Terms of admission to the hospital and performing endovascular procedures in patients with acute myocardial infarction without ST segment elevation in real clinical practice

Aim. To find out the relationship of the severity of patients condition, with acute myocardial infarction without ST segment elevation (NSTEMI), upon admission to the hospital on the basis of the Global Registry of Acute Coronary Events (GRACE) scale with the time interval between the onset of the disease and up to hospitalization (“pain–hospitalization”), and to clarify the effect of the GRACE score on the time interval to endovascular procedures (EVP) – “door–balloon”, in real clinical practice.

Material and methods. The study included 421 NSTEMI patients. Patients were admitted between 2000 and 2017. All patients underwent coronary angiography followed by EVP. Depending on the clinical condition, at admitted to the hospital, patients were divided into risk groups on the GRACE scale. According to the indicators – “pain–hospitalization” and “door–balloon” – 3 time intervals were allocated: ≤6 hours, 6–24 and >24 hours.

Results. At admission, 73.9% (311) patients had an average and high risk on the GRACE scale. Patients with high risk were significantly more often (49.6%) hospitalized during the first 6 hours after onset of the disease than later (p<0.05). 2/3 of all patients and 3/4 of patients with high risk had the time interval of “pain–hospitalization” up to 24 hours. 51.8% patients in the total group and 65.8% among high-risk patients had a “door–balloon” interval up to 6 hours. During first 24 hours after hospitalization EVP was successfully completed on 90.7% of patients. One patient had a fatal outcome. At discharge none of the patients were observed the symptoms of angina pectoris and congestive heart failure.

Conclusion. In the all group, according to the allocated time intervals “pain–hospitalization”, patients were distributed practically equally. The severity of the condition of the studied patients is indicated by the fact that almost 3/4 of them had a high and average risk on the GRACE scale. It is encouraging that in the first 6 hours from the onset of the disease, high-risk patients were significantly more often hospitalized. Almost 2/3 of high-risk patients and more than half of all patients had a “door–balloon” indicator-up to 6 hours. It is important that in the first 24 hours, successful EVP was performed in 90.7% of patients. Thus, our results (low mortality, absence of angina and heart failure after EVP) indicate the correct management and treatment of NSTEMI patients, which is close to the latest world recommendations, comes from real life circumstances and can be recommended for real clinical practice.