M. Shved, T. Dobryansky, I. Yastremska

I. Horbachevsky Ternopil State Medical University

Introduction. The presence of critical lower extremity ischemia (CLEI) in patients with acute coronary syndrome (ACS) limits the possibility of early invasive interventions and determines the tactics of medical preparation for surgery and prevention of complications.

The aim of the study. To assess the dynamics of life quality using the EQ-5D-5L questionnaire in patients with myocardial infarction (MI) in combination with obliterative atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications in the inpatient phase of treatment under the influence of metabolic therapy.

 Materials and methods. 67 patients with ACS (MI) in combination with CLEI due to stenotic atherosclerosis of the iliac-femoral arterial segment were examined: 35 patients of the main group who underwent emergency balloon angioplasty and infarct-dependent coronary artery stenting in addition with L-arginine/L-carnitine complex (“TIVOR-L”; “Yuri-Pharm”; in the form of intravenous infusions for seven days of 100.0 ml once / day). 32 patients in the comparison group received only standard protocol treatment. All patients, in addition to general clinical, laboratory and instrumental methods, were additionally assessed for quality of life according to the EQ-5D-5L questionnaire. Statistical processing of indicators was performed by the method of variation statistics. Samples were checked for normality of data distribution according to the test of S. Shapiro – M. Wilk, parametric (t-test, Student’s test) methods were used. Confidence interval (CI) and relative risk (RR) were used to more accurately assess the accuracy.

Results. In patients of both groups, the severity of the clinical condition did not differ significantly and was due to typical manifestations of ACS and CLEI. In patients of the main group, the use of intravenous infusions of arginine-carnitine mixture against the background of the standard protocol treatment program led to the elimination of anginal syndrome in all patients and reduced functional class of acute heart failure. When evaluating the effectiveness of the proposed combination treatment and its subjective perception by patients, it was found that initially patients of both groups evaluated their quality of life with similar relatively low scores: an average of 26.14 ± 10.15 and 25.68 ± 9.74 points (p > 0.05). We note a significantly higher assessment of quality of life in patients after a course of comprehensive treatment, whose quality of life index improved by an average of 160.9 % and reached the level of 86.5 ± 8.3 points. During the standard treatment program in patients with ACS in combination with CLEI there was a significant improvement in well-being, the total quality of life index increased by 40.2 %.

Сonclusions. Patients in the experimental group with acute coronary syndrome and critical lower extremity ischemia who received arginine-carnitine mixture in addition to complex standard protocol drug treatment had significantly reduced feelings of chest pain/discomfort and anxiety / depression and tended to increase motor activity.

