OPTIMIZATION OF INTENSIVE CARE FOLLOWING ENDOVASCULAR INTERVENTIONS IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME

Аннотация

The leading cause of death in elderly patients currently remains heart disease, in particular acute coronary syndrome (ACS). Recently, revascularization therapy centers have been opened in almost all regions of our country. In particular, percutaneous coronary interventions (PCI) are carried out effectively to manage patients with ACS to improve the quality of life . These so-called endovascular interventions are currently a highly effective treatment method that can significantly improve the condition of patients and increase their tolerance to physical activity, returning people to normal everyday life. This article presents a retrospective analysis of intensive care of elderly and senile patients who underwent percutaneous coronary intervention with different types of stenting . The analysis revealed that most patients were diagnosed with ACS. Over 267 endovascular interventions were performed in 178 patients. Key words: intensive care , percutaneous coronary intervention, stenting , acute coronary syndrome, postinfarction cardiosclerosis. Relevance. The problem of acute coronary syndrome (ACS) is the focus of scientific research, since the consequences of coronary atherosclerosis lead to almost half of the deaths of the population [18, 19 ]. Recently, indications for myocardial revascularization in this group of patients have been expanding, which allows increasing tolerance to physical activity, significantly reducing the risk of recurrent myocardial infarction, and increasing long-term survival. Old age of the patient is often https://scientific-jl.org/obr 4 0 Выпуск журнала №-70 Часть–9_ июня –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 associated with a large number of concomitant diseases, as well as with high risks of cardiac surgery [11, 20 ] . In this regard, it became necessary to classify age groups of the population. The World Health Organization (WHO) adopted a classification of age groups approved by the Congress of Gerontologists and Geriatricians; the entire population over 50 years of age is divided into four age categories: 1) mature age - 45-59 years; 2) elderly age - 60-74 years; 3) old age - 75-90 years; 4) long-livers - 90 years and older [12, 21 ]. In elderly patients with severe forms of acute coronary syndrome (ACS), conservative treatment methods cannot always provide adequate control of anginal symptoms of the disease and reduce the risk of coronary events. In such cases, interventional interventions with revascularization of the coronary arteries are the only methods of choice. They are the "gold" standard in the treatment of patients with severe forms of ACS and not only relieve them of anginal symptoms , but also increase survival. In this regard, there is data according to which the authors claim that the operations of choice for patients of older age groups are endovascular methods, the implementation of which has a minimal surgical risk, and also reduces the risk of developing acute myocardial infarction (MI) in the late postoperative period [5, 16, 19]. Detection of ACS in the elderly and old people is facilitated by the high frequency of stenosing coronary atherosclerosis [9, 17]. Percutaneous coronary intervention does not reduce mortality, but improves the quality of life, especially in severe angina [4, 10]. Modern revascularization technology allows interventions to be performed even in patients 85 years of age and older without reducing efficiency and with an acceptable risk [2, 15]. In patients 75 years of age and older, as well as in younger patients, radial access reduces the risk of bleeding and complications at the site of vascular access [6, 8]. Active discussions regarding the advantages of stents of various modifications are not yet complete. According to the RESEARCH and T-SEARCH registries, in patients over 80 years of age, implantation of drug-eluting stents reduced the risk of vascular events by 50% compared to bare metal ones. stents [1, 7, 11]. When choosing stents , https://scientific-jl.org/obr 4 1 Выпуск журнала №-70 Часть–9_ июня –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 one can take into account information about the greater safety of modern polymer stents that release everolimus ( Xience ) or zotarolimus ( Rezolute ) [3, 13]. Thus, diagnosis and treatment of ACS in elderly patients requires knowledge of the characteristics of the aging organism, the peculiarities of the manifestations of the disease in old age, the increased risk of complications of treatment, which can help practicing physicians more successfully control this dangerous disease. Objective: To analyze the methods of intensive care after percutaneous coronary intervention as one of the methods of managing patients with acute coronary syndrome in elderly patients. Materials and methods: We conducted a retrospective analysis of elderly patients who underwent PCI from January 1 to September 1, 2023, according to the data of the Samarkand Regional