Source: http://roscardio.ru/en/current-issue-rjc.html
Timestamp: 2019-04-21 03:03:17+00:00

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Aim. To identify the risk factors for bleeding of BARC scale 2-5 types in patients after acute coronary syndrome (ACS).
Material and methods. The data of 1502 patients from the open multicenter study, ORACUL II, were used — 894 men (59,5%) and 608 women (40,5%), mean age — 65,7±12,9 years. Five hundred sixty (37,3%) patients had ACS with ST-segment elevation and 942 (62,7%) — ACS without ST-segment elevation. Bleeding was recorded in 164 patients (10,9%), including index admission — in 39 (2,6%) patients, of which severe (types 3-5) — 0,5%, significant — 1,7% (types 2-5).
Results. Within a year after discharge, bleeding was observed in 126 (8,4%) patients, large — 0,8%, significant — 2,4%. The development of bleeding type 2-5 was associated with the presence of gastric ulcer and duodenal ulcer, gastrointestinal bleeding in history, decreased creatinine, hemoglobin clearance, age of patients, the use of anticoagulants in the composition of triple or double antithrombotic therapy, conducting of percutaneous interventional procedures, the presence of heart failure 2-4 Killip class at admission. ROC analysis showed that the predictive value of the ORACLE bleeding risk scale is 0,762, sensitivity — 62%, specificity — 78%.
Conclusion. Thus, we based on routine clinical practice have created a simple scale for assessing the risk of bleeding in patients with ACS.
Key words: acute coronary syndrome, bleeding, BARC, mortality, ORACLE risk scale.
1 Central State Medical Academy of the Presidential Administration of the Russian Federation, Moscow; 2City Clinical Hospital № 51, Moscow; 3Institute for Biochemical Physics, Moscow; 4 Stavropol Regional Clinical Psychiatric Hospital № 1, Stavropol; 5Kazan State Medical University, Kazan; 6City Clinical Hospital № 17, Moscow; 7Stavropol State Medical University, Stavropol, Russia.
O. S. ORCID: 0000-0001-5292-1336, Zubova E. A. ORCID: 0000-0001-8377-1350, Karmanchikova E. A. ORCID: 0000-0002-3991-2547, Khasanov N. R. ORCID: 0000-0001-8582-708X, Chichkova M. A. ORCID: 0000-0002-6962-3260, Boeva O. I.
ORCID: 0000-0002-1816-8309, Galyavich A. S. ORCID: 0000-0002-4510-6197, Zateyshchikov D. A. ORCID: 0000-0001-7065-2045.
Tukish O. V., Garganeeva A. A.
Aim. To study the features of disease progress and approaches to the diagnostics of acute myocardial infarction (MI) among elderly and senile patients and their influence on the management in the acute period of disease.
Materials and methods. The study was performed using the WHO program “Register of acute myocardial infarction” (Tomsk). The study included 410 patients (60 years and older), who had acute MI. The study group is represented by a comparable number of men (n=212) and women (n=198). The mean age of patients was 71 (66; 77) years (women are 5 years older than men (p<0,001)). Statistical processing was performed using the program Statistica V10.0.
prehospital phase of medical care due to a longer time before the first medical contact (p=0,005), as well as a late help-seeking (120 [49; 311,5] minutes). In 28% of patients, the level of creatine kinase-MB remained normal, and the indicator of troponin I exceeded the maximum values only in half of the cases. One fifth of the patients underwent acute MI treatment in non-core hospitals, which resulted in a low frequency of intervention (38%) and increasing by 2 times the chance of death within 5 years. The level of hospital mortality from acute MI in elderly patients in noncore hospitals was 3 times higher than in specialized departments (p<0,001).
Conclusion. Difficulties in diagnostics of MI in patients of older age groups is caused by the prevalence of comorbid pathology, an atypical manifestations of the disease and low information content of biochemical markers of myocardial necrosis. It leads to an increase in time delays at the prehospital phase and frequent hospitalization of patients in non-core hospitals, making it impossible for them to receive timely, preferred therapy.