References

1. Gandziuk VA, Dyachuk DD, Kondratyuk NU. Dynamics of morbidity and mortality due to diseases of the circulatory system in Ukraine (regional aspect). Bulletin of Biology and Medicine. 2017;2(136):319-322 (Ukrainian)
2. Kovalenko VM, Kornatsky VM, editors. Current health problems and their minimization in the context of the armed conflict in Ukraine; Kyiv: National Research Center Institute of Cardiology acad. MD Strazheska; 2018. 216 p. (Ukrainian)
3. Kovalenko VM. Cardiology in Ukraine: yesterday, today and in the future. Ukrainian Journal of Cardiology. 2015;2:9-16 (Ukrainian)
4. Kolotylo OB. Correction of prooxidant-antioxidant balance in patients with critical lower extremity ischemia and high risk of reperfusion-reoxygenation complications. Medical and Clinical Chemistry. 2019;21(3):92-96 (Ukrainian)
5. Shved M, Pello M. Influence of cardioprotective metabolic therapy on the occurrence of rhythm and conduction disorders in patients with myocardial infarction with metabolic syndrome. Arithmology. 2018;2(26):58-59 (Ukrainian)
6. Shved MI, Tsuglevich LV, Geryak SM. Clinical efficacy of cardiocytoprotective therapy in patients with acute coronary syndrome (myocardial infarction) who underwent balloon angioplasty and coronary artery stenting. Archive of Clinical Medicine. 2019;(1):31-37 (Ukrainian)
7. Astashkin E, Glezer M. Role of L-carnitine in energy metabolism cardiomyocytes and treatment of diseases of cardiovascular system. Cardiology and Cardiovascular Surgery. 2012;6(2):58-
8. Brogan R, Alabas O, Almudarra S, Hall M, Dondo B, Mamas M, Gale P. Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2019;8(1):68-77.
9. Dalal J, Digrajkar A, Das B, Bansal M et al. ST2 elevation in heart failure, predictive of a high early mortality. Indian Heart Journal. 2018;70(6):822-827.
10. Di Nicolantonio J, Lavie C, Fares H. L-carnitine in the secondary prevention of cardiovascular disease: Systematic revien and meta-analysis. Mayo Clin Proc. 2013;5(3):1-8.
11. EuroQol Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208.
12. Fakhry F. Endovascular revascularization and supervised exercise for peripheral artery disease and intermittent claudication: a randomized clinical trial. 2017;314:1936-1944.
13. Gach O, Husseini Z, Lancellotti P. Acute coronary syndrome. Rev Med Liege. 2018;73(5-6):243-250.
14. Gallo M, Trivedi J, Monreal G, Ganzel B, Slaughter M. Risk factors and outcomes in redo coronary artery bypass grafting. Heart Lung Circ. 2020;29(3):384-389.
15. George J, Shmuel S, Roth A. L-arginine attenuates lymphocyte activation and antioxidized LDL antibody levels in patients undergoing angioplasty. 2004;174:323-327.
16. Hicks J, Montes-Cortes D, Cruz-Dominguez M. Antioxidants decrease reperfusion induced arrhythmias in myocardial infarction with ST-elevation. Frontiersin Bioscience. 2007;12:2029-
17. Khobzey MK, Sirenko YuM, Stepanenko AV. Nakaz MOZ Ukrainy N 455 vid 02.07.2014. Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy ta medychnoi reabilitatsii khvorykh na hostryi koronarnyi syndrom z elevatsiieiu sehmenta ST [Ministry of Health of Ukraine Order No. 455 dated 2 July 2014. Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care and medical rehabilitation of patients with acute coronary syndrome with ST segment elevation] (Ukrainian)
18. Kolotylo А, Iftodiy А, Venher I, Kostiv S, Herasymiuk N. Revascularization of combined occlusion of extracranial arteries and aorto-ileum-femoral arterial route in cinditions of risk of development of reperfusion-reroxygenation syndrome. Georgian Med News. 2019;(286):24-28.
19. Komalasari R, Nurjanah, Yoche MM. Quality of life of people with cardiovascular disease: a descriptive study. Asian Pac Isl Nurs J. 2019;4(2):92-96.
20. Moryś JM, Bellwon J, Höfer S, Rynkiewicz A, Gruchała M. Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure. Arch Med Sci. 2016;12(2):326-333.
21. Murai T, Yonetsu T, Kanaji Y, Usui E, Hoshino M, Hada M, Hamaya R, Kanno Y, Lee T, Kakuta T. Prognostic value of the index of microcirculatory resistance after percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome. Catheter Cardiovasc Interv. 2018;92(6):1063-1074.
22. Norgren L, Hiatt WR, Dormandy JA, Harris KA. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(1):5-67.
23. Peters CML, Lodder P, de Vries J et al. Two-year Outcome of Quality of Life and Health Status for the Elderly with Chronic Limb-threatening Ischemia. Clin Interv Aging. 2020;15:2383-2395.
24. Raffee L, Alawneh K, Ibdah R, Rawashdeh S, Zoghoul S, Ewais A, Al-Mistarehi A. Prevalence, clinical characteristics, and risk among patients with ischemic heart disease in the young jordanian population. Open Access Emerg Med. 2020;12:389-397.
25. Rizzon P, Biasko G, Biase M. High doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects. Eur Heart J. 1989;10(6):502-508.
26. Rumsfeld JS, Alexander KP, Goff DC Jr, Graham MM, Ho PM, Masoudi FA et al. Cardiovascular health: the importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation. 2013;127(22):2233-2249.
27. Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA et al. FOURIER steering committee and investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376(18):1713-1722.
28. Teraa M, Conte MS, Moll FL, Verhaar MC. Critical Limb Ischemia: Current Trends and Future Directions. J Am Heart Assoc. 2016;5(2):e002938.
29. Widmer J, Lerman A. Endothelial dysfunction and cardiovascular disease. Glob Cardiol Sci Pract. 2014;(3):291-308.