Acute myocardial infarction complicated by cardiogenic shock in Ukraine: multicentre registry analysis 2021-2022.

Background: Data on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world. Materials and methods: The Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients. Results: We analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS. Conclusions: Despite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS.

Long-term consequences of primary percutaneous coronary intervention in patients with st-elevation myocardial infarction.

OBJECTIVE: The aim: To investigate long-term effects of primary percutaneous coronary interventions (pPCI) in patients with STEMI basing on the prevalence of clinically relevant endpoints. PATIENTS AND METHODS: Materials and methods: Totally 200 patients with STEMI hospitalized within a period of "therapeutic window" for revascularization were included into the study. 100 patients who additionally to pPCI underwent manual thromboaspiration entered the main group. The comparison group consisted of 100 patients who underwent standard pPCI. RESULTS: Results: Six months after the pPCI, the incidence of either major adverse cardiac events and the combined endpoint did not differ in the main and comparative groups (11.8% vs. 12.5%, p = 0.888 and 18.2% vs. 20.8%, p = 0.658, respectively). There were no significant differences in these endpoints taken separately. In twelve months after procedure, also there were no significant differences between the groups. However, a tendency toward lower incidence of chest pain was observed in the main group (p = 0.08) during this period that was lost in 24 months after pPCI. None of these techniques demonstrated significant advantages during the whole duration of the follow-up period. CONCLUSION: Conclusions: The addition of manual thromboaspiration to the standard pPCI in patients with STEMI and severe thrombosis of the culprit artery did not significantly influence the prognosis.

ASIT as the component of bronchial asthma's therapy can improve the adherence to the treatment.

OBJECTIVE: The aim: To compare the treatment adherence of patients with Bronchial Asthma (BA) receiving basic treatment and its combination with allergen-specific immunotherapy. PATIENTS AND METHODS: Materials and methods: The study included 104 patients aged from 18 to 50 with BA. All patients were divided into two groups. The main group (MG) consisted of 51 patients receiving basic medical treatment and ASIT. 38 of them received subcutaneous ASIT and 13 patients received sublingual ASIT. The comparative group (CG) consisted of 53 patients who received only basic therapy. The patients' observation duration was for a year. RESULTS: Results: All patients were done the computer spirometry with a bronchodilation test, determination of the total IgE level, questionnaires (quality of life, control of asthma, adherence to treatment). Also the major and minor component of allergy house dust mites and specific IgG4 were determined in patients of main groups. After 12 months of observation in both groups the spirometry rates improved (the main group result was 16.9%, the control group - was 12.8%). The indicators of asthma's control also increased (MG by 28%, in CG - 21%, (p <0,05)). After individual conversations and training the patients improved and adherence to the treatment too. In the beginning of our research the mean level in MG was 3.2 ± 0.3 points, in - CG-3.3 ± 0.2 points (p> 0.05), after 12 months it increased to 6.3 ± 0.2 points in MG vs 5. 8 ± 0.1 points in CG (p <0.05). CONCLUSION: Conclusion: Patients' combining basic therapy with SIT had significantly better results of the overall BA's controllability compared to the patients' receiving only basic therapy.

ASIT therapy: advantages and adverse effects. own results and literature data.

OBJECTIVE: Introduction: Allergy is an important medical, social and economic problem nowadays, as it causes disability and patients' quality of life decreases. According to the update data all the existing therapeutic options haven't been used in huge majority of patients. Allergen-specific immunotherapy (ASIT) underuse in particular. One of the reasons for the low frequency of this treatment method using is the fear of systemic and local allergic. The aim of the study was to find out the incidence and severity of adverse reactions in patients receiving subcutaneous and sublingual ASIT. PATIENTS AND METHODS: Materials and methods: In conducted research we compared peculiarities of adverse reactions using sublingual and subcutaneous ASIT methods. Criteria for inclusion in the research were age from 18 to 50 years, diagnosed intermittent or persistent BA. The investigation involved 51 patients with combined basic drug therapy and ASIT, which was performed with injected allergens for 38 patients and sublingual allergens - for 13 individuals. RESULTS: Results: Local reactions were recorded in five patients (13.16%), who received injected ASIT. In four patients (10.52%), dry rales were observed for a short period after injection of the allergen. Local side effect was observed in one patient (7.69%) during sublingual ASIT. CONCLUSION: Conclusions: Adverse reactions, that occur during ASIT, do not pose a threat to patients' lives. However, the therapeutic effect after the year of treatment was significantly better than in patients who used medications only. Modern drugs are safe and, if all the rules are followed, the risk of adverse effects is very low.

