Dissertation for the degree of Doctor of Philosophy in the speciality 222 – Medicine (field of knowledge 22 ‘Healthcare’). – State Institution ‘Amosov National Scientific Center of Cardiovascular Surgery and Hereditary Pathology of the National Academy of Medical Sciences of Ukraine’, Kyiv, 2026.
The thesis is devoted to a topical issue in modern interventional cardiology — the specific features of treating acute coronary syndrome (ACS) in elderly patients. The relevance of the work is, in particular, due to the progressive increase in the average age of the population in Ukraine, which has significantly intensified since the start of the Russian Federation’s full-scale invasion of Ukraine in 2022, against the backdrop of a steady rise in the National Health Service of Ukraine’s expenditure on the treatment of acute coronary syndrome from 2019 to 2025. The development of ACS remains one of the leading factors contributing to a poor prognosis and mortality in patients with ischaemic heart disease (IHD). The average annual mortality rate from CHD in Ukraine also shows an upward trend, rising from 278,714 cases in 2015 to 304,060 in 2021. The risk of death from ACS in elderly patients (aged 85 and over) is 10 times higher compared to those under 65 years of age. According to definitions by the UN, WHO, and international cardiology societies, patients aged 65 and over are classified as elderly.
This doctoral research analyses the pathophysiological mechanisms of cardiovascular ageing and their role in the development of ACS, as well as their impact on the specific clinical presentation and poorer prognosis in older patients. The central mechanisms identified include the phenomenon of cellular ageing (senescence), the secretory phenotype of systemic inflammation, coronary calcification, increased vascular stiffness, widespread atherosclerotic burden, and geriatric status, in particular, senile asthenia (frailty) syndrome. It has been shown that these age-related factors directly influence the success of percutaneous coronary interventions (PCI) in older patients. The study presents the characteristics of atypical patient presentations and describes adapted approaches to the management of patients with acute coronary syndrome. In particular, for the first time in Ukraine, the effectiveness of deep learning models in the diagnosis of acute coronary syndrome in the absence of ST-segment elevation on the electrocardiogram has been determined using a representative sample. An approach to the selection and establishment of peripheral arterial access for performing PCI under real-time ultrasound guidance is described, as well as the characteristics of securing vascular access in the presence of severe radial artery calcification in patients with CAD.
An analysis of differences between younger and older age groups identified clinical and diagnostic features of ACS in older patients. In particular, it was found that patients with CAD admitted to hospital for ACS more frequently complain of shortness of breath and weakness, and are also more likely to have concomitant atrial fibrillation. The study found no statistically significant difference in the frequency of ST-segment elevation on the electrocardiogram between younger and older age groups, contrary to data from the literature, which may be interpreted as a sign of underdiagnosis of acute coronary syndrome in patients with SVG in the absence of classic electrocardiographic criteria when deciding on hospital admission.
A comparative analysis was conducted of patients with CAD and ACS who underwent PCI and coronary artery bypass grafting (CABG). It was found that coronary artery bypass grafting, in contrast to PCI, is performed less frequently in women, is less likely to be performed in urgently admitted patients and in patients with elevated cardiac biomarkers according to laboratory test results, and is also associated with a longer duration of hospitalisation. It was established that the presence of comorbidities did not result in a statistically significant difference in the choice of revascularisation technique for acute coronary syndrome.
