Digitalization of the Electrocardiogram in the Optimization of the Treatment of Acute and Chronic Coronary Syndromes With the Use of Ranolazine

Aim – to evaluate the effectiveness of ranolazine in optimizing the treatment of acute and chronic coronary syndromes, using the capabilities of a differentiated electrocardiogram.Material and methods. 135 patients were involved in the study: 45 patients with ST-segment elevation myocardial infarction (STEMI) and 90 patients with stable angina pectoris (SA), functional class II-III. Depending on the treatment received, patients with STEMI were divided into group I, with inclusion in basic therapy of ranolazine (Pn), which consisted of 30 people, and control group II, which included 15 patients who received only basic therapy (K). People with SA were divided into three groups depending on the drugs included in the complex therapy (antiplatelet agents, statins and nitrates): group A - 30 patients additionally took lercanidipine and enalapril as part of the "polypill" drug (LE), group B - 30 people who received lercanidipine and enalapril as part of the "polypill" drug and ranolazine (LE+Rn), group V - 30 participants who took ramipril and ranolazine (Pm+Pn). The duration of treatment was 30 days. All patients were interviewed according to the EQ-5D-5L questionnaire with the EQ-VAS visual analog scale, carried out echocardiography and electrocardiogram (ECG) with digitalization of its indicators using the "Smart-ECG" medical software.Results. In patients with STEMI in group I (Rn) we noted increasing in quality of life (40.00 (30.00; 50.00), Δ +100.00%, p<0.001), left ventricular ejection fraction (LVEF) (50.50 (44.50; 55.00) %, Δ +6.93% (р<0.001) and the ratio of maximal speed (MSR) in the ischemic zone (0.64 (0.55; 0.71), Δ +76.56%, p<0.001). The frequency of increasing of MSR in the ischemic zone was significantly higher when ranolazine was included in the basic treatment (OR=7.000; 95% CI: 1.167; 42.001, p=0.020). An increase in the quality of life and a decrease in MSR in lead V2 (marker lead to assess LV hypertrophy) were observed in all groups of SA (in all cases p<0.05). In group B (LE+Rn), the greatest increase in LVEF was recorded (57.00 (55.25; 60.75) %, Δ +8.77 %, p<0.001). An increase of MSR in the ischemic zone was observed in group B (LE+Pn) (1.02 (0.62; 1.18), Δ +17.65%, p<0.001) and in group V (Pm+Pn) (0.86 (0.57; 1.05), Δ +12.79%, p<0.001). Conclusions. The addition of ranolazine in the treatment of STEMI and SA contributed to the improvement of the quality of life, the optimization of the contractile capacity of the myocardium due to the increase of LVEF, the increase of MSR indicator of the differentiated ECG in the ischemic zone, which confirmed the reduction of the electrical instability of the ischemic myocardium.