol abuse and aggravated heredity), severe and complicated course of the disease due to the presence of combined multivascular coronary artery disease and a large volume of myocardial necrosis, such as "paraclinical portrait" signs) as pronounced manifestations of necro-resorptive and inflammatory syndromes: leukocytosis over 11∙109/l, ESR over 20 mm/h, hyperglycemia >8.4 mmol/l, hyperaspartate aminotransferaseemia >60 U/l, T-troponinemia over 600 ng/ml and CF-creatine phosphatemia over 50 U/l and symptoms of systolic (EF less than 50 %) and diastolic heart dysfunction due to its post-infarction remodeling.
Conclusions. For "paraclinical portrait" of a patient with ACS (MI) with elevation of the ST segment in combination with critical ischemia of the lower extremities due to stenotic atherosclerosis of the iliac-femoral arterial segment is characterized by "pronounced" manifestations of necro-resorptive and inflammatory syndromes in combination with high frequency (EF less than 50 %) and diastolic heart dysfunction due to its post-infarction remodeling and the risk of cardiac death (more than 160 points on the GRACE scale).
References
Handzyuk, V.A., Diachuk, D.D., & Kondratiuk, N.Yu. (2017). Dynamika zakhvoriuvanosti i smertnosti vnaslidok khvorob systemy kovoobihu v Ukraini (rehionalnyi aspekt) [Dynamics of morbidity and mortality due to diseases of the circulatory system in Ukraine (regional aspect)]. Visnyk problem biolohii i medytsyny – Bull. Probl. Biol. Med., 2 (136), 319-322 [in Ukrainian].
Bokeriya, L.A., Stupakov, I.N., Samorodskaya, I.V., & Botnar, Yu.M. (2007). Serdechno-sosudistyye zabolevaniya v RF na rubezhe vekov: smertnost, rasprostranennost, faktory riska [Cardiovascular diseases in the Russian Federation at the turn of the century: mortality, prevalence, risk factors]. Byulleten Natsionalnoho nauchno-prakticheskoho tsentra serdechno-sosudistoy khirurgii imeni A. N. Bakuleva Ministerstva zdravokhraneniya Rossiyskoy Federatsii – National Scientific and Practical Center for Cardiovascular Surgery named after A.N. Bakuleva of the Ministry of Health of the Russian Federation Bulletin, 8, 5-11 [in Russian].
Barbarash, O.L., Zykov, M.V., Kashtalap, V.V., & Barbarash, I.S. (2011). Rasprostranennost i klinicheskaya znachimost multifokalnogo ateroskleroza u patsiyentov s ishemicheskoy boleznyu serdtsa [Prevalence and clinical significance of multifocal atherosclerosis in patients with coronary heart disease]. Kardiologiya – Cardiology, 8, 66-71 [in Russian].
Zykova, D.S. (2013). Kliniko-prognosticheskaya znachimost multifokalnogo ateroskleroza, faktorov nespetsificheskogo vospaleniya i polimorfizma genov u bolnykh ostrym koronarnym sindromom [Clinical and prognostic significance of multifocal atherosclerosis, factors of nonspecific inflammation and gene polymorphism in patients with acute coronary syndrome]. Candidateʼs thesis. Kemerovo [in Russian].
Henyk, S.M., & Symchych, A.V. (2016). Reperfuziinyi syndrom pislia revaskuliaryzatsii ishemii nyzhnikh kintsivok [Reperfusion syndrome after revascularization of lower extremity ischemia]. Sertse i sudyny – Heart and Vessels, 3, 104-108 [in Ukrainian].
Grigoryev, A.M. (2014). Faktory riska neblagopriyatnykh iskhodov koronarnogo shuntirovaniya u patsiyentov s izolirovannym i multifokalnym aterosklerozom [Risk factors for unfavorable outcomes of coronary artery bypass grafting in patients with isolated and multifocal atherosclerosis]. Candidateʼs thesis. Kemerovo [in Russian].
Sinkov, M.A. (2011). Effektivnost pervichnogo ChKV u bolnykh infarktom miokarda i soputstvuiushchim multifokalnym aterosklerozom [Efficiency of primary PCI in patients with myocardial infarction and concomitant multifocal atherosclerosis]. Candidateʼs thesis. Novosibirsk [in Russian].
Van der Wal, A.C. (2007). Coronary artery pathology. Heart, 93 (11), 1484-1489. DOI: 10.1136/hrt.2004.038364.
Fakhry, F., Spronk, S., van der Laan, L., Wever, J.J., Teijink, J.A., Hoffmann, W.H., …, & Hunink, M.G. (2015). Endovascular revascularization and supervised exercise for peripheral artery disease and intermittent claudication: a randomized clinical trial. JAMA, 314 (18), 1936-1944. DOI: 10.1001/jama.2015.14851.
Sabatine, M.S., Giugliano, R.P., Keech, A.C., Honarpour, N., Wiviott, S.D., Murphy, S.A., …, & Pedersen, T.R. (2017). Evolocumab and clinical outcomes in patients with cardiovascular disease. N. Engl. J. Med., 376 (18), 1713-1722. DOI: 10.1056/NEJMoa1615664.
Strobl, F.F., Brechtel, K., Schmehl, J., Zeller, T., Reiser, M.F., Claussen, C.D., & Tepe, G. (2013). Twelve-month results of a randomized trial comparing mono with dual antiplatelet therapy in endovascularly treated patients with peripheral artery disease. J. Endovasc. Ther., 20 (5), 699-706. DOI: 10.1583/13-4275MR.1.
(2014). Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi ta tretynnoi medychnoi dopomohy «Hostryi koronarnyi syndrom z elevatsiieiu sehmenta ST». Nakaz Ministerstva okhorony zdorovia Ukrainy vid 02.07.2014 № 455. Ministry of Health of Ukraine No. 455 from 02.07.2014. Unified clinical protocol for primary, secondary and tertiary care: "Acute coronary syndrome with elevation of the ST segment". No. 455, 78 [in Ukrainian].
Ibanez, B., James, S., Agewall, S., Antunes, M.J., Bucciarelli-Ducci, C., Bueno, H., …, & Widimský, P. (2018). 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., 39 (2), 119-177. DOI: https://doi.org/10.1093/eurheartj/ehx393.
Karpishchenko, A.I. (2001). Meditsinskaya laboratornaya diagnostika (programmy i algoritmy) Meditsinskiye laboratornyye tekhnologii i diagnostika [Medical laboratory diagnostics (programs and algorithms). Medical laboratory technologies and diagnostics]. Saint Petersburg: Intermedika [in Russian].
Douglas, P.S., Garcia, M.J., Haines, D.E., Lai, W.W., Manning, W.J., Patel, A.R., …, & Weiner, R.B. (2011). ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J. Am. Soc. Echocardiogr., 24 (3), 229-267. DOI: 10.1016/j.echo.2010.12.008.
Papadopoulos, K., Lekakis, I., & Nicolaides, E. (2017). The predictive value of the syntax score in patients with chronic coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting: a pilot study. Open Cardiovasc. Med. J., 11, 28-32. DOI: 10.2174/1874192401711010028.
(2010). An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N. Engl. J. Med., 329 (10), 673-682. DOI: 10.1056/NEJM199309023291001.
Rebrova, O.Yu. (2006). Statisticheskiy analiz meditsinskikh dannykh. Primeneniye paketa prikladnykh programm STATISTICA. [Statistical analysis of medical data. Application of the STATISTICA software package]. Moscow: MediaSfera [in Russian].
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