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In the structure of total mortality, cardiovascular diseases are in the first place in the world. The main and most common reason for this is the incidence of myocardial infarction (MI). The basis of the pathogenesis of MI with ST elevation is persistent and complete thrombotic occlusion of the large epicardial branch of the coronary artery, leading to extensive necrosis of the heart muscle with the development of life-threatening complications, including death, the frequency of which is 8–10 %. The prognosis for MI is influenced by the presence of risk factors, complications, hemodynamic status, polymorbidity, as well as tactics for restoring coronary blood flow. To eliminate acute coronary artery occlusion, conservative treatment is used – thrombolytic therapy, surgical – primary percutaneous intervention, thromboextraction, coronary bypass surgery, as well as their combination. Today, there are scattered and isolated studies characterizing the approach to treatment in patients with MI with ST elevation in various diseases and with polymorbid pathology, the relationship with risk factors and laboratory and instrumental data has not been established, among which predictors of rapid response and death in patients with polymorbid pathology for emergency physicians have not been determined. It can be assumed that the chosen optimal patient management tactics in a specific clinical situation, taking into account the above-mentioned factors, will reduce the development of complications and increase the survival rate of patients with MI.

Aim. To analyze the frequency, indications, and outcomes of using glycoprotein IIb/IIIa inhibitors in patients with acute myocardial infarction (AMI) in Russia based on data from a multicenter registry.Material and methods. This work is part of the REGION-MI (Russian Registry of Acute Myocardial Infarction) multicenter retrospective-prospective observational study, which included patients admitted to hospitals in 45 regions of Russia with a diagnosis of AMI from 2020 to 2023. The decision to prescribe glycoprotein IIb/IIIa inhibitors was made by physicians. The observation period was 12 months, the following outcomes were recorded: cardiovascular events (relapse/repeated AMI, stent thrombosis, revascularisation), hemorrhagic complications, and in-hospital and all-cause mortality during the entire observation period. The study is conducted on the "Quinta" platform. Statistical data processing was performed using IBM SPSS Statistics ver.24.Results. A total of 10,884 patients were included in the registry, glycoprotein IIb/IIIa inhibitors were prescribed to 114 patients (1%), all of whom underwent percutaneous coronary intervention (PCI), while among patients with non-ST elevation myocardial infarction, the frequency of IIb/IIIa inhibitors was 0.5%, among ST-segment elevation myocardial infarction patients — 1.3%. Eptifibatide was used most often (67.5%), tirofiban was prescribed in 28.9% of cases, abciximab — 2.6%, framon — 0.9%. The most common indication for prescribing drugs were complications of PCI, in particular — distal embolism. There was a higher incidence of cardiogenic shock and multivessel revascularization in the glycoprotein IIb/IIIa inhibitor group. In-hospital mortality and adverse events within 180 days (death, cardiovascular events) did not differ between patients who did and did not receive glycoprotein IIb/IIIa inhibitors. The use of glycoprotein IIb/IIIa inhibitors in this study was associated with an increased risk of all in-hospital bleeding (odds ratio 9.656, confidence interval 2.859-3,894, p

The aim of the study is to identify social and economic factors associated with the development of coronary and cerebral ischemic events in urban residents based on the results of a three-year follow-up. Material and methods. The prospective non-interventional observational study included 431 patients. Data on the coronary and cerebral ischemic events in history, and social, economic and demographic data were collected at the baseline. Follow-up appointments were scheduled 3 years later to assess new cases of coronary and cerebral ischemic events. Taking into account the presence or absence of the adverse events in history at the baseline and follow-up visit, four groups of patients were formed. There were 350 (81.2 %) people without a coronary history (group 1), and 81 (18.8 %) with it (group 2). Respondents without a coronary history were divided into a subgroup with the absence of new ischemic (coronary and cerebral) events at the repeat stage, numbering 246 (57.1 %) people (1a), as well as a subgroup with their development – 104 (24.1 %) (1b). Similarly, respondents with a coronary history were divided into a subgroup with the absence of adverse events at the second stage, which included 35 (8.1 %) people (2a), as well as a subgroup with their occurrence – 46 (10.7 %) (2b). Results. At the baseline, only 18.8 % out of 431 patients had coronary events in history. At the follow-up visit, 150 (34.8 %) patients presented with new coronary or cerebral ischemic events: 10.7 % of those cases were fatal, 1.9 % – new cases of myocardial infarction, 3.5 % – cases of stroke, 13.5 % – new cases of angina pectoris, and 5.3 % – other diseases associated with coronary artery disease. One third out of 350 patients without coronary events in history and half of patients with coronary events in history presented with newly developed adverse events. Young respondents (35–49 years old) with no coronary history were 3 times more likely to have coronary and cerebral ischemic events over 3 years than people of the same age, but with previous diseases of the cardiovascular system. During the 3-year followup period, the risk of coronary and cerebral ischemic events in patients with coronary events in history was associated unemployment odds ratio (OR) 2.74 (95 % confidence interval (CI) 1.33; 5.66, p = 0.006), widowhood OR 2.98 (95 % CI 1.32; 6.74, p = 0.008), living in a rural area OR 2.30 (95 % CI 1.16; 4.55, p = 0.017) and female gender OR 2.63 (95 % CI 1.28; 5.43, p = 0.008). Conclusions. The risk of coronary and cerebral ischemic events during the 3-year follow-up period in the population of urban residents is associated with social and economic determinants such as female gender, unemployment, living in a rural area, and widowhood in the presence of a coronary history. 35–49-year-old men without a coronary history should also be considered as a group of special attention for the prevention of adverse events.

