Modern potential of thrombotic complication prevention among patients with acute coronary syndrome without ST segment elevation in real clinical practice (Part I)

Aim. To compare therapeutic and diagnostic measures, as well as the incidence of cardiovascular events (CVE), during hospitalization, one-year and five-year follow-up period among the patients with acute coronary syndrome without ST segment elevation (non-STE ACS), who were urgently hospitalized to a therapy department of a large multi-field hospital, or to a specialised cardiology department. This comparison was aimed at identifying the methods for further medical service optimization. Material and methods. This retrospective, historical cohort study included 350 consecutive medical histories of non-STE ACS patients, urgently hospitalized to the urgent cardiology department (Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences), and 370 medical histories of the patients hospitalized to the therapy department (City Hospital No. 1). Results. In the therapy department, non-STE ACS patients received fewer diagnostic and therapeutic procedures than in the cardiology department, due to limited resources. The risk levels at in- and out-patient treatment stages were not assessed adequately, which resulted in a higher incidence of adverse outcomes throughout the follow-up period. Original clopidogrel was administered to 6 % and 0 % of the cardiology and therapy department patients, respectively. Since there is no statistically significant difference in hard outcomes between original and generic clopidogrel (Zyllt), the latter could be recommended to ACS patients. Conclusion. Non-STE ACS patients with high risk should be referred to specialised cardiology hospitals, where invasive diagnostic and treatment (percutaneous coronary intervention) could be performed. High effectiveness and good safety profile should improve Zyllt treatment compliance in most patients after ACS and/or revascularization.

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