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Aim. To identify genetic markers of risk for ST-elevated myocardial infarction (STEMI).Material and methods. The study included 210 patients (119 men, 91 women) with STEMI, hospitalized from December 21, 2016 to June 16, 2017 The average age of men was 55,5±9,5 years, women — 57,5±9,1 years. The diagnosis of STEMI was verified according to the criteria of the European Society of Cardiology (2015, 2017). During hospitalization, patients underwent clinical and instrumental examination, stipulated by medical care standards and clinical guidelines We also conducted a genetic study of single nucleotide polymorphisms (SNPs), which showed their association with the risk of coronary artery disease (CAD) and acute myocardial infarction (AMI) according to the GWAS: rs2820315 of the LMOD1 gene (Leiomodin 1, mapped on chromosome 1), rs9349379 of the PHACTR1 gene (regulator 1 of actin and phosphotase, localized on chromosome 6p241), rs867186 of the PROCR gene (Protein C receptor, located on chromosome 20q11.22), rsi1799883 of the FABP2 gene (Fatty acid-binding protein 2, located on chromosome 4q26). Statistical data analysis was performed using the SPSS 170.5 software package and authorial odds ratio (OR) calculator.Results. Carriage of the CC genotype of rs2820315 polymorphism of the LMOD gene is associated with an increased risk of STEMI by 1,87 times (95% CI 1,2862,722, p=0,016). Carriers of the CT genotype of rs2820315 polymorphism have a reduced risk of STEMI (OR 0,633; 95% CI 0,436-0,918, p=0,016).Conclusion. In order to identify risk groups for STEMI development, the study of the rs2820315 polymorphism of the LMOD gene is recommended. This will define the high-risk group for STEMI for developing of personalized programs for primary and secondary prevention of cardiovascular events in practical health care, which will contribute to reducing of STEMI mortality.

Dual antiplatelet therapy serves to improve the clinical results of thrombolytic therapy after STEMI, until recently consisted of acetylsalicylic acid and clopidogrel. In this category of patients, ticagrelor, widely used by acute coronary syndrome as more effective than clopidogrel, had no serious evidence of efficacy and safety. The TREAT study discussed in this article has been implemented to supply a gap in the evidence base of ticagrelor. The results of observation within 12 months after randomization to taking ticagrelor or clopidogrel of patients who received thrombolytic showed that the hemorrhagic safety regarding the major bleeding of ticagrelor is comparable with clopidogrel. The results of the TREAT study with the previously obtained results of the PLATO study make it possible to broaden indications for the use of ticagrelor (or switching from clopidogrel) in the first 24 hours from the onset of a myocardial infarction in patients who received thrombolytic therapy as an initial reperfusion.

Aim. To study the effect of the 48-week atorvastatin therapy on the mechanisms of arrhythmogenesis, determined during daily ECG monitoring, in patients with ST-elevated myocardial infarction (STEMI).Material and methods. The study included 104 people. Patients were randomized into two groups: a high-dose statin therapy group who took 80 mg of atorvastatin per day, and a comparison group who received atorvastatin 20 mg/day for 48 weeks. Upon admission and every 12 weeks, the total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol and triglycerides were determined. At the 7-9th day, 24th and 48th weeks of STEMI the daily ECG monitoring on 12 leads using the Holter Analysis-Astrocard complex (Meditek CJSC, Russia) with an assessment of the circadian dynamics of the heart rate, late ventricular potentials, duration, variability and dispersion of the QT interval, temporal and spectral parameters of heart rate variability, heart rate turbulence and the frequency of ventricular arrhythmias. Various cardiovascular events in the postinfarction period were taken as the end points.Results. Depending on the achievement/non-achievement of the LDL-С target level in the treatment process, two groups were identified: highly effective lipidlowering therapy “HET” — 51 people and relatively effective lipid-lowering therapy “RET” — 49 patients. In the HET group, QT dispersion regression was obtained from the 24th week of treatment; in the RET group, the dynamics of QTe disp, sdQTe, sdQTa values was not found. A positive transformation of all parameters characterizing the post-depolarization activity was revealed only in the HET group: a decrease in QRSf and HFLA, an RMS increase. Significant differences were obtained in the most of the parameters of both temporal and spectral analysis of HRV in the HET group. Clinically significant rhythm and conduction disturbances were more frequently recorded in patients of the RET group.Conclusion. Achieving the target LDL values in atorvastatin therapy in patients with STEMI is associated with the electrophysiological stability of the myocardium and the clinical well-being of patients in the post-infarction period.