Practice of percutaneous coronary interventions in non-ST-elevation acute coronary syndrome (based on the CONTRAST registry data)

Aim. To assess real-world practice in the use of invasive diagnostic and treatment methods in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) within the registry of the regional vascular centre. Material and methods. The study included 136 patients consecutively admitted on an emergency basis to the vascular center in Sergiyev Posad between October 2018 and March 2019 with a diagnosis of NSTE-ACS. The mean age was 63±11 years, and 61% were male. Results. All patients underwent coronary angiography (CAG) as soon as possible after hospital admission (less than 2 hours). None of the patients had absolute contraindications for percutaneous coronary intervention (PCI). All 136 patients were divided into 3 groups based on the chosen invasive treatment strategy: patients who did not undergo PCI at the inpatient stage of treatment and with long-term follow-up — 69 people (50.7%; group 1); patients who underwent PCI during the current hospitalisation — 50 people (36.8%; group 2); patients who underwent delayed PCI after the current hospitalisation — 17 people (12.5%; group 3). The decision to perform PCI was not influenced by the disease patterns or the GRACE risk score. The results of the CAG showed that patients in group 3 had three-vessel coronary artery disease significantly more often than in groups 1 and 2 (59% vs 22% and 34%, p=0.001). Regression analysis showed that the detection of damage to only one coronary artery significantly increased the likelihood of PCI. This probability progressively decreased as the extent of CAD increased. Conclusion. In the regional vascular centre, in-hospital PCI was performed in only 36% of patients diagnosed with NSTE-ACS. When deciding on PCI, physicians were primarily guided not by the degree of risk of cardiovascular complications, as required by clinical guidelines, but rather by the technical feasibility and safety of the procedure.