Key words: myocardial infarction, elders, diagnostics of myocardial infarction, troponin, non-core hospitals.
Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.
Tukish O. V. ORCID: 0000-0002-7661-5808, Garganeeva A. A. ORCID: 0000-0002-9488-6900.
Acute coronary syndrome (ACS) and its complications is one of the main reasons of mortality and invalidation in the world. New biomarkers, such as ST2, NT-proBNP и Pentraxin-3 (Ptx-3) present much more opportunities in the diagnostics of diseases and risk of its development.
Aim. To investigate standards and “new” biomarkers in different variants of MI and cardiovascular events in 1 year after MI.
Material and methods. In 180 patients with MI (61,4±1,7 years) we determined the serum concentration of standard and “new” (ST2, NT-proBNP, Ptx-3) biomarkers in groups with Q/non-Q, STEMI and NSTEMI and the endpoints (MI, strokes, repeated hospitalizations and sudden deaths) in 1 year (384,3±21,2 days) after MI.
Results. Patients with Q-MI and STEMI had higher risk of unfavorable cardiovascular events (p<0,05). Ptx-3 >43,9 ng/ml was shown to be risk factor for sudden death (sensitivity 70,0%, specificity 52,9%), and >125,9±0,06 ng/ml (74,1% and 44,1%) — of recurrent MI.
Conclusion. NT-proBNP, ST2 and Ptx-3 showed prognostic value in the diagnostics of unfavorable cardiovascular endpoints.
Key words: myocardial infarction, long-term prognosis, stimulating growth factor ST2, N-terminal pro-brain natriuretic peptide (NT-proBNP), Pentraxin-3 (Ptx-3).
Funding. The following works were carried out with the support of the grant of the “Umnik Helsnet NTI”: design, information collection, analysis and interpretation of data, construction of statistical models.
Acknowledgments: Head of cardiology department of Clinical Hospital № 21, MD Tulbaev E. L., fifth-year student of the Belarusian State Medical University Dozhdev S. S., postgraduate student of Ufa State Aviation Technical University Akhmetvaleev R. R.
1 Bashkir state Medical University, Ufa; 2Ufa State Aviation University, Ufa, Russia.
Khamitova A. F. ORCID: 0000-0002-7496-7172, Zagidullin Sh. Z. ORCID: 0000-0002-7249-3364, Lakman I. R. ORCID: 0000-0001-9876-9202, Gareeva D. F. ORCID: 0000-0002-1874-8661, Zagidullin N. Sh. ORCID: 0000-0003-2386-6707.
Atabekov T. A., Batalov R. E., Krivolapov S. N., Sazonova S. I., Khlynyn M. S., Levintas A. D., Popov S. V.
Aim. Defibrillation lead implantation technique optimization using cardiac scintigraphy in patients with coronary artery disease (CAD).
Material and methods. In this study 81 patients (male — 72, age 64,0±8,7 years with CAD and indications for the cardioverter-defibrillator (ICD) implantation were examined. Patients were divided into two groups. In 1-st group before ICD implantation, patients underwent cardiac 99m Tc-methoxy-isobutyl-isonitrile scintigraphy for right ventricle wall perfusion disorders assessment. In this group defibrillating lead was implanted to the septal position, if the perfusion disorders were in the apical segments, and to the apical position, if perfusion disorders were in the septal segment. In 2-nd group lead was implanted using conventional approach. Defibrillating lead parameters (threshold, sense, impedance and shock impedance on 1-st, 7-th, 30-th and 180-th follow-up days) were compared.
at all follow-up days (p=0,0001) and impedance on 1-st (p=0,003), 30-th (p=0,0001) and 180-th day (p=0,002), respectively.
Conclusion. Assessment of right ventricular perfusion before ICD implantation can reduce threshold and raise sense, thereby prolong the ICD longevity and improve life-threatening ventricular tachyarrhythmia detection in the early and long-term period in patients with CAD.
