Changing in the profile of a patient with acute coronary syndrome without ST-segment elevation over the years 2015-2020

Abstract

The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome without ST segment elevation. A distinctive feature of the work is the recruitment of patients in the same medical institution for different periods of time, which makes possible to trace the dynamics of the clinical profile of patients in the population of Dnipro, a large industrial center of Ukraine. The prevalence of arterial hypertension, chronic heart failure and previous myocardial infarction remained at the same level. In the 2017-2020’s group compared with the 2015’s group, electrocardiographic  manifestations of acute coronary syndrome without ST-segment elevation upon admission were more often detected. Laboratory indicators such as hemoglobin, creatinine and total cholesterol levels remained the same. Another interesting finding is a statistically significant decrease in the number of patients with a reduced glomerular filtration rate according to MDRD (less than 60 ml/min/1.73 m²) in the 2017-2020’s group compared to patients in 2015’s group, although the clinical course of the disease remained practically unchanged. There was a trend towards a worsening of the clinical status and prognosis, namely, increase in the prevalence of atrial fibrillation and diabetes mellitus, increase in the risk of GRACE, as well as increase in the quantity of verified diagnoses of unstable angina, which is most likely associated with the increased use of high-sensitivity troponin. Noteworthy feature is that increase in the quantity of high-risk patients led to an increase in the mean GRACE score.