Possibilities for improving hospital and remote forecasts for unstable angina
- 作者: Boytsov S.A.1,2, Provatorov S.I.1
-
隶属关系:
- Chazov National Medical Research Center of Cardiology
- Russian University of Medicine
- 期: 卷 96, 编号 1 (2024)
- 页面: 5-10
- 栏目: Editorial
- ##submission.dateSubmitted##: 03.06.2021
- ##submission.dateAccepted##: 03.06.2021
- ##submission.datePublished##: 25.01.2024
- URL: https://ter-arkhiv.ru/0040-3660/article/view/71285
- DOI: https://doi.org/10.26442/00403660.2024.01.202555
- ID: 71285
如何引用文章
全文:
详细
Unstable angina (UA) is a type of acute coronary syndrome (ACS) without ischemic myocardial damage. The main criterion for the diagnosis of UA in ACS is the absence of changes in the concentration of cardiac troponin in the patient’s blood. When the volume of myocardial damage is small, it may be difficult to detect myocardial infarction in a patient using low-sensitivity tests for determining of cardiac troponin in the blood. This issue may lead to overdiagnosis of UA in patients with non-STE ACS. Optimal drug therapy and revascularization of the coronary arteries significantly reduce the risk of death and the development of myocardial infarction both in the hospital and in the long-term period in patients with UA. Outpatient follow-up and provision of free of charge medications to patients may reduce long-term mortality after an episode of UA.
全文:
作者简介
Sergey Boytsov
Chazov National Medical Research Center of Cardiology; Russian University of Medicine
Email: semaver@yandex.ru
ORCID iD: 0000-0001-6998-8406
академик РАН, доктор медицинских наук, профессор, ген. дир. ФГБУ «НМИЦК им. акад. Е.И. Чазова», профессор кафедры терапии и профилактической медицины ФГБОУ ВО «Российский университет медицины»
俄罗斯联邦, Moscow; MoscowSergei Provatorov
Chazov National Medical Research Center of Cardiology
编辑信件的主要联系方式.
Email: semaver@yandex.ru
ORCID iD: 0000-0002-7936-3634
доктор медицинских наук, гл. научный сотрудник лаб. совершенствования оказания медицинской помощи больным с ишемической болезнью сердца
俄罗斯联邦, Moscow参考
- Fowler NO. “Preinfarctional” angina. A need for an objective definition and for a controlled clinical trial of its management. Circulation. 1971;44(5):755-8. doi: 10.1161/01.cir.44.5.755
- Conti CR, Greene B, Pitt B, et al. Coronary surgery in unstable angina pectoris. Circulation. 1971;44(Suppl. 2):154.
- Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-826. doi: 10.1093/eurheartj/ehad191
- Harper RW, Kennedy G, DeSanctis RW, Hutter AM Jr. The incidence and pattern of angina prior to acute myocardial infarction: a study of 577 cases. Am Heart J. 1979;97(2):178-83. doi: 10.1016/0002-8703(79)90353-3
- Kloner RA, Shook T, Antman EM, et al. Prospective temporal analysis of the onset of preinfarction angina versus outcome: an ancillary study in TIMI-9B. Circulation. 1998;97(11):1042-5. doi: 10.1161/01.cir.97.11.1042
- Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics – 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113(6):e85-151. doi: 10.1161/CIRCULATIONAHA.105.171600
- Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38-360. doi: 10.1161/CIR.0000000000000350
- Барбараш О.Л., Дупляков Д.В., Затейщиков Д.А., и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(4):4449 [Barbarash OL, Duplyakov DV, Zateischikov DA, et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):4449 (in Russian)]. doi: 10.15829/1560-4071-2021-4449
- Apple FS, Ler R, Murakami MM. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem. 2012;58(11):1574-81. doi: 10.1373/clinchem.2012.192716
- Jhund PS, Claggett BL, Voors AA, et al. Elevation in high-sensitivity troponin T in heart failure and preserved ejection fraction and influence of treatment with the angiotensin receptor neprilysin inhibitor LCZ696. Circ Heart Fail. 2014;7(6):953-9. doi: 10.1161/CIRCHEARTFAILURE.114.001427
- deFilippi C, Seliger SL, Kelley W, et al. Interpreting cardiac troponin results from high-sensitivity assays in chronic kidney disease without acute coronary syndrome. Clin Chem. 2012;58(9):1342-51. doi: 10.1373/clinchem.2012.185322