Key words: cardioverter-defibrillator, 99mTc-methoxy-isobutyl-isonitrile, defibrillating lead, cardiac scintigraphy, threshold, sense, impedance.
Tomsk National Research Medical Center, Tomsk, Russia.
Atabekov T. A. ORCID: 0000-0003-2645-4142, Batalov R. E. ORCID: 0000-0003-1415-3932, Krivolapov S. N. ORCID: 0000-0001-8121-8287, Sazonova S. I. ORCID: 0000-0003-2799-3260, Khlynyn M. S. ORCID: 0000-0002-9885-5204, Levintas A. D.
ORCID: 0000-0003-4313-0975, Popov S. V. ORCID: 0000-0002-9050-4493.
Aim. To study associations of the estimated glomerular filtration rate (eGFR) with non-coronary atherosclerosis progression criteria and risk factors one year after coronary bypass surgery (CABG).
and group 2 (n=129) with progression of atherosclerosis.
Conclusion. In patients with progression of non-coronary atherosclerosis 1 year after CABG CKD-EPI eGFR was lower compared to patients without progression. In the long-term period the estimated values of renal function are significantly higher in patients without atherosclerosis progression.
Key words: coronary artery bypass, renal dysfunction, estimated glomerular filtration rate, atherosclerosis progression.
1 Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical University, Kemerovo, Russia.
Bezdenezhnykh A. V. ORCID: 0000-0002-4420-4350, Sumin A. N. ORCID: 0000-0002-0963-4793, Bezdenezhnykh N. A. ORCID: 0000-0002-9396-4575, Kazachek Ya. V. ORCID: 0000-0002-1491-0799, Barbarash O. L. ORCID: 0000-0002-4642-3610.
Aim. To determine the severity of chronic kidney disease (CKD) in patients after acute coronary syndrome (ACS).
of the East Kazakhstan Region for 1 year were studied. A total of 659 case histories were analyzed, of which 263 were patients with myocardial infarction (MI), and 396 were patients with unstable angina (UA). The diagnostic criteria for CKD were: proteinuria, levels of creatinine, glomerular filtration rate (GFR) <60 ml/min/1,73 m2. CKD stage was determined by the parameters of GFR.
was more often diagnosed in patients with UA.
Conclusion. The results of study allowed us to characterize the severity of CKD in patients undergoing ACS. We consider that widespread introduction of international and national clinical guidelines on the diagnosis, treatment and prevention of CKD in patients undergoing ACS is needed.
Key words: acute coronary syndrome, myocardial infarction, unstable angina, chronic kidney disease.
1 State Medical University, Semey, Republic of Kazakhstan; 2Astana Medical University, Astana, Republic of Kazakhstan; 3Omsk Region Clinical Hospital № 9, Omsk, Russia.
Borovikova O. A. ORCID: 0000-0003-2720-0953, Shalgumbaeva G. M. ORCID: 0000-0003-3310-4490.
Shames D. V., Galyavich A. S., Galeeva Z. M., Baleeva L. V.
Aim. To identify the effect of preprocedural laboratory parameters on the occurrence of in-stent restenosis in various types of stents, to assess the significance of gender, age and various forms of coronary artery disease (CAD) as risk factors for coronary artery restenosis after stenting.
Material and methods. The study included 436 patients with CAD, which were divided into 2 groups. The study group included 218 patients with in-stent restenosis. The control group consisted of 218 patients with CAD without in-stent restenosis. Inclusion criteria were acute or chronic form of CAD, age 45-74 years, CAG and percutaneous coronary intervention (PCI) with emergency or planned stenting of the native coronary artery, repeated CAG in history due to signs/symptoms of myocardial ischemia. Exclusion criteria: age younger than 45 years and over 74 years, coronary artery bypass surgery (CABG), cancer, autoimmune disease, anemia, liver failure, chronic kidney disease S4-S5, recent blood transfusion, hypo-or hyperthyroidism.
