Difficulties in treatment of acute coronary syndrome in a patient with end-stage chronic renal failure on program hemodialysis (case description)

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Abstract

Background. The surgical treatment of the coronary heart disease (acute coronary syndrome) in patients undergoing program hemodialysis has its own characteristics, which are not fully reflected in the cardiological recommendations. In particular, coronary artery bypass grafting is preferable to stenting, the drug of choice among p2y12 platelet receptor blockers is clopidogrel, with the infeasibility of rosuvastatin prescription. All these points are often ignored by treating doctors from the cardiology team when choosing the optimal treatment strategy for patients in this group.

Description of the clinical case. The article presents a case of treating acute coronary syndrome in a patient undergoing program hemodialysis. The problems of coronary revascularization and the drug therapy in this category of patients are discussed, and the ways to solve them are shown by the example of this clinical case.

Conclusion. In special cases, such as acute coronary syndrome in patients with chronic renal failure who are on program hemodialysis, the endovascular treatment strategy should be considered only if the specifics of the prescribed pharmacotherapy are taken into account.

About the authors

Aleksandr V. Bocharov

Kostroma Regional Clinical Hospital named after Korolev E.I.

Author for correspondence.
Email: bocharovav@mail.ru
ORCID iD: 0000-0002-6027-2898
SPIN-code: 6073-1445

MD, PhD

Russian Federation, Kostroma

Denis V. Sidorov

Kostroma Regional Clinical Hospital named after Korolev E.I.

Email: denis.sidorov1972@mail.ru
Russian Federation, Kostroma

Leonid V. Popov

National Medical and Surgical Center named after N.I. Pirogov

Email: popovcardio@mail.ru
ORCID iD: 0000-0002-0530-3268

MD, PhD, Professor

Russian Federation, Moscow

References

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Supplementary files

Supplementary Files
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2. Fig. 1. Patient B., 64 years old, with acute coronary syndrome, who is on programmed hemodialysis: electrocardiogram upon admission

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3. Fig. 2. Patient B., 64 years old, with acute coronary syndrome, on programmed hemodialysis: with transradial coronary angiography, subocclusion of the middle third of the anterior descending artery was revealed (indicated by the arrow)

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4. Fig. 3. Patient B., 64 years old, with acute coronary syndrome, on programmed hemodialysis: transradial coronary angiography revealed subocclusion of the mouth of the first branch of the blunt edge (indicated by the arrow)

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5. Fig. 4. Patient B., 64 years old, with acute coronary syndrome, on programmed hemodialysis: coronary angiography by transradial access revealed subocclusion of the proximal third of the right coronary artery (indicated by the arrow)

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6. Fig. 5. Patient B., 64 years old, with acute coronary syndrome, undergoing programmed hemodialysis: control coronary angiogram after stenting of the anterior descending artery and blunt edge branch

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Copyright (c) 2020 Bocharov A.V., Sidorov D.V., Popov L.V.

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