Vol. 6, Issue 12 (2017)

Author(s):
Tetyana Solomenchuk, Vasyl Protsko and Olena Vosukh

Abstract:
Introduction. Given the high morbidity and growth in recent decades of lethality from acute forms of CAD, especially among women, there are questions about the impact of risk factors on the adverse and complicated course of non-ST elevation ACS, among which one of the most important is the development of estrogen deficiency due to the onset of menopause. Aim. Conduct a comparative analysis of the risk factors of the occurrence of an unfavorable course of non-ST elevation ACS in women, depending on the hormonal status. Materials and methods. The study involved 112 women with non-ST elevation ACS aged 39 to 72 years (mean age 58.52 ± 0.99 years). They were divided into two groups: group A – 64 patients with estradiol level <80 pmol/L and LH / FSH index <1; group B – 48 patients with estradiol level >80 pmol/L and LH / FSH> 1. The features of the course were determined by comparing the basic clinical characteristics and anamnestic data at the time of hospitalization. Results. In women with estrogen deficiency (A) in 1.3-1.5 times there is a higher prevalence of hypertension (82.81 ± 4.72%) and angina (79.69 ± 5.02%). In persons with a preserved hormonal balance (B) – diabetes (31.25 ± 5.15%), smoking (54.16 ± 7.19%) and professional hazards (89.58 ± 4.41%), a larger proportion of persons with atypical pain syndrome (47.92 ± 7.21%) and late hospitalization (58.33 ± 7.11%). Their course was more frequent with rhythm and conduction disorders (68.75 ± 6.69%), with recurrence of pain syndrome (35.42 ± 2.43%) and longer treatment. In group A, pulmonary edema was more common (68.75 ± 5.79%), 48.43 ± 6.24% of them were at high risk of in-hospital mortality (GRACE risk score), at three-fold higher risk of recurrent MI, at 5.7 higher risk of HF and twice higher – the chance of death. Conclusions. In the group of women with estrogen deficiencywith non-ST elevation ACS develops on the background of greater prevalence and duration of hypertension and angina, accompanied by a heavier and more unfavorable prognosis. In women with relatively preserved hormonal status, non-ST elevation ACS occurs on the background of a greater prevalence of smoking and the impact of professionally harmful labor, diabetes, which promote predominantly atypical symptoms and their late hospitalization, and more frequent development of life-threatening arrhythmias, recurrence of pain syndrome and prolongation of treatment.