Results. According to the study, the risk in-stent restenosis is 5,2 times higher in patients in the 65-69 years age group and 9,9 times higher in the 70-74 years age group compared with the group of young patients (45-49 years). In-stent restenosis is 2,7 times more common in men than in women. Predictors of restenosis were red cell distribution width, mean platelet volume, Gensini score with OR 1,5; 1,4; 1,1; 1,5, respectively.
Conclusion. Risk factors for coronary artery restenosis after stenting are markers of chronic inflammation, such as the red cell distribution width, mean platelet volume. The risk of restenosis is higher in the male population. In old age, the risk of restenosis increases, however, young people and middle-aged people do not differ in risk of in-stent restenosis.
Key words: restenosis, coronary artery disease, percutaneous coronary intervention, holometallic stent, drug-eluting stent, predictors.
Shames D. V. ORCID: 0000-0002-7613-836X, Galyavich A. S. ORCID: 0000-0002-4510-6197, Galeeva Z. M. ORCID: 0000-0002-9580-3695, Baleeva L. V. ORCID: 0000-0002-7974-5894.
Aim. To evaluate the diagnostic accuracy of a noninvasive method of fractional flow reserve (FFR) assessment based on a one-dimensional hemodynamic model build on data obtained from the coronary computed tomography angiography (CCTA).
Material and methods. The study enrolled 57 patients: 16 of them underwent 64-slice computed tomography — included retrospectively, 34 — prospectively, with a 640-slice CT scan. Specialists from the Laboratory of Mathematical Modeling processed CT images and evaluated noninvasive FFR. Ischemia was confirmed if FFR <0,80 and disproved if FFR ≥0,80. After that the prospective group of patients was hospitalized for invasive FFR assessment as a reference standard; if ischemia was proved, patients underwent stent implantation. In the retrospective group, patients already had invasive FFR values estimated.
Statistical analysis was performed using R programming language packages (cran-r.project.com). Continuous variables are presented as mean values ± standard deviations, order variables are presented as medians with interquartile ranges in parentheses. We used the D’Agostino-Pearson omnibus test for the assessment of normality of distribution; a Q-Q Plot was also constructed. We performed the Bland-Altman analysis and ROC-analysis for comparison of these two methods, and the Pearson’s chi-squared to assess the degree of correlation.
Results. During data processing, 3 patients of the retrospective and 34 patients of the prospective group were excluded from the study. The sensitivity of our method was 90,91% (95% CI; 58,72-99,77), specificity — 86,67% (95% CI; 59,54-98,34), P<0,05, accuracy — 88,46 (95% CI; 69,85-97,55) — in per-vessel analysis. In perpatient analysis, the sensitivity was 91,67% (95% CI; 61,52-99,79), specificity — 80% (95% CI; 28,36-99,49), (P<0,05); accuracy 88,24 (95% CI; 63,56-98,54).
Conclusion. Our method has quite a high accuracy and can be successfully used in clinical practice in order to enhance the diagnostic efficiency of the CCTA.
Key words: noninvasive assessment of the fractional flow reserve, coronary artery disease, coronary computed tomography angiography.
Funding. The work was supported by RFBR grants 17-51-53160, 18-31-20048, 18-00-01524, Phiyu Liang’s work was supported by the National Natural Science Foundation of China (grant № 81611530715, 11832003). The funds were used to develop a model and a program for mathematical modeling of blood flow, part of the funds was spent on publishing articles in foreign publications.
Clinical Hospital № 1, Moscow, Russia; 6Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 7B. V. Petrovsky Russian Research Center of Surgery, Moscow, Russia; 8 Clinical hospital № 1 (Volyn), Moscow, Russia; 9Scientific Research Institute of System Analysis, Moscow, Russia; 10 Skolkovo Institute of Science and Technology, Moscow, Russia.