- Eggers KM, Jernberg T, Lindahl B. Unstable Angina in the Era of Cardiac Troponin Assays with Improved Sensitivity – a Clinical Dilemma. Am J Med. 2017;130(12):1423-30.e5. doi: 10.1016/j.amjmed.2017.05.037
- Braunwald E. Unstable angina. A classification. Circulation. 1989;80(2):410-4. doi: 10.1161/01.cir.80.2.410
- Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000;102(1):118-22. doi: 10.1161/01.CIR.102.1.118
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-69. doi: 10.1093/eurheartj/ehy462
- Katus HA, Giannitsis E. Prognostic Value of Serum Troponin T in Unstable Angina. Clin Chem. 2018;64(2):396-7. doi: 10.1373/clinchem.2017.272799
- van Miltenburg-van Zijl AJ, Simoons ML, Veerhoek RJ, Bossuyt PM. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris. J Am Coll Cardiol. 1995;25(6):1286-92. doi: 10.1016/0735-1097(95)00009-S
- Beigel R, Matetzky S, Gavrielov-Yusim N, et al. Predictors of high-risk angiographic findings in patients with non-ST-segment elevation acute coronary syndrome. Catheter Cardiovasc Interv. 2014;83(5):677-83. doi: 10.1002/ccd.25081
- Butt JH, Kofoed KF, Kelbæk H, et al. Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial. J Am Heart Assoc. 2021;10(19):e022333. doi: 10.1161/JAHA.121.022333
- Shah BN, Balaji G, Alhajiri A, et al. Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Circ Cardiovasc Imaging. 2013;6(2):202-9. doi: 10.1161/CIRCIMAGING.112.980797
- Gaibazzi N, Reverberi C, Badano L. Usefulness of contrast stress-echocardiography or exercise-electrocardiography to predict long-term acute coronary syndromes in patients presenting with chest pain without electrocardiographic abnormalities or 12-hour troponin elevation. Am J Cardiol. 2011;107(2):161-7. doi: 10.1016/j.amjcard.2010.08.066
- Linde JJ, Kelbek H, Hansen TF, et al. Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol. 2020;75(5):453-63. doi: 10.1016/j.jacc.2019.12.012
- Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360(21):2165-75. doi: 10.1056/NEJMoa0807986
- Desperak P, Hawranek M, Gąsior P, et al. Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes. Cardiol J. 2019;26(2):157-68. doi: 10.5603/CJ.a2017.0110
- Garcia S, Sandoval Y, Roukoz H, et al. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol. 2013;62(16):1421-31. doi: 10.1016/j.jacc.2013.05.033
- Généreux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol. 2012;59(24):2165-74. doi: 10.1016/j.jacc.2012.03.010
- Farmer D, Jimenez E. Re-evaluating the Role of CABG in Acute Coronary Syndromes. Curr Cardiol Rep. 2020;22(11):148. doi: 10.1007/s11886-020-01386-y
- Ramanathan K, Abel JG, Park JE, et al. Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes. J Am Coll Cardiol. 2017;70(24):2995-3006. doi: 10.1016/j.jacc.2017.10.029
- Benedetto U, Sinha S, Mulla A, et al. Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study). Int J Cardiol. 2022;362:14-9. doi: 10.1016/j.ijcard.2022.04.067
- Jang JS, Jin HY, Seo JS, et al. Meta-analysis of multivessel versus culprit-only percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome and multivessel coronary disease. Am J Cardiol. 2015;115(8):1027-32. doi: 10.1016/j.amjcard.2015.01.530
- Gazes PC, Mobley Jr. EM, Faris Jr. HM, et al. Preinfarctional (unstable) angina – a prospective study – ten year follow-up. Prognostic significance of electrocardiographic changes. Circulation. 1973;48(2):331-7. doi: 10.1161/01.CIR.48.2.331
- Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985;313(22):1369-75. doi: 10.1056/NEJM198511283132201
- Mulcahy R, Conroy R, Katz R, Fitzpatrick M. Does intensive medical therapy influence the outcome in unstable angina? Clin Cardiol. 1990;13(10):687-9. doi: 10.1002/clc.4960131003
- Valentín V. Clopidogrel in acute coronary syndromes with non-ST elevation. Clinical implications of the CURE trial. Rev Esp Cardiol. 2001;54(10):1127-34 (in Spanish).
- Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5
- Эрлих А.Д. 12-месячные исходы у пациентов с острым коронарным синдромом, включенных в российский регистр «РЕКОРД-3». Российский кардиологический журнал. 2018;(3):23-30 [Erlikh AD. Twelve months outcomes in patients with acute coronary syndrome, by the national registry RECORD-3. Russian Journal of Cardiology. 2018;3:23-30 (in Russian)]. doi: 10.15829/1560-4071-2018-3-23-30
- Щинова А.М., Потехина А.В., Долгушева Ю.А. Cопоставление госпитальной и отдаленной летальности и оценка их предикторов у пациентов, перенесших инфаркт миокарда и нестабильную стенокардию. Альманах клинической медицины. 2023;51(2):77-85 [Shchinova AM, Potekhina AV, Dolgusheva YuA, et al. Comparison of in-hospital and long-term mortality and assessment of their predictors in patients with myocardial infarction and unstable angina. Almanac of Clinical Medicine. 2023;51(2):77-85 (in Russian)]. doi: 10.18786/2072-0505-2023-51-013
- Roos A, Edgren G, Holzmann MJ. Unstable Angina Pectoris With Myocardial Injury Versus Myocardial Infarction in the Era of High-Sensitivity Cardiac Troponin. Am J Cardiol. 2022;169:32-41. doi: 10.1016/j.amjcard.2021.12.044
- Katus HA, Giannitsis E. Prognostic Value of Serum Troponin T in Unstable Angina. Clin Chem. 2018;64(2):396-7. doi: 10.1373/clinchem.2017.272799
- Sasaki S, Inoue K, Shiozaki M, et al. One-Year Outcome of Patients with Chest Pain in the Rule-Out Group According to the 0-Hour/1-Hour Algorithm. Int Heart J. 2023;64(4):590-5. doi: 10.1536/ihj.23-076
- Щинова А.М., Потехина А.В., Долгушева Ю.А., и др. Сопоставление эффективности вторичной профилактики и отдаленной летальности после перенесенного острого коронарного синдрома в зависимости от формы диспансерного наблюдения. Российский кардиологический журнал. 2023;28(7S):9-10 [Shchinova AM, Potekhina AV, Dolgusheva YuA, et al. Comparison of the effectiveness of secondary prevention and long-term mortality after acute coronary syndrome depending on the form of follow-up. Russian Journal of Cardiology. 2023;28(7S):9-10 (in Russian)]. doi: 10.15829/1560-4071-2023-7S
- Chow CK, Brieger D, Ryan M, et al. Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study. Heart Asia. 2019;11(1):e 011122. doi: 10.1136/heartasia-2018-011122
- Об утверждении порядка проведения диспансерного наблюдения за взрослыми: приказ Минздрава России от 15.03.2022 г. №168н. Режим доступа: https://rg.ru/documents/2022/04/22/minzdrav-prikaz168-site-dok.html. Ссылка активна на 03.12.2023 [Ob utverzhdenii poriadka provedeniia dispansernogo nabliudeniia za vzroslymi: prikaz Minzdrava Rossii ot 15.03.2022 g. №168n. Available at: https://rg.ru/documents/2022/04/22/minzdrav-prikaz168-site-dok.html. Accessed: 03.12.2023 (in Russian)].
- Об утверждении перечня лекарственных препаратов для медицинского применения в целях обеспечения в амбулаторных условиях лиц, находящихся под диспансерным наблюдением, которые перенесли острое нарушение мозгового кровообращения, инфаркт миокарда, а также которым выполнены аортокоронарное шунтирование, ангиопластика коронарных артерий со стентированием и катетерная абляция по поводу сердечно-сосудистых заболеваний, в течение 2 лет с даты постановки диагноза и (или) выполнения хирургического вмешательства: приказ Минздрава России от 29.09.2022. №639н. Режим доступа: https://rg.ru/documents/2022/10/28/minzdrav-prikaz639-site-dok.html. Ссылка активна на 03.12.2023 [Ob utverzhdenii perechnia lekarstvennykh preparatov dlia meditsinskogo primeneniia v tseliakh obespecheniia v ambulatornykh usloviiakh lits, nakhodiashchikhsia pod dispansernym nabliudeniem, kotorye perenesli ostroe narushenie mozgovogo krovoobrashcheniia, infarkt miokarda, a takzhe kotorym vypolneny aortokoronarnoe shuntirovanie, angioplastika koronarnykh arterii so stentirovaniem i kateternaia abliatsiia po povodu serdechno-sosudistykh zabolevanii, v techenie 2 let s daty postanovki diagnoza i (ili) vypolneniia khirurgicheskogo vmeshatel'stva: prikaz Minzdrava Rossii ot 29.09.2022. №639n. Available at: https://rg.ru/documents/2022/10/28/minzdrav-prikaz639-site-dok.html. Accessed: 03.12.2023 (in Russian)].
补充文件
![](/img/style/loading.gif)