Comparative Assessment of the Clinical Course, Drug Therapy and Outcomes in Myocardial Infarction without or with Obstructive Coronary Artery Disease

Aim. To compare clinical features, drug therapy and outcomes in patients with non-obstructive and obstructive coronary artery infarction.Material and methods. The study included 206 patients with a diagnosis of myocardial infraction (MI). According to the results of coronarography, patients were divided into two groups: 103 patients (group 1; MINOCA) did not have obstructive involvement coronary arterial (CA): in 67 (65%) of cases, there is no data for atherosclerotic coronary bed lesion, another 36 (35%) – have CA stenosis up to 50%. 103 patients (group 2) with MI and obstructive CA (MIOCA). The patients of the second group in 100% of cases underwent endoprosthesis of CA, the affection of which caused infraction. The second group was selected by the copy method comparatively to the first group. The analysis of clinical peculiarities, medication and outcomes was made in these groups of patients, in particular.Results and conclusions. The clinical “portrait” of patients with MI in nonobstructive and obstructive CA involvement did not differ significantly. Higher serum level of total cholesterol (5.6 [4.4;6.2] vs 5.1 [4.4;5.8] mmol/l р=0.04) and cholesterol of low-density lipoproteins (2.9 [2.2;3.5] vs 2.5 [2.1;2.9] mmol/l р=0,01), troponin [2.8 [0.7;15.0] vs 1.2 [0.1;7.7] ng/ml р=0.02) were identified in blood tests of MIOCA patients in the comparison with MINOCA group. Antero-lateral (р=0.02) and unspecified localization of MI (р=0.03) was more frequent in the MINOCA group. The differences in therapeutic approach were manifested in the more frequent prescription of double antiplatelet therapy: (99.0% vs 80.6% р< 0.01) in MIOCA patients. In the MINOCA group а more frequent prescription of dihydropyridine calcium channel blocking agents was registered (23.3% vs 2.9% р<0.01). The unfavorable outcomes for MINOCA is comparable to MIOCA in terms of the incidence of hospital mortality (2.9% against 4.9%; p>0.05), annual mortality (5.1% against 7.8%; p>0.05), and combined endpoint (6.8% against 10.7%; p>0.05).Conclusion. Despite the similarity of the clinical presentations of MI with obstructive and nonobstructive CA involvement in real clinical practice, there are differences in the pharmacotherapeutic approach in the management of these groups of patients. MINOCA is characterized by an unfavorable outcomes similar to MIOCA.

Systematic review of overactive bladder therapy in females

Although the prevalence of overactive bladder (OAB) is similarin both male and female populations, females have a greater tendencyto seek medical advice regarding their symptoms. A reviewof the evidence of therapy among women shows that a variety ofmodalities has been shown to be effective for symptom improvementin women with OAB. Bladder retraining/re-education shouldbe considered for all women with OAB. With respect to first-linepharmacotherapy with antimuscarinic agents, the development ofextended release preparations, bladder selective M3 antagonistsand alternative routes of delivery, have improved compliance andpersistence. Other pharmacotherapeutic options with potential forproviding benefit include antidepressants, vasopressin analogues,alpha-adrenoceptor antagonists and beta-adrenoceptor agonists.There are also a number of newer agents currently being investigated,including calcium channel blocking agents, potassium channelopening drugs, beta agonists and neurokinin receptor antagonists.Intravesical injections of botulinum toxin may be an alternative,while surgery can be considered for truly intractable cases.