Relevance. To investigate the prognostic value of the Charlson Comorbidity Index (CCI) and its components in assessing outcomes related to in-hospital and 18‑month mortality and to determine additional prognostic value when incorporating them into the GRACE score among patients with acute myocardial infarction (MI). Material and methods. A prospective study enrolled 712 patients diagnosed with acute MI who underwent coronary angiography within 24 hours of hospitalization. Results and Discussion. Of the patients, 61 % were male, median age 65 (interquartile range [IQR] 56–74years). In-hospital and 18‑month mortality rates were 5.1 % (n = 36) and 12.1 % (n = 86), respectively. Median GRACE, CCI scores were 117 (IQR: 98–141), and 4 (IQR: 3–6) respectively. Common comorbidities within the CCI components included previous MI (21.8 %), diabetes mellitus (21.1 %), chronic pulmonary disease (16.2 %), dementia (9.2 %), peptic ulcer disease (9.1 %), renal failure (8.6 %). Factors associated with in-hospital and 18‑month mortality included chronic lung disease (odds ratio [OR] = 4.21 and 2.04, respectively) and renal failure (OR = 3.51 and 1.99, respectively) after adjusting for GRACE score. Dementia (OR 2.10; 95 % confidence interval [CI] 1.11–3.97) was a significant risk factor for 18‑month mortality. CCI was associated with in-hospital and 18‑month mortality (GRACE-adjusted OR 1.29, 95 % CI:1.07–1.57, p = 0.001 and 1.37, 95 % CI (1.20–1.57, p = 0.001, respectively). CCI demonstrated good predictive ability for in-hospital mortality (area under the ROC Curve [AUC]: 0.826) and modest performance for 18‑month mortality (AUC: 0.797). Adding chronic lung disease, renal failure in the GRACE score significantly improved the predictive efficacy for in-hospital mortality, with an AUC of 0.932 (95 % CI: 0.905–0.959, p = 0.001). Including CCI in the GRACE score enhanced the prediction efficiency for 18‑month mortality (AUC 0.819, 95 % CI: 0.768–0.871, p = 0.001). Conclusion. The CCI demonstrated moderate prognostic value in assessing in-hospital mortality among patients with acute MI and good predictive ability for long-term mortality. The CCI and its components (chronic lung disease, renal failure) added prognostic significance in addition to the GRACE score for predicting both short-term and long-term adverse outcomes.

Aim. To compare the clinical effectiveness of two patient management programs for 12 months after myocardial infarction (MI) (standard outpatient monitoring and office- based management with additional active remote medical supervision).Material and methods. 150 patients with non-fatal MI aged 35 to 70 years were included. At discharge, patients were randomized into groups with different followup programs for 12 months after MI (standard outpatient follow-up (n=75) or its combination with active remote patient monitoring (n=75)). One year after MI, the following parameters were was assessed: vital status, frequency of emergency cardiovascular hospitalizations due to coronary insufficiency, actual adherence to therapy and regular outpatient follow-up, achieving target parameters of cardiovascular health, and dynamics of behavioral risk factors.Results. In the group of patients with MI who spent 12 months in a combined program, compared with patients with standard monitoring, 4.8 times fewer combined ischemic events were registered (p300 g per week) (p=0.032), 1.4 times more often — fresh fruits and berries (>300 g per week) (p=0.003), 1.2 times more often reported about reducing the consumption of complex carbohydrates to > ¼ of the plate per day (p=0.036).Conclusion. An original program of combined standard outpatient monitoring of patients and their active remote monitoring for 12 months after MI demonstrated advantages in secondary prevention of cardiovascular events and modification of cardiovascular risk factors.

Aim. To analyze demographic, anamnestic and clinical parameters in subjects with coronary artery disease (CAD) or peripheral artery disease (PAD) included in the XATOA study from Russian centers and to compare them with the total population of the international registry.Material and methods. XATOA study is an international, multicenter, prospective registry, where characteristics of patients receiving dual pathway inhibition therapy with rivaroxaban 2,5 mg twice a day and low-dose acetylsalicylic acid (ASA) daily were analyzed. The secondary endpoint of the study was to assess clinical outcomes and bleeding rates in real world setting.This analysis was based on the comparison of indicators presented in tables of descriptive statistics from the XATOA study database for subjects from Russia and the general study database respectively. The methodology of this sub-analysis is descriptive only and does not imply any statistical difference assessment.Results. The Russian population included 795 subjects: 232 (29.2%) subjects with CAD; 293 (36.9%) subjects with PAD and 270 (34.0%) subjects with both. The average follow-up period was 14.4 months. The most common antithrombotic treatment regimen for patients with CAD or PAD prior enrollment in the registry was ASA monotherapy (81.3%); ACE inhibitors/ARBs were prescribed in 61.8%, lipid-l owering therapy in 68.9%. After the enrollment and prescription of rivaroxaban 2.5 mg BID + ASA, the incidence of myocardial infarction, stroke or cardio-v ascular death in subjects in the Russian Federation remained at 1.9%, and the incidence of major adverse limb events (MALE) at 0.8%, which corresponds to the results obtained in the COMPASS randomized controlled trial. Major bleeding was reported in 1 subject (

Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.

Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. From gastroenterological practice, PPIs are being actively introduced into other specialties, in particular in cardiology and rheumatology, where they are used to protect the mucous membrane of the gastrointestinal tract and prevent gastrointestinal bleeding during long-term antithrombotic therapy and long-term use of non-steroidal anti-inflammatory drugs. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the relationship between PPIs and a number of diseases/conditions, including the question of a possible association of PPI use with an increased risk of cardiovascular complications, but note the inconsistency of these data. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to 12/01/2023. In this review, we examined the possible cardiovascular risk of long-term use of PPIs. Analysis of publications, despite a number of contradictions, allows us to conclude that the cardiovascular risk with long-term use of PPIs is real and must be taken into account when prescribing PPIs for a long period and to comorbid/multimorbid patients.

Stroke, myocardial infarction (MI), and other main non-communicable diseases (NCDs) remain major causes of mortality and disability globally. Up to 80% of cardiovascular events and up to 60% of NCDs are associated with potentially controlled risk factors (RFs). State-of-the-art digital technologies can help bridge the gap between evidence-based prevention methods and their critically low availability in routine clinical practice. An innovative digital platform named PreventS-MD® is a specially developed tool for healthcare professionals to be used under time constraints. With PreventS-MD®, clinicians can estimate patient's 10-year cardiovascular risk within several minutes. Then, they automatically get adapted results and recommendations to address identified RFs as well as graphical representation of specific RF contribution to overall stroke and MI risks. If some additional time is available, the clinician and the patient can collaboratively set customized achievable goals to correct modifiable RFs. An integrated analytical module provides healthcare managers with current digital risk profiles of the relevant population to evaluate prevention effectiveness and to forecast the load throughout the healthcare levels. PreventS-MD® has several unique advantages, including time-saving design, the function to activate motivated RF correction, individually tailored recommendations, and information on personally changed digital profiles of vascular risks. As cardiovascular diseases and main NCDs have a lot of common RFs, PreventS-MD® implemented into routine clinical practice will utilize a complex approach to the prevention of main NCDs, decreasing both stroke and MI burden and addressing complications of chronic pulmonary and kidney disease, tumors of any type, dementia, etc.

BACKGROUND: Considering the high cardiovascular risk in patients with familial hypercholesterolemia (FH), early diagnosis and treatment are the basis for the prevention of vascular accidents. In the absence of universal screening, the results of more targeted diagnostics are of interest — the search for lipid metabolism disorders in young relatives of patients with atherosclerotic vascular diseases. OBJECTIVE: To determine the effectiveness of targeted screening for identifying patients with FH, which will justify its widespread use in clinical practice. MATERIALS AND METHODS: At the start of the observational study, 584 patients were identified from the vascular centers of the Krasnoyarsk Regional Hospital, Krasnoyarsk Interdistrict Clinical Hospital No. 20 named after. I.S. Berzon, who had lipid profile data and early cardiovascular events (all forms of coronary heart diseases), including reconstructive vascular interventions up to 55 years in men and up to 60 years in women in the case of first-degree relatives and up to 50 years in second-degree relatives. The study examined patients’ relatives aged 44 years. To diagnose FH in participants aged 16 years, the scale developed by a network of Dutch lipid clinics was used; in participants aged 16 years, the S. Broome criteria were used. Targeted screening and lipid parameters in individuals with probable, possible, and definite FH were analyzed. Data processing was performed using Microsoft Excel and Statistica v. 12.0 (USA). Parametric (calculation of the median and 25th and 75th quartiles) and nonparametric (statistical significance of differences was determined using the Mann–Whitney and χ2 tests) methods were used. RESULTS: The study examined 70 children and 104 adults aged 44 years whose first- and/or second-degree relatives suffered premature vascular events. In the general group of participants, 42 (24.14%) patients had FH (of which 18 were 17 years old) and 37 (21.2%) had hyperlipoproteinemia (a). Definite FH was documented in 16 (9.1%) patients, probable in another 16, and possible in 9. Hyperlipoproteinemia (a) was found in 37 (21.2% of general group) patients, including 12 children (17.1% of pediatric group). CONCLUSION: Not more than 30% of the population are aware of the hereditary nature of lipid metabolism disorders and atherosclerotic diseases. Targeted screening is the least expensive and most effective tool for identifying patients with FH and hyperdipoproteinemia (a).

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme involved in the regulation of blood cholesterol levels by binding to low-density lipoprotein receptors and promoting their degradation. Pivotal studies have shown that PCSK9 inhibition by monoclonal antibodies, alirocumab and evolocumab, and the small interfering RNA (inclisiran) reduces the risk of cardiovascular diseases in individuals with coronary heart disease. However, the place of the PCSK9 inhibitors in treatment of patients with acute coronary syndrome has not been determined yet. The article discusses studies on the addition of PCSK9 inhibitors to therapy during the acute phase of myocardial infarction as well as pathophysiological prerequisites for their use.

