Резюме
Дорошенко О.В. Особливості клінічного перебігу гострого коронарного синдрому.
 У статті досліджувався перебіг гострого коронарного синдрому без підйому сегмента ST у госпітальний період. Аналізувався вплив різних факторів ризику на перебіг гострого коронарного синдрому без підйому сегмента ST. Визначено, що несприятливими чинниками перебігу гострого коронарного синдрому без підйому сегмента ST є старший вік пацієнта, наявність цукрового діабету, гіпертонічної хвороби, порушення ритму, рецидивуючий перебіг.
Ключові слова: гострий коронарний синдром, перебіг, несприятливі чинники.
Резюме
Дорошенко О.В. Особенности клинического течения острого коронарного синдрома.
В статье исследовалось течение острого коронарного синдрома без подъема сегмента ST в период госпитального наблюдения. Анализировалось влияние различных факторов риска на течение острого коронарного синдрома без подъема сегмента ST. Определено, что неблагоприятными факторами течения острого коронарного синдрома без подъема сегмента ST являются: старший возраст пациента, наличие сахарного диабета, гипертонической болезни, нарушения ритма, рецидивирующее течение заболевания.
Ключевые слова: острый коронарный синдром, течение, неблагоприятные факторы.
Summary
Doroshenko O.V. Clinical features of acute coronary syndrome.
The article studied the clinical features of acute coronary syndrome without ST segment elevation in the hospital period. Analyzed the impact of various risk factors on the course of acute coronary syndrome without segment elevation ST. Determined that the adverse factors of acute coronary syndrome without ST segment elevation is older patient age, presence of diabetes, hypertension, arrhythmia, recurrent course.
Key words: acute coronary syndrome, clinical features, the adverse factors.
Рецензент: д.мед.н., проф. О.М. Корж

УДК 616.127-005.8+616.12-009.72-008.63]-036

Харківська медична академія післядипломної освіти

Харьковская медицинская академия последипломного образования

61176, г. Харьков, ул.Корчагинцев, 58

Kharkov medical academy of Postgraduate Education

61176, Kharkov, 58 str.Korchahyntsev

dorosenkoo@i.ua

One of the major health problems in Ukraine today is the growing incidence and prevalence of the most socially significant cardiovascular diseases: atherosclerosis, arterial hypertension (AH), coronary artery disease (CAD), leading to high morbidity, mortality, especially among people of working age, reduced life expectancy [13, 14].

Clinical symptoms of CAD reported nearly 9 million adults Ukraine (www.ukrstat.gov.ua). Altered coronary artery of atherosclerosis is the cause of at least 50,000 annually myocardial infarction, and mortality from myocardial infarction is in different regions of Ukraine from 12 to 32%.

According to the materials of the report of the working group of the European Society of Cardiology (ESC),  increase in mortality and the incidence of heart disease and blood vessels observed in Central and Eastern Europe. In particular, in Ukraine registered the highest among 30 countries in Europe indices of cardiovascular disease in men and women, as well as one of the highest death rates from coronary heart disease [6]. And most significantly (in 3-7 times) excess of these indicators in Ukraine, compared with most European countries, is seen in young people. According to the American Heart Association (AHA), mortality from cardiovascular diseases men aged 37 to 47 years in Ukraine is perhaps the highest in the world [11].

The most adverse are acute coronary syndromes (ACS), namely, unstable angina, acute myocardial infarction (AMI).

ACS is a leading pathologies in cardiology. For one year, in USА admitted about 2 million people with an acute coronary syndrome. Approximately 600,000 of them suffering from acute myocardial infarction and a half million patients have ACS without myocardial infarction. The latter group of patients has a higher mortality than patients with the development of myocardial infarction [3, 8].

Pathological, angioskopical and biological observations have shown that unstable angina and MI are characterized by various clinical manifestations, but have the same pathophysiologic mechanism: plaque rupture or erosion with varying degrees of thrombosis or embolism.

The development of ACS accompanied by a significant increase in mortality, morbidity and health care costs as the underlying disease and its complications. Thus, unstable angina in 2-10% of patients completed the development of AMI. Mortality during unstable angina is 5%, with 30% of AMI, including more than half – before hospitalization  due to sudden cardiac death [7].

