СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ БЕЗ ПОДЪЕМА СЕГМЕНТА ST В ЗАВИСИМОСТИ ОТ СТЕПЕНИ СТЕНОЗИРОВАНИЯ КОРОНАРНЫХ АРТЕРИЙ (ПО ДАННЫМ РЕГИСТРА РЕКОРД-3)

Abstract

The aim of the study was to create a patient portrait, to evaluate prognosis, and establish the principles of therapy in\xa0patients with acute coronary syndrome without ST elevation with non-obstructive coronary atherosclerosis in comparison\xa0with the obstructive coronary atherosclerosis group. Material and Methods . Data come from the acute coronary syndrome register REСORD-3 that was implemented in the\xa0Emergency Cardiology Department of Cardiology Research Institute, Tomsk National Research Medical Centre, along with\xa045 other centers in Russia. Patients with myocardial infarction without ST segment elevation who were exposed to coronary\xa0angiography were separated into two independent groups based on whether they had MINОСА or not: 148 persons with\xa0non-obstructive coronary atherosclerosis and 537 persons with obstructive coronary atherosclerosis. Results . Non-obstructive coronary atherosclerosis group, compared to obstructive coronary atherosclerosis, comprised\xa075 women (50.7%) compared to 177 men (32.9%). Hypertension was detected less often in this group: 120 (81.1%) versus\xa0475 (88.5%). The rates of diabetes mellitus were 16 (10.8%) versus 115 (21.4%) and the rates of smoking were 162 patients\xa0(30.2%) versus 32 (21.6%), respectively, in patients with and without non-obstructive coronary atherosclerosis.\xa0Non-obstructive coronary atherosclerosis group had significantly lower rate of individuals with diagnostic increase in\xa0cardiospecific enzymes. This may be indicative of non-prolonged myocardial ischemia that, in some cases, does not lead\xa0to necrosis. The final diagnosis of non-ST segment elevation myocardial infarction was significantly less confirmed in\xa0patients with non-obstructive coronary atherosclerosis (14.8 vs. 45.3%). However, in this group, the “other cardiac cause\xa0of hospitalization” was more frequent (29.7 vs. 2.2% of cases), which explains the need to continue the diagnostic search\xa0to exclude all possible causes of the chest pain. The variety of final diagnoses in patients with acute coronary syndrome\xa0with non-obstructive coronary atherosclerosis and “clean” coronary arteries should encourage a thorough analysis of the\xa0pathogenesis in each of these patients. Conclusion . A typical acute coronary syndrome patient with non-obstructive coronary atherosclerosis without ST segment\xa0elevation was represented by a 59 (53:65)-year-old woman with traditional risk factors for coronary heart disease, but the\xa0incidence of each of these factors was less than in the obstructive coronary atherosclerosis group. Final diagnosis of non-ST\xa0segment elevation myocardial infarction was confirmed significantly less often in patients with non-obstructive coronary\xa0atherosclerosis. The mortality rates did not differ between groups and were minimal. Acute coronary syndrome patients\xa0with non-obstructive coronary atherosclerosis without ST segment elevation were less likely to receive ticagrelor and statins\xa0in hospital, but they were administered more often with fondaparinux. Patients with non-obstructive coronary atherosclerosis\xa0at discharge were less likely to be recommended to take antiplatelet agents, statins, and nitrates.