APPROACHES TO DIAGNOSIS AND TREATMENT OF PATIENTS WITH NON-STSEGMENT ELEVATION ACUTE CORONARY SYNDROME IN RUSSIAN HOSPITALS. RECORD-3 REGISTRY DATA

The registries of acute coronary syndrome (ACS) are the main tool for quality assessment of medical care and provision of medicines in this disease. Purpose: based on the results of the Russian RECORD-3 registry we aimed at estimating the main clinical characteristics, approaches to diagnosis, treatment and outcomes of in-hospital treatment in patients with non-STsegment elevation ACS (NSTE-ACS) in Russian hospitals participating in the registry. Materials and methods. RECORD-3 registry of ACS was performed in 47 hospitals of 37 Russian cities in March to April, 2015. The analysis comprised 1495 patients with NSTE-ACS. Results. When dividing the patients with NSTE-ACS into the groups of subjects, admitted to PCI centers (n=1012) and noninvasive hospitals (n=483), we found that the patients in PCI centers were more often males, were younger, and had more often history of revascularization procedures. At the same time, the patients in noninvasive hospitals had a greater severity: high incidence rates of arterial hypertension, hypercholesterinemia, and atrial fibrillation. ACS forms, complicated with acute heart failure, were more frequent in noninvasive hospitals: 16% (n=76) vs. 11% (n=111) in PCI centers, р=0.006. The patients from noninvasive hospitals less often received statins, beta-blockers, and fondaparinux, but they received more frequently clopidogrel, angiotensin-converting enzyme inhibitors, diuretics, nitroglycerin, pressor amines, and anticoagulants including subcutaneous administrations of unfractionated heparin. The frequency of fatal outcomes in NSTE-ACS was higher in noninvasive hospitals (3.7% vs. 1.7%, p=0.022). Conclusions. The situation with medication underuse in the treatment of patients with NSTE-ACS persists in noninvasive hospitals accompanied by an increase in the hospital mortality rate as compared with PCI centers.

1. Sigurjonsdottir R., Barywani S., Albertsson P., Fu M. Long-term major adverse cardiovascular events and quality of life after coronary angiography in elderly patients with acute coronary syndrome // Int. J. Cardiol. – 2016. — Vol. 222. — P. 481–485 [Electronic resource] doi: 10.1016/j.ijcard.2016.07.237.

2. Hall M., Dondo T.B., Yan A.T. et al. Association of clinical factors and therapeutic strategies with improvements in survival following non-ST-elevation myocardial infarction, 2003–2013 // JAMA. 2016 Aug 30 [Electronic resource] doi: 10.1001/ jama.2016.10766.

3. Эрлих А.Д., Барбараш О.Л., Кашталап В.В., Грацианский Н.А. Степень следования клиническим руководствам при остром коронарном синдроме без подъема ST: связь с исходами, предикторы «плохого» лечения (результаты регистра «Рекорд-3») // Комплексные проблемы серд.-сосуд. заболеваний. — 2016. — № 2. — С. 75–82.

4. Бернс С.А., Зыкова Д.С., Шмидт Е.А. и др. Клиническая и прогностическая значимость мультифокального атеросклероза у больных с острым коронарным синдромом без подъема сегмента ST // Кардиология. — 2012. — Т. 52(7). — С. 4–8.

5. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) // European Heart Journal Advance Access published August 29, 2015 // Eur. Heart J. [Electronic resource] doi:10.1093/eurheartj/ehv320.

6. Эрлих А.Д., Харченко М.С., Барбараш О.Л., Кашталап В.В. и др. Степень приверженности к выполнению руководств по лечению острого коронарного синдрома в клинической практике российских стационаров и исходы в период госпитализации (данные регистра «РЕКОРД-2») // Кардиология. — 2013. — № 1. — С. 14–22.

7. Бойцов С.А. Профилактика неинфекционных заболеваний в стране: от «что делать» к «как делать» // Проф. медицина. — 2012. — № 2. — С. 3–10.

8. Эрлих А.Д., Грацианский Н.А. Регистр острых коронарных синдромов РЕКОРД. Характеристика больных и лечение до выписки из стационара // Кардиология. — 2009. — Т. 49(7/8). — С. 4–13.

9. Peterson E.D., Roe M.T., Mulgund J., et al. Association between Hospital Process Performance and Outcomes among Patients with Acute Coronary Syndromes // JAMA. — 2006. — Vol. 295(16). — P. 1912–1920.

10. Samama C.M., Rosencher N., Lecoules N. et al. Сomparison of fondaparinux with low molecular weight heparin for venous thromboembolism prevention in patients requiring rigid or semi-rigid immobilization for isolated non-surgical below-knee injury // J. Thromb. Haemostasis. — 2013. — Vol. 11(10). — P. 1833–1843.

11. Попонина Т.М., Калилевич Н.А., Кистенева И.В. и др. Влияние дезагрегантов на агрегацию тромбоцитов у больных с острым коронарным синдромом без подъема сегмента ST // Тер. архив. — 2004. — Т. 76(8). — С. 18–22.