II конгресс сердечно-сосудистых хирургов
                   и интервенционных радиологов
     Северо-Западного федерального округа

Острый коронарный синдром

ST-segment elevation in non-atherosclerotic coronaries: a brief overview
2010 г.
Subhash Chandra • Vikas Singh • Mahendra Nehra • Dipti Agarwal • Nishit Singh
The most common, clinically significant cause of ST elevation is an angiographically demonstrable occlusive disease due to atherosclerotic changes in coronary artery. Often, a patient presenting with non-specific complaints and ST-segment elevation on the electrocardiogram, is sent for a cardiac catheterization only to see no luminal stenosis on the angiogram. This clinical review is intended to inform emergency medicine physicians and internists about the conditions in which ST-segment elevation is accompanied with no atherosclerotic lesion on coronary angiography. These situations make a diverse array of conditions ranging from anomalous coronaries to anatomically normal coronaries with varied degrees of myocardial injury. These conditions are briefly reviewed in this article.

Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial
2009 г.
Mustafa Toma, Christopher E. Buller, Cynthia M.Westerhout, Yuling Fu, William W. O’Neill, David R. Holmes Jr, Christian W. Hamm, Christopher B. Granger, and PaulW. Armstrong, for the APEX-AMI Investigators
Non-culprit coronary interventions were performed at the time of primary PCI in 10% of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.

Sex, age, and clinical presentation of acute coronary syndromes
2003 г.
Annika Rosengren, Lars Wallentin, Anselm K Gitt, Solomon Behar, Alexander Battler, David Hasdai
Aim To investigate sex differences in clinical presentation in younger and older patients hospitalised with a wide spectrum of acute coronary syndromes (ACS). Methods and results We analysed 10 253 patients with a discharge diagnosis of ACS in the Euro Heart Survey of patients with Acute Coronary Syndromes. There were 1010 women and 3709 men <65 years. Among patients <65 years, fewer women than men presented with ST elevation, (OR [odds ratio]: 0.62 [0.53–0.71]) and developed Qwave myocardial infarction (OR 0.58 [0.50–0.67]), whereas in patients P65 years there was no significant sex difference. Women <65 years were more likely than men of the same age to be discharged with a diagnosis of unstable angina (OR 1.56 [1.35–1.79]), but there was no sex difference in older patients; the p for interaction between sex and age for both was <0.0001. Among patients who underwent coronary angiography, both younger and older women were less likely than men to have 3-vessel or main stem disease. In a logistic regression analysis stratified for age, female sex was a significant negative determinant of presenting with ST elevation in patients <65 years (OR 0.68 [0.58–0.79]), whereas there was no effect of sex in patients P65 years. Conclusion In younger patients with ACS, women were less likely than men to present with ST elevation and more likely to be discharged with a diagnosis of unstable angina. In older patients there were no differences in clinical presentation. Both older and younger women had less extensive atherosclerosis. The findings suggest a different pathophysiology of ACS in younger, but not older, women. c 2004 Published by Elsevier Ltd on behalf of The European Society of Cardiology.

Door-to-Balloon Time in Primary Percutaneous Coronary Intervention Predicts Degree of Myocardial Necrosis
2010 г.
Robert M. Minutello, MD Luke Kim, MD Smita Aggarwal, MD Linda J. Cuomo, MD Dmitriy N. Feldman, MD S. Chiu Wong, MD
Reduced door-to-balloon time in primary percutaneous coronary intervention for the treatment of ST-elevation myocardial infarction has been associated with lower cardiac mortality rates. However, it remains unclear whether door-to-balloon time is predominantly a surrogate for overall peri-myocardial infarction care and is not independently predictive of outcomes, particularly when differences in door-to-balloon time have narrowed and previous studies have contained myocardial infarction-selection bias. We analyzed 179 consecutive patients who presented emergently at our cardiac catheterization laboratory with ST-elevation myocardial infarction within 12 hours of symptom onset and who underwent primary percutaneous coronary intervention within 3 hours of presentation. Our curve estimation regression model used the natural logarithm (ln) of area under the curve (AUC) of creatine kinase to evaluate the effect of door-to-balloon time on cardiac biomarker levels. We correlated ln (AUC–creatine kinase) with improvement of left ventricular ejection fraction at follow-up and with the intermediate-term mortality rate. Median door-to-balloon time was 87 minutes (interquartile range, 65–113 min). The ln (AUC–creatine kinase) correlated significantly with door-to-balloon time (r=0.2, P=0.02). Upon propensity-score analysis, door-to-balloon time remained a significant independent predictor of ln (AUC–creatine kinase) (β=0.15, P=0.03). Upon use of a Cox regression model, ln (AUC–creatine kinase) independently predicted death (P=0.04) and recovery of left ventricular function (P=0.001) at follow-up (mean, 14 mo). Longer door-to-balloon time independently predicts increased myocardial cell damage, and ln (AUC–creatine kinase) predicts improvement in left ventricular systolic function and intermediate-term death after ST-elevation myocardial infarction.