Proton pump inhibitors are the most effective drugs for the treatment of acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. There are no reviews in the domestic literature on the safety of PPIs during long-term use. In this regard, a search was conducted in the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to November 15, 2023, which showed that long-term use of PPIs is associated with the possible development of numerous side effects. The first publications examined the likely side effects of long-term use of PPIs: the development of infections, increased risk of fractures and kidney pathology, and possible side effects: the risk of cancer and electrolyte disturbances. This review examines the possible cardiovascular risk of long-term PPI use and a number of rare side effects, many of which have been described in recent years. The key to mitigating side effects is judicious use of PPIs at the lowest effective dose and as quickly as possible. If there are clear indications for long-term PPI use, monitoring should be carried out to identify side effects.

The article describes a clinical case of biventricular arrhythmogenic cardiomyopathy (ACM) presented with myocardial infarction (MI) — like event in a young patient. The patient was hospitalized with suspected acute coronary syndrome and an episode of ventricular tachycardia (VT). Based on increased cardiac troponin, left ventricular systolic dysfunction with wall motion abnormalities, and nonobstructive coronary arteries the initial diagnosis of type 2 MI was made. To verify the etiology behind VT and ventricular structural abnormalities cardiac magnetic resonance imaging (MRI) was performed. Abnormalities of both right and left ventricles demonstrated by MRI and supported by the genetic testing established the diagnosis of biventricular ACM. Since the diagnosis was made, initially diagnosed MI was reassessed in favor of acute myocardial injury as a characteristic of ACM course. ACM should be included into differential diagnosis with MI and acute myocarditis in patients with elevated troponin and nonobstructive coronary arteries.

Against the background of military operations, post-traumatic stress disorder, the progression of the atherosclerotic process is observed, which can lead to myocardial infarction even in young people. Left ventricular aneurysm (LVA) in military personnel is the result of untimely revascularization of an infarct-related artery, gunshot wound to the heart, chest trauma, etc. The presence of a dyskinetic area promotes formation of blood clots in the LVA cavity. LVA thrombosis is associated with an increased risk of embolism, ischemic stroke, and death. Case description. A 37-year-old military servant A. was urgently hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a mobile thrombus in the area of LVA, size 4.5 x 3 cm, with signs of lysis and a threat of separation according to echo data. The patient was found to suffer Q-wave myocardial infarction 5 months ago; at the time of examination there was decompensation of the condition and a decrease in the left ventricular contractility to 34%. The patient underwent urgent operation: on-pump coronary artery bypass grafting, LVA resection with thrombectomy. The duration of the operation was 7 hours, the aortic cross-clamp time was 53 minutes, the perfusion time was 93 minutes, the blood loss was 500 ml. The postoperative period was uneventful. The patient was discharged on the 7th day with improvement, the ejection fraction was 40%. Conclusion. The lack of an opportunity to conduct timely electrocardiography and echo for military personnel with acute chest pain reduces the chances of diagnosis and treatment of myocardial infarction within the therapeutic window, which leads to the occurrence of complicated forms of coronary heart disease, namely LVA. Echo is of crucial importance in deciding on emergency cardiac surgery for thrombosed LVA.

Unstable angina (UA) is a type of acute coronary syndrome (ACS) without ischemic myocardial damage. The main criterion for the diagnosis of UA in ACS is the absence of changes in the concentration of cardiac troponin in the patient’s blood. When the volume of myocardial damage is small, it may be difficult to detect myocardial infarction in a patient using low-sensitivity tests for determining of cardiac troponin in the blood. This issue may lead to overdiagnosis of UA in patients with non-STE ACS. Optimal drug therapy and revascularization of the coronary arteries significantly reduce the risk of death and the development of myocardial infarction both in the hospital and in the long-term period in patients with UA. Outpatient follow-up and provision of free of charge medications to patients may reduce long-term mortality after an episode of UA.

The aim. This study aimed to determine the effectiveness of the OMI AI deep learning model for the diagnosis of myocardial infarction in patients with non ST-elevation acute coronary syndrome. Materials and methods. This single-center retrospective observational study analyzed the data of 238 patients admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a primary diagnosis of non ST-elevation acute coronary syndrome. The inclusion criteria for the study were: age ≥18 years, symptoms of acute coronary syndrome, at least one 10-second 12-lead electrocardiography on admission, no changes typical of ST-segment elevation myocardial infarction on electrocardiography, and at least one laboratory blood test for biomarkers of myocardial damage. Results. The final analysis included data from 116 patients, 69 (59.5%) men and 47 (40.5%) women aged 43 to 88 years (mean age 67±11 years), of whom 34 were older patients (≥75 years). Of these, 29 (25%) patients were discharged with a diagnosis of acute myocardial infarction, 60 (51.7%) with a diagnosis of unstable angina, and 27 (23.3%) patients with other diagnoses. When analyzing electrocardiographic data by the OMI AI model, true positive results were obtained in 23 cases (19.8%), true negative results in 76 cases (65.5%), false positive results in 11 cases (9.5%), and false negative results in 6 cases (5%). Accordingly, the model’s sensitivity was 67% and specificity was 93%. The positive and negative predictive values for the model under study were 0.793 and 0.874, respectively. The accuracy of the model was 85.34% (95% CI: 77.78% to 90.64%). Conclusions. The use of the artificial intelligence tools has the potential to improve the accuracy of diagnosis of myocardial infarction during hospitalization, accelerate the provision of specialized care and improve prognosis in patients with non ST-elevation acute coronary syndrome.

