Analysis of the management of patients with acute coronary syndrome from the standpoint of clinical guidelines

Introduction. To improve myocardial infarction treatment outcomes, a comprehensive analysis of clinical practice is conducted.
Aim. To analyze the implementation of clinical recommendations for the management of patients with acute coronary syndrome (ACS) in real practice using the example of the Regional Vascular Center (RVC) in Ivanovo.
Materials and methods. We analyzed 330 cases of management of patients with an established diagnosis of acute myocardial infarction, admitted to the RVC in one year. To form a representative sample, patients with an established diagnosis of acute myocardial infarction admitted from the 1st to the 10th of each month were included. The time parameters, clinical, instrumental and laboratory data, interventional and drug treatment in the hospital were assessed.
Results. In the structure of ACS, ST-ACS was predominant (70.9%). The average time from the onset of symptoms to calling for emergency medical care was 1.8 hours, with 81.0% seeking emergency medical care within the first 2 hours. Thrombolytic therapy at the prehospital stage was performed in 10.3% of cases. The time from diagnosis to guidewire insertion during primary percutaneous coronary intervention for ST-segment acute coronary syndrome was 2.1 ± 1.07 hours; less than 90 minutes in 43% of patients. The most commonly used regimen was a combination of a minimum dose of bisoprolol 2.5 mg and perindopril (1/4 dose), which was administered to more than half of patients (218 patients, 70.8%). Beta-blockers were used in 95% of STEMI cases with a left ventricular ejection fraction (LVEF) ≤ 40%. If indicated (LVEF < 40%, heart failure, hypertension, chronic kidney disease, diabetes mellitus), an ACE inhibitor or angiotensin receptor blocker was prescribed in 76.9% of patients.
Conclusion. The analysis demonstrated that the scope and quality of medical care for patients with ACS corresponds to clinical guidelines. No significant deviations from target time and quality indicators were found.

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