Assessment of visceral adipose tissue in patients with coronary artery disease using bioelectrical impedance analysis

Aim. To study visceral adipose tissue (VAT) content in patients with coronary artery disease (CAD) using the bioimpedance analysis, to identify metabolic disorders associated with visceral obesity, and to determine the role of individual risk factors in the formation of coronary artery lesions using modern statistical methods.Material and methods. A total of 152 patients were examined (women, 66; men, 86). The median age of patients was 63 [55;69] years. This observational study assessed anthropometric parameters, such as height, weight, body mass index, waist circumference, whole-body fat percentage, and specifically VAT mass, as well as the relationship of these parameters with blood levels of triglycerides, high-density lipoprotein cholesterol (HDL-C) and glucose. Height was measured using a metal height meter RM-1 “Diakoms”. Weight, body mass index, wholebody fat percentage, and VAT mass were measured using the Omron BF-508 body composition monitor (Omron, Japan). Epicardial adipose tissue (EAT) thickness was assessed using two-dimensional echocardiography on a Philips Sonos 5500 ultrasound system (Germany).Results. Bioimpedance analysis revealed a higher VAT content in patients with CAD compared with those without CAD (14 [11;18]% vs 13 [10;14,5]%, respectively (p=0,025)). During the ROC analysis, cut-off values for VAT ≥15% and EAT ≥7,5 mm were identified, associated with a higher risk of CAD. In multivariate analysis, only HDL-C levels were significantly associated with CAD, while at the same time, univariate analysis demonstrated the significance of VAT and EAT in predicting CAD.Conclusion. The results showed that an increased VAT content and low HDL-C level is associated with the presence of CAD

TREATMENT CHARACTERISTICS OF ACUTE CORONARY SYNDROME IN ELDERLY PATIENTS: PRACTICE OF N.I. PIROGOV CITY CLINICAL HOSPITAL №1

Aim. Assessment of compliance the management of elderly patients (≥75 years) with acute coronary syndrome (ACS) with existing guidelines and evaluation of ACS features during the last two years of working period of the Regional vascular center and compare the results with the data from Russian and foreign registries, randomized clinical studies (RCS) and recommendations. Material and methods. Analysis of diagnostic and treatment data of 999 patients, aged 75 years and over, who were taken by ambulance or made their own way to N. I. Pirogov City Clinical Hospital №1 (CCH №1) in Moscow and were hospitalized during the period between the 1st January 2014 and the 31st of December 2015 in the intensive care unit for patients with myocardial infarction with the initial diagnoses of ACS, myocardial infarction and unstable angina. Results. The elderly patients with ACS admitted to the CCH №1 in 2014 and 2015 were 41% and 54% of all patients with ACS, respectively; women prevailed in all age subgroups. There was no age difference between the subgroups of ACS in patients with elevation ST-segment and ACS in patients without ST-segment elevation. A high frequency of comorbidity in the elderly patients with ACS was observed; hypertension was the most common disease with an incidence rate of 95% without significant difference between the genders. The incidence of percutaneous coronary intervention (PCI) and coronary angiography (CAG) significantly increased in 2015 compared with 2014 (p<0.0001, risk ratio 0.56, 95% confidence interval 0.420.76). A reduction in hospital deaths was also found (p<0.0001, risk ratio 1.51, 95% confidence interval 0.94-2.43). Dual antiplatelet therapy (DAT) was prescribed to elderly patients in clinical practice approximately in 70% of cases; DAT was performed significantly more often in 2015 than in 2014. Conclusion. There are a high percentage of the elderly patients with ACS admitted to the CCH №1. This proportion is dramatically higher than this in the Russian and foreign registries and RCS, that could influence on the outcome of patient care. The widespread use of interventional diagnostic and treatment methods (CAG and PCI) allows to improve substantially the clinical outcomes of ACS. A possibility of unconditional following the guidelines regarding the prescription of DAT to the elderly patients with ACS in real clinical practice may be limited by the high incidence of concomitant pathology

How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

The number of elderly patients with diabetes mellitus (DM) is constantly growing in general population. Accordantly, we have the growth of such patients in the group of acute coronary syndrome (ACS).Aim. To compare clinical characteristics of the elderly patient (>75 years old) with and without DM.Material and methods. This retrospective study included 1133 ACS patients who were aged ≥75 years and admitted to the City Clinical Hospital №1 from 01.01.2015 to 31.12.2016. Median age was 80 years, 66% were women. We analyzed 4 patient subgroups: Group 1 – 105 patients with ST-segment elevation myocardial infarction (STEMI) and DM, Group 2 – 254 STEMI patients without DM, Group 3 – 222 non-STEMI patients with DM and Group 4 – 552 non-STEMI patients without DM. We used Student’s t-test and c2 tests to find significant difference between pairs of groups.Results. Median age of patients in 4 groups was 80, 81, 81 and 80 years (p>0.05), age variance was 75-100 years. DM was found in 29% of all elderly patients with no difference between STEMI and non-STEMI groups. STEMI and non-STEMI patients with DM were more likely women. NonSTEMI patients with DM more often had hypertension, previous stroke, lower median Hb (121 vs 127 g/l; p<0.001). Angiography data demonstrated more often three-vessel disease (43% vs 29.7%) and less one-vessel disease (15% vs 25.6%; p<0.05) between groups 3 and 4. Glomerular filtration rate (GFR) <60 ml/min/1.73 m2 occurred in 74%, 73%, 77% and 74% in patients of 4 groups (p>0,05), but GFR<45 ml/min/1.73 m2 was more prevalent in patients with DM than without DM: 45%, 39%, 45%, 36% in 4 groups. Finally, mortality rates didn’t demonstrate significant difference between DM and non-DM patients with STEMI (10% vs 13%; p>0.05) and non-STEMI (7% vs 7%) groups.Conclusion. DM is associated with ACS approximately in one third of the elderly patients and is not associated with its type (STEMI or non-STEMI). In STEMI and non-STEMI patients the female sex and GFR level <45 ml/min/1.73 m2 were associated with DM. In non-STEMI group multi-vessel disease and presence of hypertension and previous stroke were associated with DM. We didn’t find any difference between mortality in elderly patients with and without DM