Y-8318-2018, Betelin V. B. ORCID: 0000-0001-6646-2660, ResearcherID: J-7375-2017, Mitina Yu. O. ORCID: 0000-0003-3742-7959, ResearcherID: Y-7930-2018, Gubina A. Yu. ORCID: 0000-0001-5206-3191, ResearcherID: Y-7935-2018, Shchekochikhin D. Yu. ORCID: 0000-0002-8209-2791, ResearcherID: E-6188-2017, Syrkin A. L. ORCID: 0000-0002-6452-1222, ResearcherID: N-1789-2017, Kopylov F. Yu. ORCID: 0000-0001-5124-6383, ResearcherID: Y-8275-2018.
Kryukov N. A., Ryzhkov A. V., Sukhova I. V., Ananyevskaya P. V., Fokin V. A., Gordeev M. L.
Aim. To identify the criteria for reversibility of structural changes in the myocardium of patients with coronary artery disease after revascularization based on analysis of data obtained using magnetic resonance imaging (MRI).
Materials and methods. We studied the long-term results of surgical treatment of 53 patients with critical reduction of left ventricle contractile function (ejection fraction less than 30%) undergoing coronary bypass surgery. Before the operation, all patients underwent cardiac MRI and transthoracic echocardiography (EchoCG). Immediate and long-term results were assessed according to EchoCG.
Results. The average observation period was 25,0±15,4 months. We found that significant predictors of improving of left ventricle contractile function are diastolic interventricular septum thickness (according to EchoCG and MRI) >10,5 mm (p<0,05); diastolic posterior wall thickness (according to EchoCG and MRI) >9,5 mm (p<0,05); degree of initially scarred myocardium according to MRI <33 points (p<0,05).
Conclusion. Detection of a viable myocardium is a prognostically important sign of a possible improvement in the functional state of left ventricle after revascularization surgery in patients with coronary artery disease, complicated by a critical reduction of myocardium contractile function. Thus, this problem can be solved by contrasting MRI.
Key words: coronary artery disease, ischemic cardiomyopathy, heart failure, coronary artery bypass surgery, direct revascularization, myocardial viability.
Kryukov N. A. ORCID: 0000-0001-6185-645X, ResearcherID: X-5522-2018, Ryzhkov A. V. ORCID: 0000-0001-5226-1104, ResearcherID: X-8943-2018, Sukhova I. V. ORCID: 0000-0002-7313-5307, ResearcherID: Y-7513-2018, Ananyevskaya P. V.
ORCID: 0000-0003-4725-9477, ResearcherID: Y-4435-2018, Fokin V. A. ORCID: 0000-0002-0539-7006, ResearcherID: P-9511-2015, Gordeev M. L. ORCID: 0000-0001-5362-3226, ResearcherID: Y-6034-2018.
Aim. To assess the efficiency of the program of prevention of chronic kidney disease (CKD) progression in patients with acute decompensation of chronic heart failure (CHF). The program included the use of nitrendipine, a calcium channel antagonist, and the replacement of single intravenous bolus dosing of furosemide with a prolonged intravenous infusion in the early stage of the disease.
Material and methods. One hundred twenty five patients with decompensation of CHF were examined and divided into 2 groups. Group 1 received standard therapy. In the group 2, an additional prevention program was carried out. The criterion of CKD progression was the change in glomerular filtration rate (GFR) in accordance with the KDIGO guidelines (2012). GFR was calculated by two methods: serum creatinine and cystatin C levels. The parameters were monitored and compared with baseline levels at admission to the hospital and on the 10th day of therapy. For the initial level was taken the patient’s GFR, calculated by the serum creatinine level prior to the present hospitalization on the background of a satisfactory condition.
Results. At admission to the hospital, in group 1 CKD progression was established in 33,3% of patients, in group 2 — in 29,3%. On the 10th day, CKD progression was noted in 47,4% of patients in group 1, in group 2 — in 23,4%.
Conclusion. The prevention program allows to reduce the number of cases of CKD progression in patients with decompensation of CHF by 2 times.
Key words: chronic kidney disease, chronic heart failure.
1 Altai State Medical University, Barnaul; 2City Hospital № 8, Barnaul, Russia.
Davydov V. V. ORCID: 0000-0001-7667-910X, Arekhina E. L. ORCID: 0000-0002-7049-5585.
of acute myocardial infarction, acute coronary syndrome and cardiac surgery.
