4
YANGI O'ZBEKISTON ILMIY
TADQIQOTLAR JURNALI
www.in-academy.uz
2-JILD 4-SON , 2-QISM (YOʻITJ)
COMPARATIVE ANALYSIS OF INTENSIVE THERAPY
OUTCOMES IN PATIENTS WITH ACUTE CORONARY
SYNDROME IN THE INTENSIVE CARE UNIT
Abibullayev Server Nedimovich, Mansurov Shokhrukh
Karimovich, Jurayev Shukhrat Faridunovich.
Samarkand branch of the Republican Scientific Center for
Emergency Medical Care. Samarkand, Uzbekistan.
https://doi.org/10.5281/zenodo.15286869
ARTICLE INFO
ABSTRACT
Qabul qilindi: 16-aprel 2025 yil
Ma’qullandi:20-aprel 2025 yil
Nashr qilindi: 26-aprel 2025 yil
Acute Coronary Syndrome (ACS) encompasses a
spectrum of clinical conditions ranging from unstable
angina to myocardial infarction with or without ST-
segment
elevation.
ST-Elevation
Myocardial
Infarction (STEMI) occurs due to complete occlusion
of a coronary artery, leading to transmural ischemia,
which is reflected by ST-segment elevation on the
ECG. In contrast, Non-ST-Elevation Myocardial
Infarction (NSTEMI) is usually associated with
subtotal
coronary
occlusion,
resulting
in
subendocardial ischemia and ST-segment depression
or T-wave inversion.This study evaluates the
effectiveness of different ICU treatment protocols for
ACS patients. A total of 87 patients were studied,
divided into two groups based on ECG changes.
Group A included STEMI patients, while Group B
included NSTEMI patients. Standard biomarkers such
as Troponin I and T, along with echocardiography
and clinical monitoring, were utilized to assess
outcomes. This paper provides comparative data on
the efficacy of specific pharmacological protocols and
their influence on cardiac recovery and prognosis.
KEY WORDS
Acute Coronary Syndrome,
ST-Elevation,
ECG,
NSTEMI,
Troponin, ICU, Intensive Therapy,
Prognosis, Echocardiography
Introduction:
Acute Coronary Syndrome (ACS) remains a major global health issue due to its
high incidence and associated morbidity and mortality. Timely recognition and proper
treatment significantly influence the clinical outcomes of affected patients. The differentiation
between STEMI and NSTEMI is fundamental, as it determines the urgency and type of
therapeutic interventions. According to international guidelines (ESC 2023, ACC/AHA 2021),
patients with ACS should be managed aggressively with antithrombotic therapy, beta-
blockers, statins, and in some cases, early invasive strategies. This study was designed to
evaluate and compare the effectiveness of different pharmacological strategies applied in an
intensive care setting. It aims to provide insight into how adherence to guideline-directed
medical therapy impacts cardiac function recovery and overall prognosis.
Materials and Methods:
A prospective observational study was conducted involving 87
patients admitted to the ICU with confirmed ACS.
Based on ECG characteristics, patients were divided into:
- Group A (STEMI): 45 patients.
- Group B (NSTEMI): 42 patients.
5
YANGI O'ZBEKISTON ILMIY
TADQIQOTLAR JURNALI
www.in-academy.uz
2-JILD 4-SON , 2-QISM (YOʻITJ)
Diagnostic protocols included:
- ECG on admission and at 48 hours.
- Troponin I and T measurement at admission and 24 hours.
- Transthoracic Echocardiography on Day 1 and Day 3.
Therapeutic protocols were administered based on ESC 2023 guidelines:
Group A (STEMI):
- Aspirin 300 mg loading, then 100 mg/day.
- Clopidogrel 600 mg loading, then 75 mg/day.
- Unfractionated Heparin IV bolus 70 IU/kg.
- Metoprolol 5 mg IV every 5 minutes (max 15 mg), then 50 mg twice/day.
- Nitroglycerin infusion (5–200 µg/min).
- Atorvastatin 80 mg/day.
Group B (NSTEMI):
- Aspirin 300 mg loading, then 100 mg/day.
- Ticagrelor 180 mg loading, then 90 mg twice/day.
- Enoxaparin 1 mg/kg SC every 12 hours.
- Ramipril 2.5 mg twice/day (up to 10 mg/day).
- Bisoprolol 5 mg/day.
- Rosuvastatin 40 mg/day.
Results:
Group A showed 85% ST-segment resolution by 48 hours. Group B had 70%
resolution of ischemic ECG changes. Troponin I levels decreased by 60% in Group A, and 45%
in Group B within 24 hours.
Echocardiographic assessment revealed a mean improvement in ejection fraction (EF) from
42% to 52% in Group A and from 45% to 51% in Group B. Wall motion abnormalities
improved more significantly in Group A.
Clinical symptoms (chest pain, dyspnea) resolved faster in Group A. The average ICU stay was
5.2 days (Group A) versus 6.8 days (Group B). 30-day mortality was lower in Group A (5.7%)
compared to Group B (7.3%). Re-infarction rates were 3.4% and 4.8%, respectively.
Discussion:
This study highlights the importance of guideline-based therapy in ACS patients,
especially in the ICU setting. STEMI patients receiving early dual antiplatelet and
anticoagulant therapy experienced quicker ECG normalization and better recovery of
myocardial function. Although NSTEMI patients did not require thrombolysis or urgent PCI in
most cases, strict adherence to medical therapy also yielded favorable outcomes. These
findings support the necessity of personalized treatment protocols based on ECG findings and
the underlying pathophysiology.
Conclusion:
Effective management of ACS in ICU relies on prompt diagnosis, ECG
differentiation, and adherence to evidence-based pharmacological strategies. This approach
leads to improved short-term outcomes, reduced complications, and better long-term survival.
Implementation of standard treatment protocols is essential in optimizing the care of patients
with ACS.
6
YANGI O'ZBEKISTON ILMIY
TADQIQOTLAR JURNALI
www.in-academy.uz
2-JILD 4-SON , 2-QISM (YOʻITJ)
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