Introduction and Purpose: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly impacting the management of critical non-COVID conditions such as myocardial infarction (MI). This review aims to explore the alterations in the management of MI during the pandemic and assess how these changes have influenced patient outcomes. State of Knowledge: Numerous studies have reported delays in MI treatment during the pandemic due to healthcare resource reallocation towards COVID-19 care and patient hesitance in seeking timely medical help. Innovations such as telemedicine have been integrated into patient care to overcome barriers. However, these changes have varied impacts on clinical outcomes, including increased mortality and complication rates among MI patients during the pandemic. This review consolidates findings from recent studies focusing on altered treatment protocols, patient care strategies, and overall health system response during this period. Summary: The management of myocardial infarction during the COVID-19 pandemic has witnessed substantial shifts, leading to both challenges and innovations in cardiac care. While some adjustments have provided temporary solutions, the overall impact on MI outcomes has highlighted the need for more resilient healthcare strategies that ensure the continuity of care for acute cardiac events during global health emergencies.

Currently, worldwide interest in lipoprotein(a) (LP(a) as one of the most important markers of premature and aggressive atherosclerosis is steadily growing. This trend is due to both the new data on the pathogenesis of hyperlipoproteinemia (a) and the development of novel treatment methods in the near future. The variety of clinical manifestations of atherosclerosis associated with high LP(a) concentrations leads such patients to specialists of various profiles. The aim of this paper was to demonstrate, using examples from the practice of two lipid centers in Krasnodar, the diversity of clinical scenarios of atherosclerosis as a systemic disease in patients with very high LP(a) levels, as well as to highlight the current and future options for the treatment of hyperlipoproteinemia (a).

Aim. Within the LIS-3 register of acute coronary syndrome (ACS), to evaluate the phenomenon of complete refusal of treatment (absolute non-adherence) after discharge from the hospital of patients diagnosed with acute myocardial infarction (AMI)/unstable angina (UA): to study the characteristics of absolutely nonadherent patients, disease outcomes after 2.5 years after first contact.Material and methods. The study was conducted within the framework of the LIS-3 register. This part of the study included patients who survived ACS and were discharged from the hospital in the first 9 months of 2014 (104 people) and patients who survived ACS and were discharged from the hospital in the first 9 months of 2018 (223 people). Of the 327 patients who survived after AMI/UA, 226 patients remained alive by the time of the first survey (on average 3 years after discharge). The created questionnaire was used, which includes questions about possible long-term outcomes, adherence to visits to medical and preventive institutions (health facilities) and adherence to drug therapy. 221 people answered questions about treatment, 11 (5%) of them did not take any drug therapy (absolutely non-adherent). On average, 29 months (2.5 years) after the initial survey, a repeat survey of completely non-adherent patients or their relatives was carried out, information was collected on the vital status of these patients, repeated cardiovascular events and on the use of recommended drug therapy, about visiting a health facility.Results. When comparing the clinical and demographic characteristics of patients who were adherent and completely non-adherent to the prescribed therapy, no significant differences were noted. By the time of the repeat survey, 4 patients from among those who were completely non-adherent had died, 2 had suffered ACS. Of the 6 patients who survived, at the time of re-contact, 2 had not started taking medications, explaining that they were feeling well, 2 had resumed taking medications in full, 2 — partially, contact with 1 patient was lost.Conclusion. A certain proportion of patients who have suffered AMI/UA completely refuse the prescribed treatment, mainly because they feel well. The likelihood of death and recurrent cardiovascular events in such patients is extremely high.

