MANAGEMENTUL PACIENȚILOR CU INFARCTUL MIOCARDIC ACUT FĂRĂ ELEVAREA SEGMENTULUI ST ÎN REPUBLICA MOLDOVA
DOI:
https://doi.org/10.52692/1857-0011.2023.1-75.09Keywords:
Acute coronary syndrome, NSTEMI, high-sensitivity troponin, major cardiovascular eventsAbstract
Purpose: To evaluate the quality of NSTEMI care in AMI centers and to identify potential gaps in the management of patients with this diagnosis.Material and methods: 550 patients with NSTEMI, hospitalized in 3 coronary angioplasty centers were enrolled in the study. The information was collected using a questionnaire composed of 179 questions, developed according to the standards of the EORP NSTEMI Registry. The research took place in two stages: retrospective observational study during 2019 and prospective in the period 01.2020-09.2022.Results. The NSTEMI rate from the total number of patients hospitalized with AMI in the Institute of Cardiology and SP Novamed, in the period 2019-2022 was 21,6%. The results of the evaluation of NSTEMI management in the studied AMI centers are close to those reported by equivalent international registries (EORP NSTEMI, FAST-MI, PLACS, MINAP), excepting some differences in certain chapters: the diagnostic strategy of NSTE-ACS, risk stratification, diagnosis and treatment of hypercholesterolemia and the antiplatelet treatment indicated at discharge. The mortality rate in the hospital was 4,2%, at 30 days m8k6,0%, at 6 months after hospitalization 10,2%, and at 12 months 12,8%. Conclusions. The rate of NSTEMI in the Republic of Moldova is lower than that reported by the international registers of IMA, while the mortality indicators are higher. These discrepancies are largely explained by gaps in NSTEMI management identified within the studied AMI centers.References
Puymirat E, Simon T, Cayla G, et al. Acute myocardial infarction: Changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI program (French registry of acute ST-elevation or non-ST-elevation myocardial infarction) 1995 to 2015. Circulation 2017 ;136(20):1908–19.
Khera S, Kolte D, Aronow WS, et al. Non-ST-elevation myocardial infarction in the United States: Contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc 2014;3(4). e000995
Goodman SG, Steg PG, Eagle KA, et al. The diagnostic and prognostic impact of the redefinition of acute myocardial infarction: Lessons from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2006;151(3):654–60.
Belle L, Cayla G, Cottin Y, et al. French Registry on Acute ST-elevation and non−ST-elevation Myocardial Infarction 2015 (FAST-MI 2015). Design and baseline data. Arch Cardiovasc Dis. 2017 ;110(6–7):366–78.
Annemans L, Danchin N, Van De Werf F, Pocock S, Licour M, Medina J, et al. Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry. Open Heart,2016;3(1): e000347.
McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011;124(1):40–7.
Polonski L, Gasior M, Gierlotka M, Osadnik T, Kalarus Z, Trusz-Gluza M, et al. A comparison of ST elevation versus non-ST elevation myocardial infarction outcomes in a large registry database: Are non-ST myocardial infarctions associated with worse long-term prognoses? Int J Cardiol. 2011,152(1):70–77.
Park HW, Yoon CH, Kang SH, Choi DJ, Kim HS, Cho MC, et al. Earlyand late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Int J Cardiol. 2013 69(4):254–61.
Montalescot G, Dallongeville J, Van Belle E, Rouanet S, Baulac C, Degrandsart A, et al. Clinical research Coronary heart disease STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry) †. Eur. Heart Journal, Volume 28, Issue 12, 2007, 1409–1417
Steg PG, Goldberg RJ, Gore JM, Fox KAA, Eagle KA, Flather MD, et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol. 2002 Aug 15;90(4):358–63.
McNamara RL, Chung SC, Jernberg T, Holmes D, Roe M, Timmis A, et al. International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWE-DEHEART/RIKS-HIA, and ACTION Registry-GWTG/ NCDR registries. Int J Cardiol. 2014;175(2):240–7.
Bueno H, Rossello X, Pocock S, Van de Werf F, Chin CT, Danchin N, et al. Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol. 2018;107(9):836–44.
Rossello X, Medina J, Pocock S, Van De Werf F, Tang Chin C, Danchin N, et al. Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking Original scientific paper. Eur Hear J Acute Cardiovasc Care . 2020;9(8):911–22.
Rosselló X, Huo Y, Pocock S, de Werf F Van, Chin CT, Danchin N, et al. Global geographical variations in ST-segment elevation myocardial infarction management and post-discharge mortality. Int J Cardiol. 2017;245:27–34.
Schiele F, Gale CP, Simon T, Fox KAA, Bueno H, Lettino M, et al. Assessment of Quality Indicators for Acute Myocardial Infarction in the FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) Registries. Circ Cardiovasc Qual Outcomes .2017 J;10(6).
Collet JP, Thiele H, Barbato E, Bauersachs J, Dendale P, Edvardsen T, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–367.
Schiele F, Aktaa S, Rossello X, Ahrens I, et al. 2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group. Eur Hear Journal Acute Cardiovasc Care. 2021;10(2):224–33.
Nadarajah R, Ludman P, Laroche C, Appelman Y, Brugaletta S, Budaj A, et al. Presentation , care , and outcomes of patients with NSTEMI according to World Bank country income classification : the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology. 2023;44:1–12.
Hall M, Dondo TB, Yan AT, Goodman SG, Bueno H, Chew DP, et al. Association of clinical factors and therapeutic strategies with improvements in survival following Non-ST-elevation myocardial infarction, 2003-2013. JAMA J Am Med Assoc. 2016;316(10):1073–82.
Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, et al. Acute myocardial infarction: Changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI program (French registry of acute ST-elevation or non-ST-elevation myocardial infarction) 1995 to 2015. Circulation. 2017;136(20):1908–19.
Abularrage CJ, Sidawy AN, Aidinian G, Singh N, Weiswasser JM, Arora S. Evaluation of the microcirculation in vascular disease. J Vasc Surg. 2005;42(3):574–81.
Mehta SR, Cannon CP, Fox KAA, Wallentin L, Boden WE, Spacek R, et al. Routine vs Selective Invasive Strategies in Patients With Acute Coronary Syndromes: A Collaborative Meta-analysis of Randomized Trials. JAMA [Internet]. 2005, ;293(23):2908–17.
Fox KAA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JGP, et al. Long-Term Outcome of a Routine Versus Selective Invasive Strategy in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome: A Meta-Analysis of Individual Patient Data. J Am Coll Cardiol. 2010 ;55(22):2435–45.
Fanning JP, Nyong J, Scott IA, Aroney CN, Walters DL. Routine invasive strategies versus selective invasive strategies for unstable angina and non-ST elevation myocardial infarction in the stent era. Cochrane Database Syst Rev. 2016(5). CD004815.
Elgendy IY, Mahmoud AN, Wen X, Bavry AA. Meta-Analysis of Randomized Trials of Long-Term AllCause Mortality in Patients With Non–ST-Elevation Acute Coronary Syndrome Managed With Routine Invasive Versus Selective Invasive Strategies. Am J Cardiol. 2017 Feb 15;119(4):560–4.
Szummer K, Wallentin L, Lindhagen L, Alfredsson J, Erlinge D, Held C, et al. Relations between implementation of new treatments and improved outcomes in patients with non-ST-elevation myocardial infarction during the last 20 years: experiences from SWEDEHEART registry 1995 to 2014. Eur Heart J . 2018 ;39(42):3766–76.
Downloads
Published
License
Copyright (c) 2023 Bulletin of the Academy of Sciences of Moldova. Medical Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
