ABSTRACT
STUDY AIM: to assess prognostic value of multifocal atherosclerosis (MFA) relative to risk of new cardiovascular catastrophes in patients with non ST elevation acute coronary syndrome (NSTEACS) during one year follow-up. MATERIAL AND METHODS: atients with NSTEACS (n=266) subjected to coronary angiography and color duplex scanning of peripheral arteries (PA) were included in this study. Presence of "end points" (cardiovascular death, stroke, myocardial infarction, unstable angina, decompensation of heart failure) was assessed after one year of follow-up. RESULTS: aximal GRACE score was revealed in patients with MFA (combined involvement of coronary arteries [CA] and peripheral arteries [PA]). Compared with patients without involvement of CA or PA unfavorable outcomes were 2 times more frequent in the presence of lesions only in CA, 3 times more frequent in the presence of combination of lesions in CA and PA stenoses <50%, 4 times more frequent in the presence of lesions in CA and PA stenosis >50%. Percutaneous coronary intervention at the hospital stage led to 3.3-fold improvement of long term prognosis in patients with single vessel CA involvement and absence of stenoses in PA, and to 1.8 fold improvement - in patients with multivessel CA involvement and PA stenoses >50%. CONCLUSION: resence of even nonsignificant PA stenoses in patients with NSTEACS predetermined high rate of unfavorable events during one year follow-up.
Subject(s)
Acute Coronary Syndrome/etiology , Atherosclerosis , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/surgery , Atherosclerosis/complications , Atherosclerosis/diagnosis , Atherosclerosis/epidemiology , Atherosclerosis/physiopathology , Coronary Angiography/methods , Coronary Angiography/statistics & numerical data , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Percutaneous Coronary Intervention/statistics & numerical data , Prognosis , Risk Assessment , Risk Factors , Russia/epidemiology , Severity of Illness Index , Ultrasonography, Doppler, Duplex/methods , Ultrasonography, Doppler, Duplex/statistics & numerical dataABSTRACT
Aim of the study was to determine incidence of multifocal atherosclerosis (MFA), to assess its clinical and prognostic significance in the hospital phase in patients with non-ST elevation acute coronary syndrome (NSTEACS). We studied data from 225 patients with duration of NSTEACS 48 hours or less, who along with usual examination were subjected to coronary angiography and color duplex scanning of extracranial arteries and arteries of lower extremities. As lesions we considered any stenosis irrespective of intima media thickness. MFA was detected in 43.6% of cases. Patients with MFA were older, they more often had history of myocardial infarction, had lower creatinine clearance, and left ventricular ejection fraction. Presence of artery stenoses in 3 vascular regions was associated with multivessel coronary artery disease. Inhospital "endpoints" (myocardial infarction, stroke, death) occurred more frequently in patients with MFA. Patients with lesions in 2 and 3 vascular beds were characterized by maximal Grace score, while those without coronary and peripheral artery involvement- by minimal Grace score. The presence of MFA in patients with NSTEACS was associated with unfavourable course of the disease. Thus ptatients with MFA were characterized by high average rating on Grace scale; involvement of three vascular beds was associated with high mortality.