In recent years, many studies have been aimed at exploring the possibilities of cardiac rehabilitation as a tool to improve the prognosis in patients after acute coronary syndrome (ACS). Endothelial dysfunction is one of the initiating mechanisms of cardiovascular diseases, and myocardial infarction in particular, so it is important to assess the dynamics of changes in the number of endothelial progenitor cells (EPCs) in patients during cardiac rehabilitation with the increase in physical activity. The aim. To establish the relationship between the level of recovery of exercise tolerance and the recovery of endothelial function by determining the number of EPCs in patients undergoing cardiac rehabilitation after ACS. Materials and methods. The study included 44 patients with ST-elevation myocardial infarction who underwent urgent stenting of the infarct-related artery, with a mean age of 59 years (Q1-Q3; 51-64). All the study participants underwent laboratory tests (CD45+/CD34+ cell count before and after the exercise test) and instrumental tests (echocardiography, bicycle ergometry, coronary angiography). Statistical processing was carried out using SPSS Statistics 23 (trial version). Results. According to the results of the exercise test at the first examination, the patients were divided into 2 groups: group 1 with low exercise tolerance (≤50 W) and group 2 with high exercise tolerance (>50 W). The data obtained indicate a link between better recovery of exercise tolerance after ACS and recovery of endothelial func-tion in patients with high exercise tolerance during follow-up compared to the patients whose exercise tolerance did not exceed 50 W, as evidenced by a statistically higher number of EPCs after exercise in patients with a favor-able course and high exercise tolerance (3633 vs. 2400 cells/ml) (p=0.006). Patients with low exercise tolerance were more likely to be diagnosed with lesions of left anterior descending coronary artery (96% vs. 70%, p=0.02). More severe coronary vascular lesions with stenosis of 75% of two or more arteries showed lower pre-exercise EPCs, but increased post-exercise EPCs (+228 cells/ml), whereas in the group with stenosis of more than 75% of one vessel, a decrease in post-exercise EPCs (–604 cells/ml) was observed (p=0.004). If patients have more than one stent, there is a 2.5-fold increased risk of decreased exercise tolerance to values of 25-50 W (relative risk = 1.8; 95% confidence interval: 1.3-2.4). Conclusions. The data obtained indicate that there is an association between a better recovery of exercise tolerance after ACS and recovery of endothelial function in patients with a favorable course at repeated examination, compared to patients whose level of exercise tolerance did not exceed 50 W (low exercise tolerance), as evidenced by a statistically greater number of EPCs after exercise test in patients with favorable course and high exercise tolerance compared with patients with unfavorable course and low exercise tolerance.

Aim. To evaluate the clinical course and inhospital outcomes of myocardial infarction (MI) in patients receiving continuous direct oral anticoagulant (DOAC) therapy.Material and methods. Data from 390 patients treated for MI were included in the analysis. The mean age was 64.1±12.8 years. The majority were men (61,5%; n=240). All patients underwent standard diagnostic and therapeutic procedures according to clinical guidelines, including coronary angiography and percutaneous coronary intervention when indicated. Clinical, anamnestic and laboratory data (including C-reactive protein level, troponin I, coagulation test) were analysed. The inhospital course of MI, mortality and incidence of complications were evaluated.Results. Patients were divided into two groups according to DOAC therapy received. The main group included 41 patients with constant DOAC intake, while the control group consisted of 349 patients not receiving DOAC. Patients aged 65 years and older accounted for 68,3% (n=28) of the main group (p=0,0033), with a high proportion of cerebral circulation disorders and venous thrombosis (p0,05). Prior DOAC administration had no significant effect on the incidence of gastrointestinal bleeding (odds ratio (OR), 3,96 (95% Confidence Interval (CI) 0,76–20,66)) and mortality (OR 1,47 (95% CI 0,37-5,85)) during hospitalization.Conclusion. Patients with MI who received continuous DOAC therapy had significantly more frequent ST-segment resolution at hospital admission compared with patients who did not receive DOAC. DOAC administration had no significant effect on mortality and incidence of inhospital complications of MI.

Background: Cardiovascular complications of COVID-19 result in challenges for differential diagnosis, patients referral and treatment, which negatively affect the outcomes. Aim: To identify clinical particulars of various types acute coronary syndrome course in patients with COVID-19. Materials and methods: This retrospective cross-sectional study included 202 patients with COVID-19 and acute coronary syndrome (ACS) admitted to a primary vascular medicine center from September to December 2020. Their medical records were used for the analysis of ACS and COVID-19 clinical course, including physical and history data, laboratory and instrumental work-up. For the analysis, the patient sampling was divided into three study groups: 50 patients with unstable angina (UA), 107 patients with acute myocardial infarction with ST segment elevation (STEMI), and 45 patients with acute myocardial infarction without ST segment elevation (non-STEMI). Results: There were no differences in clinical manifestations of ACS in the study groups. As far as clinical manifestations of coronavirus infections are concerned, the patients differed significantly as per prevalence of fever and dry cough. Fever was present in 22 (44%) UA patients, 18 (17%) of STEMI patients and in 10 (22%) of non-STEMI patients (p 0.001 for comparison of 3 groups, Kruskall-Wallis test), whereas dry cough was present in 18 (36%), 19 (18%), and 14 (31%) patients, respectively (p = 0.029). Paired comparison (Mann-Whitney test with Bonferroni adjustment) showed significant differences between US and STEMI groups for both symptoms. The number of involved vessels (median [25%; 75%]) in UA patients was 0 [0; 2], in STEMI and non-STEMI patients 2 [1; 3] (p 0.001). A left coronary artery stenosis was detected in 2 (6%) of the UA patients, 13 (14%) of the STEMI and 4 (13%) of the non-STEMI patients (p = 0.452); left anterior descending artery stenosis, in 12 (36%), 67 (72%) and 23 (72%) patients, respectively (p 0.001). In the pairwise comparison, there were differences between UA and STEMI groups and between UA and non-STEMI groups. A left circumflex artery stenosis was found in 7 (21%) of the UA patients, 45 (48%) of the STEMI and 18 (56%) of the non-STEMI patients (p = 0.008); the pairwise comparisons showed the difference between UA and non-STEMI study groups. A right coronary artery stenosis was identified in 9 (27%), 64 (69%) and 18 (56%) of the study patients, respectively (p 0.001); in the pairwise comparison the difference was found between the UA and STEMI group. There were significant differences in the percentage of the right descendent and right coronary artery stenosis: the right descending artery stenosis was 70% [45; 80] in the UA patients, 90% [70; 100] in the STEMI and 95% [70; 100] in the non-STEMI patients (p = 0.013), whereas the right coronary artery stenosis was 50% [45; 80], 90% [70; 100], 90% [60; 100], respectively (p = 0.018). In the pairwise comparison, the differences were found between the UA and STEMI patients in both arteries. The STEMI patients had higher TIMI thrombus grade scores than those with non-STEMI: 3 [0; 5] vs 0 [0; 4] (p = 0.023). The rates of successful percutaneous coronary intervention and achievement of TIMI flow grade 3 between them was not significantly different (p = 0.170). Conclusion: The ACS patients with ACS and COVID-19 have high thrombotic load according to coronary angiography and TIMI score in the case of STEMI and more frequent absence of hemodynamically significant stenosis in those with UA and non-STEMI. The absence of any difference in clinical manifestations of ACS and viral infection between the study groups (except fever and dry cough difference between the UA and STEMI patients) indicates that specific characteristics of the ACS course in COVID-19 patients can be identified only by coronaroangiography.

