Assessment of the effectiveness and safety of the use of fortelyzin in patients with stemi in the conditions of emergency medical care of the Republic of Dagestan

In the Republic of Dagestan the implementation of the regional project «Combating Cardiovascular Diseases» continues, with the functioning of vascular centers, while the use of a pharmacoinvasive strategy at the pre-hospital stage is of great importance in patients with acute myocardial infarction. Aim: to study data on prehospital systemic thrombolysis in patients with STEMI (acute myocardial infarction with ST segment elevation) throughout the Republic of Dagestan. The objectives of the study were to analyze statistical data on the work of the emergency medical service in the RD for 2022, 2023 and 6 months of 2024, as well as study materials on the use of the drug Fortelysin as a component of intensive prehospital therapy for STEMI, with justification for the need to develop and implement a protocol for an effective strategy for providing emergency medical care in patients with STEMI throughout the entire territory of the Republic of Dagestan. Materials and methods of research. The study included 103 emergency medical care call cards for patients with acute myocardial infarction for the period 2022, 2023 and the first 6 months of 2024. on the territory of the Republic of Dagestan. Fortelysin used as a thrombolytic in all patients. Research results. The use of fortelysin in patients with AMI in the conditions of emergency medical care RD showed high efficiency (cessation of pain syndrome observed in 73% of cases, and a decrease in the ST-segment by 50% from the initial one recorded in 52% of patients) and safety (there was a low likelihood of serious side effects). Also, it is necessary to note a trend towards a decrease in the use of pharmacoinvasive strategies at the pre-hospital stage, to a greater extent in the mountainous regions of the Republic. Conclusion. The reasons for the decrease in the use of pharmacoinvasive strategy at the pre-hospital stage, mainly in the mountainous regions of the Republic, have been identified. Specialists of district ambulance services have insufficient knowledge about modern fibrinolytics. They are guided by their fears of reperfusion arrhythmia and bleeding when making a decision to perform TLT. The remoteness of medical institutions providing specialized care, geographical peculiarities of the region also contributes to the refusal of TLT. The efficacy, safety and convenience of fortelisin application (standard dosage) at the prehospital stage are shown. The use of an easy-to-use, easy-to-use, effective and safe thrombolytic, which does not require complex calculations and special equipment, throughout the whole territory of the RD will contribute to the improvement of treatment results of patients with STEMI and reduction of mortality from cardiovascular diseases in the region.

1. Boytsov S. A., Shakhnovich R. M., Tereshchenko S. N., Erlikh A. D., Pevzner D. V., Gulyan R. G. et al. Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction —  REGION-IM. Cardiology, 2024, Vol.  64, No  2, рр. 3–17  (In  Russ.). doi: 10.18087/cardio.2024.2.n2601.

2. Shalnev V. I. Thrombolytic therapy for acute myocardial infarction at the prehospital stage: clinical guidelines and real practice. Emergency medical care, 2020, No. 4, рр. 70–76 (In Russ.). doi: 10.24884/2072-6716-2020-21-4-70-76.

3. Khorolets E. V., Shlyk S. V. Possibilities of reperfusion therapy for patients with acute myocardial infarction. Consilium Medicum, 2020, Vol.  22, No.  5, рр. 87– 91 (In Russ.). doi: 10.26442/20751753.2020.5.200182.

4. Kuraev N. Sh., Daniyalova N. D. Analysis of the effectiveness of the Dagestan Center for Disaster Medicine in 2019–2022. Emergency Medicine, 2024, No. 1, рр. 10–14 (In Russ.). doi: 10.33266/2070-1004-2024-1-10-14.