The influence of the manual thrombus aspiration on the short term effectiveness of the percutaneous revascularization in patients with coronary artery thrombosis.

OBJECTIVE: Introduction: Percutaneous coronary intervention (PCI) is one of the main issues in treatment of acute coronary syndrome with ST segment elevation (STEMI). The manual thrombus aspiration was believed to improve the results of intervention especially in patients with coronary thrombosis. The aim: To explore the influence of manual thrombus aspiration on the short-termed prognosis after PCI in patients with STEMI and visible coronary thrombosis. PATIENTS AND METHODS: Materials and methods: 50 patients with STEMI and visible coronary thrombosis were included for exploration. Main group (MG) consists of 25 patients to whom manual thrombus aspiration was performed and comparison group (CG) of 25 patients whom were performed just conventional PCI. RESULTS: Results: In the 84% patients of the MG and in 72% CG was gained ТІМІ 3 flow grade after the procedure (р=0.5). MBG 3 was reached in similar number of patients from both groups ( р=0.37). Comparison of the ejection fraction of the LV and its' wall motion score brought the same results. The trend to better indexes of glomerular filtration rate was observed in the patients of the MG (р=0.18). Need of the balloon angioplasty before stenting was the unique index improved by the manual thrombus aspiration (р=0.02). CONCLUSION: Conclisions: No significant advantages of the manual thrombus aspiration usage weren't revealed compearing to conventional PCI in our study in the patients with STEMI and visible coronary thrombosis. At the same time few insignificant trends were reveled. So the more powerful trial is needed to solve this problem.

Estimation of cardiosurgical intervention risk according to EuroSCORE in patients with acute coronary syndrome and different gallbladder conditions before coronary artery bypass grafting.

INTRODUCTION: Estimation of cardiosurgical intervention risk according to EuroSCORE is an important aspect of cardiosurgery. EuroSCORE allows prediction of the probability of a post-operational fatal outcome. AIM: To estimate the influence of gallbladder condition on the prognosis after coronary artery bypass grafting (CABG) and and the interactions between metabolic background and cardiosurgical intervention risk. MATERIAL AND METHODS: We investigated data of 98 patients with unstable angina pectoris or acute myocardial infarction before planned CABG. These patients were divided into the following groups according to their gallbladder condition: intact bladder; bile sludge or cholesterosis; bent gallbladder body; gallbladder neck deformations or cholecystitis; cholelithiasis; history of cholecystectomy. RESULTS: The mean cardiosurgical intervention risk score according to the EuroSCORE system in our patients was 6.03 ±0.62%. It was significantly higher in patients with low serum bilirubin levels. There were direct correlations between the risk score result and presence of left ventricular dilatation (r = 0.31, p < 0.05) and fasting glucose level (r = 0.82, p < 0.01), as well as with means of other parameters, i.e., left atrial dimension, right ventricular size, grade of stenosis of anterior interventricular branch of left coronary artery, serum levels of total cholesterol, ß-lipoproteins, bilirubin and potassium. CONCLUSIONS: These correlations suggest that the EuroSCORE results estimated before surgery may be used as a simple informative prognostic criterion of intra-operational cardiac mortality and also as a marker of structural and functional heart condition and metabolic background. However, these correlations were different in patients with different gallbladder conditions.