Key words: telomere, telomerase, physical training, cardiac rehabilitation.
Aronov D. M. ORCID: 0000-0003-0484-9805.
In recent years, the problem of P2Y12 inhibitor switching, called escalation and de-escalation of double antiplatelet therapy (DAPT), in patients with acute coronary syndrome (ACS) has been the subject of active discussion.
Aim. To assess the frequency and clinical consequences of transition from ticagrelor to clopidogrel and from clopidogrel to ticagrelor in real clinical practice in patients with ACS.
Material and methods. Three hundred eight patients with ACS were included in the open, observational study. 121 patients (39,3%) receive conservative treatment, and 187 (60,7%) had invasive management tactics — percutaneous coronary interventions (PCI). In the group of conservative treatment switching from ticagrelor to clopidogrel and back was performed in 7 (5,8%) and 12 (9,9%) patients, respectively. In the second group switching from ticagrelor to clopidogrel and back were observed in 42 (34,7%) and 41 (33,9%) patients, respectively. Switching from one P2Y12 inhibitor to another occurred on 2-4 months from the beginning of therapy. The frequency of the following adverse events was chosen as the primary end point: death, re-infarction, re-hospitalization due to the development of chest pain syndrome, the need for coronary angiography or PCI.
Results. In both groups of patients with ACS, the best survival was shown by patients who had an escalation of DAPT. In turn, during de-escalation, a significant decrease in survival cases was observed with the onset of one of the endpoint events (RR 2,88 with 95% CI 1,23-6,78; p<0,02).
Conclusion. The study indicates a high frequency of de-escalation and escalation of DAPT, carried out in the outpatient management of patients undergoing ACS. There is a need of additional issue-related studies.
Key words: acute coronary syndrome, ticagrelor, clopidogrel, balloon dilatation angioplasty, percutaneous coronary intervention, coronary artery disease, acute myocardial infarction.
1 Volgograd Regional Clinical Cardiology Center, Volgograd; 2 Volgograd State Medical University, Volgograd, Russia.
Shamraev R. L. ORCID: 0000-0002-3337-7184, Ilyukhin O. V. ORCID: 0000-0002-4514-5145, Ivanenko V. V. ORCID: 0000-0003-3271-5257, Merzlyakov S. G. ORCID: 0000-0002-1762-1773, Lopatin Yu. M. ORCID: 0000-0003-1943-1137.
Key words: myocardial infarction, Turner syndrome.
1 Kazan State Medical University, Kazan; 2Interregional Clinical Diagnostic Center, Kazan, Russia.
Galyavich A. S. ORCID: 0000-0002-4510-6197, Galeeva Z. M. ORCID: 0000-0002-9580-3695, Baleeva L. V. ORCID: 0000-0002-7974-5894, Safina E. G. ORCID: 0000-0002-4315-3678, Murzina E. A. ORCID: 0000-0003-1275-2800, Kuvshinova L. E.
ORCID: 0000-0003-1196-3331, Gizatullina N. F. ORCID: 0000-0001-7677-2937.
Artyukhina E. A., Strebkova E. D., Revishvili A. Sh.
The presented clinical case demonstrates an individual choice of a staged comprehensive approach to interventional treatment of a patient with coronary artery disease and ventricular tachyrhythmias, focused on myocardial revascularization and interventional abolition of ventricular tachyrhythmias.
Key words: ventricular tachyrhythmias, radiofrequency ablation, substrate mapping.
A. V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russia.
Artyukhina E. A. ORCID: 0000-0001-7065-0250, Strebkova E. D. ORCID: 0000-0001-5837-7255, ResearcherID: C-3956-2019, Revishvili A. Sh. ORCID: 0000-0003-1791-9163.
myocardial infarction, recurrent myocardial infarction, re-infarction, cardiac procedural myocardial injury, takotsubo syndrome, myocardial infarction with nonobstructive coronary arteries (MINOCA).

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