 Females with ACS are significant differences in the clinical picture of the disease. ACS symptoms in women are often less pronounced and not specific, compared with men pain in women more often associated with atypical course of the disease - concerned about complaints of abdominal pain, shortness of breath, nausea, weakness, palpitations, dizziness, fatigue, loss of appetite [2, 4]. Among patients with coronary artery disease increased the number of young women [1].

It should also be noted that today marked tendency to younger  MI. So, at the age of 40 MI was observed with a frequency of  0,1-0,6  per 1 thousand men and 0,03-0,04 per 1 thousand women, ranging from 2 to 7% of all cases of MI, recorded at the age of 65 years [5, 10, 12]. In some developed countries in this age group has from 4 to 8% of the overal  l structure of morbidity. ACS also often associated with diabetes and hypertension [9].

The aim of our study was to identify adverse factors of  ACS.

We made a retrospective analysis of medical records of 727 patients who were treated in the   Multidisciplinary Clinical Hospital № 25 in Kharkiv. Of these, 449 men (61.8%) and 278 women (38.2%) aged 36 to 89 years. The average age of patients was 65,1 ± 1,8 year. Most patients with ACS were over 65 years - 383 patients (52.7%), and less than 65 years - 344 patients (47.3%), ACS in patients aged 45 and younger was in 35 patients (4.8% ). In all age groups the precedence number of men. However, in patients aged ≤ 45 years old significantly more often men - 31 (88.6%) than females - 4 (11.4%) (p <0,05)

From the 727 patients  myocardial infarction was diagnosed in 468 patients (64.4%), including 295 men (63%) and 173 women (37%), unstable angina in 259 patients (35.6%), including 154 men (59.5%) and 105 women (40.5%). Death had registrated in 57 patients with myocardial infarction (12.4%) and in 7 patients with unstable angina (2.6%). The most  patients with ACS had arterial hypertension  - 496 patients (68%), and many had disturbances of rhythm and conduction - in 329 patients (45.3%).

According to our study, 197 patients (27%) with ACS had diabetes mellitus (DM). These patients were slightly older - 66,28 ± 1,14 years compared with patients without diabetes (64,6 ± 1,28 years), most of them women - 100 (50.8%), while in the group without DM - 178 women (33.6%) (p <0,05). Was observed trend towards more frequent presence of comorbidities in patients with concomitant diabetes, such as hypertension - 143 patients (72.6%) compared with the group without DM - 353 (66.6%) and 70 obese (35.5% ) and 158 (29.8%), respectively in the presence and without diabetes.

In patients with ACS and diabetes was significantly worse prognosis, adverse fatalities factors were reported in 26 (13.2%) patients with diabetes and 38 (7.2%) patients without diabetes (p <0,05).

During hospital observation of patients with ACS 64 patients died (8.8%). We have identified a group of favorable course (663 patients), and unfavorable - 64 patients (ACS flow over fatal). According to our data, 48 (75%) deaths occur in the patients older than 65 years (p <0,05). The vast majority of these complications were myocardial infarction - 57 patients (89%), while unstable angina led to this in 7 cases (11%).

The patients in  unfavorable course  were older - 71,3 ± 1,2 years, compared with a group of favorable course - 64,5 ± 1,14 years, significantly more likely to develop fatal in patients with diabetes - in 40% of cases, also significantly higher than in the group with a favorable background for the development of essential hypertension and diabetes (31% of cases) (p <0,05). Analysis of ECG data showed no statistically significant difference in infarct localization in both groups. However, an unfavorable course of ACS was observed in the presence of arrhythmias and conduction. Thus, in patients with fatal arrhythmia encountered in 64% of cases. In most cases it was atrial fibrillation - 47.3% (p <0,05). ACS recurrence was observed in 41% of cases in a group of fatal cases and 8% in the group with benign course.

In percentage mortality from the first day of hospitalization was higher among women, this trend continued in the following days. However, this pattern did not reach significant difference.

Thus, we can conclude that older patient age, presence of diabetes and hypertension, a history of arrhythmias (atrial fibrillation), recurrent ischemia are unfavorable course of ACS in the hospital period.

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