Acute myocardial infarction complicated by cardiogenic shock in Ukraine: multicentre registry analysis 2021–2022

BackgroundData on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world.Materials and methodsThe Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients.ResultsWe analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS.ConclusionsDespite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS

Soluble ST2 in Predicting Adverse Outcome after Revascularization with Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction

Aim: The aim of the study was to investigate the relationship between the soluble suppression of tumorigenicity 2 (sST2) level and the degree of epicardial blood flow recovery in patients with myocardial infarction with ST-segment elevation (STEMI) after percutaneous coronary intervention. Material and Methods: The study involved 61 patients (83.6% males), with a mean age of 59.85±10.01 years. sST2 level was measured by enzyme immunoassay. Patients were divided into two groups. The first group (n=12) included patients with thrombolysis in myocardial infarction (TIMI) ?II flow grade, the second group (n=49) with TIMI III flow grade. Results: The sST2 level was significantly higher in the first hours of the disease in the group with decreased epicardial blood flow (TIMI ?II) after percutaneous coronary intervention (p=0.003). Receiver operating characteristics curve analysis showed that sST2 levels over 34.2 ng/ml, detected on admission, was an independent predictor of adverse revascularization (TIMI ?II) in patients with STEMI with a sensitivity of 92.3% and a specificity of 62.5%; the area under curve was 0.811 (95% CI: 0.651 - 0.873; p=0.001). Both the univariate (OR: 1.020, 95% CI: 1.001-1.041, p=0.028) and multivariate (OR: 1.030; 95% CI: 1.002-1.057; p=0.033) analyzes showed that sST2 was a significant predictor of the unfavorable outcome of epicardial vascular revascularization (TIMI ???). Conclusion: sST2 is highly associated with the degree of blood flow recovery after percutaneous coronary intervention in patients with STEMI and is of great clinical importance as a prognostic marker

Tactical and Technical Aspects of Minimally Invasive Left Internal Mammary Artery – Left Anterior Descending Artery Bypass and Hybrid Coronary Revascularization on Its Basis

Reducing surgical trauma is one of the obvious ways of reducing perioperative risks and improving surgical techniques, which is also very positively perceived by patients. Hybrid coronary revascularization (HCR) is one of the ways of minimizing surgical trauma during coronary revascularization.Objectives: to note the tactical and technical aspects of the minimally invasive left internal mammary artery-left anterior descending artery bypass (mini-LIMA-LAD) and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones.Materials and methods: Between 2011 and 2019, 39 mini-LIMA-LAD operations were performed at the SI “V. T. Zaycev IGUS NAMSU”. The average age of patients was 60.6±8.2 years, 5 (13 %) of patients were female. In nine patients mini-LIMA-LAD was the first (in eight) or second (in one) stage of the planned HCR.Results and discussion: There were no perioperative deaths, myocardial infarctions or conversions. At a median follow-up time of 49.5 [Q1; Q3: 34.3; 70.6] months one patient died 13 months after surgery. Four patients had angina recurrences at different times. The article discusses the tactical and technical aspects of mini-LIMA-LAD and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones.Conclusions: Mini-LIMA-LAD and HCR on its basis are a low-traumatic alternative to traditional coronary bypass through sternotomy with acceptable early and long-term results. They have a much better cosmetic effect, especially for women, but are more demanding in surgical technique and tissue handling. The strategy of coronary revascularization described, unlike other less traumatic techniques, does not require expensive additional equipment and can be performed by regular mean