Myocardial infarction is a formidable manifestation of coronary artery disease and accounts for one third of deaths associated with coronary disease. In Russia, from 400 to 500 thousand patients with acute coronary syndrome are hospitalized annually, about half of them with myocardial infarction (MI). The dynamics of the number of hospitalized patients in recent years indicates its reduction. Short-term mortality (30-day, including hospital mortality) after acute MI has decreased significantly over the past 50 years: in absolute terms from 30 % in 1950 to 5–8 % at present. However, long-term mortality after MI did not improve. Moreover, in recent years, the rate of decline in 30-day mortality from MI has decreased significantly, almost reaching a “plateau” over the past 15 years. It has been established that in terms of the impact on survival, disability and quality of life of the working population, MI is an important not only medical but also social problem. This review of the literature discusses changes in approaches to reducing mortality in MI, as well as the main events in evidence-based cardiology over the past 50 years, which have made it possible to effectively manage the risk of death in this category of patients.

Background. Acute coronary syndrome is widespread in the adult population and has clear diagnostic criteria. In pediatric practice, this pathology is rare, and often implies difficulties in diagnosis. Case description. A 16-year-old male with negative paternal history, hypercholesterolemia, dyslipidemia, and excessive body weight developed myocardial infarction on the background of acute tonsillitis. In the onset of the disease, the adolescent demonstrated clinical signs of acute respiratory infection and coronary spasm. Electrocardiogram revealed ST segment elevation above the baseline in leads I, II, III, aVF, V4–V6 and biochemical markers of myocardial necrosis. Echocardiography revealed signs of focal hypokinesis of the left ventricle, newly detected degree 2 mitral regurgitation. Percutaneous coronary angiography revealed no signs of coronary artery stenosis. The patient received conventional medical treatment of acute myocardial infarction as well as antibacterial therapy. He was discharged in satisfactory condition. After 1 year of follow-up after the myocardial infarction the patient showed no pathologic changes both on stress-echocardiography and electrocardiogram. Three-year catamnesis appeared to be favorable. Conclusion. The presented clinical case demonstrates the individual mechanism of acute coronary syndrome development in children. Pediatricians should be aware of the risk of developing acute coronary syndrome against the background of infectious pathology.

Aim. To determine the predictors of recurrent cardiovascular events in patients after ST-segment elevation myocardial infarction (STEMI) and hemodynamicallysignificant stenosis only in the infarct-related coronary artery.Material and methods. The present study involved 151 patients with STEMI. The mean age of patients was 51 (95% confidence interval (CI), 41–61 years) years. One of the inclusion criteria of patients was significant stenosis exclusively in the infarct-related artery. All patients underwent a 24-hour Holter electrocardiography (ECG) monitoring with the analysis of heart rate turbulence (HRT), heart rate variability (HRV), ventricular late potentials and chronotropic load; two-dimensional (2D) echocardiography with the analysis of volumetric parameters and left ventricular ejection fraction; determination of brain natriuretic peptide (BNP). The follow-up duration was 144 weeks. Repeated cardiovascular events (acute heart failure, revascularization, repeated myocardial infarction, cardiovascular death) were analyzed as endpoints. Two groups of patients were identified depending on the recurrent event endpoints: “RE” group — 26 patients (17.2%) with registered recurrent cardiac events, and “ST” group — 125 patients (82.8%) without cardiovascular events in stable post-infarction period.Results. Initial BNP values were lower in the “ST” group (p48=0.0035, p96=0.004, p144=0.001). The intergroup differences demonstrate a higher concentration of BNP levels in the “RE” group both initially (p=0,001) and at the 96th week (p=0,04). Left ventricular ejection fraction was higher in the “ST” group (p=0,001) both initially and at the 144th week in contrast to the “RE” group: 48,9% (44,7-53,2) vs 44,2% (38,5-49,9) (p=0,009). Pathological HRT was also significantly higher in the “RE” group both initially (p=0,003) and by the 96th week of the follow-up (p=0,007), while HRV demonstrated low initial values with a slow tendency to restoration. There were following risk factors for recurrent cardiovascular events in patients in the post-infarction period: weight — relative risk (RR), 1.21 (95% CI, 1,01-1,46) (p=0,03); body mass index — RR, 0,56 (95% CI, 0,325-0,96) (p=0,046); chronotropic load — RR, 1,03 (95% CI, 1,02-1,12) (p=0,04); BNP — RR, 1,012 (95% CI, 1,003-1,08) (p=0,01); left ventricular end-systolic dimension (ESD) — RR, 1,04 (95% CI, 1,01-1,13) (p=0,36).Conclusion. There were following independent predictors of recurrent cardiovascular events in patients after STEMI: weight, body mass index, chronotropic load, BNP and ESD.

Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.

Myocardial infarction remains one of the most common causes of chronic heart failure. Modern innovative treatment of patients with high cardiovascular risk is the use of sodium-glucose cotransporter type 2 inhibitors - a class of antidiabetic drugs. This review is devoted to the study of dapagliflozin and empagliflozin effect on the quality of life and prognosis in patients with myocardial infarction and chronic heart failure. Special attention in the review is paid to the analysis of some pleiotropic effects of drugs in clinical studies of patients with various variants of coronary heart disease, as well as in experimental studies on animals. The systematic review was carried out in accordance with the recommendations and reporting provisions for Systematic Reviews and Meta-analyses (PRISMA). The search was conducted in PubMed electronic databases, elibrary.ru without restrictions on the date of publication of publications. The last search was carried out on August 12, 2023.

Cardiac pain during myocardial infarction is the cause of morbidity and mortality in Ukraine in 50,000 patients. The dynamics of morbidity rates from myocardial infarction in the city of Vinnytsia over five years were studied, which increased compared of the data of 2018 to 2022. Instead, there was a trend toward a decrease in the death rate from MI from 2018 to 2022, which indicates the successful operation of medical institutions and the effective treatment of these patients.

Intraventricular septum rupture is a rare mechanic complication of myocardial infarction associated with high mortality. This case describes STEMI in recovered patient after COVID 19 associated pneumonia, which was complicated by ventricular septum rupture followed by cardiogenic shock. It was managed by percutaneous occluder implantation. The procedure was complicated by right ventricular wall rupture. Postmortem examination of myocardium showed the signs of inflammation infiltrate and myocyte necrosis, according to histopathological Dallas criteria diagnosis of COVID-19 associated myocarditis was established. The COVID-19 pandemic has contributed to increasing cardiovascular mortality. This is typically attributed to diminishing resources for timely and appropriate medical care, and patients late presentations for fear of contracting the infection. Cardiovascular complication of COVID-19 may be another contributing factor. Further research is needed to improve our understanding of the mechanisms and long-term sequelae of myocardium damage in COVID-19, to optimize treatment strategy and subsequent follow-up in such patients.

The article presents and discusses Botkin's case sheet focused on his cardiac disease. Analysis of the clinical symptoms and course of the disease provides an opportunity from the standpoint of modern clinical cardiology to characterize the features of Botkin's disease course at all stages of its cardiological continuum and assess the diagnostic capabilities and managing approach to such patients. The comorbidity of ischemic heart disease and gallstone disease in the case of Dr. Sergey P. Botkin, a Russian general practitioner, pathologist, physiologist, and one of the founders of scientific medicine in Russia, is being discussed.

BACKGROUND: Cardiovascular complications during pregnancy and postpartum period are rare but often fatal. The causes and mechanisms of the development of such complications are not fully understood. Spontaneous dissection of the coronary artery against the background of the influence of sex hormones is one of the mechanisms for the development of acute coronary syndrome in the postpartum period. The false lumen of the intramural hematoma overlaps the true lumen, causing arterial obstruction, leading to acute myocardial hypoxia. Thus, awareness that the pathophysiology of spontaneous coronary artery dissection differs from that of acute coronary syndrome associated with atherosclerotic plaque rupture is important, and these patients require different treatment approaches. Currently, an unambiguous and precise strategy for this pathology has not been established, which is why difficulties remain in the management of these patients and choosing treatment strategies. CLINICAL CASE DESCRIPTION: The article describes a complex clinical case of the development of acute myocardial infarction in the postpartum period in a young woman without risk factors against the background of spontaneous dissection of the coronary artery, complicated by cardiogenic shock, which required emergency percutaneous coronary intervention and stenting of the infarct-dependent artery. The postoperative period proceeded with complications, and extracorporeal membrane oxygenation was required. However, an integrated approach and correctly chosen treatment strategies help stabilize the patients condition. CONCLUSION: Currently, no unambiguous and precise strategy of treatment has been established, so difficulties remain in the management of patients and decision making. In our opinion, an individual patient approach should be followed, taking into account the general state of the organism, type and volume of dissection, consequences and complications, and experience and technical capabilities of the clinic.

Objective: to estimate the incidence of recurrent myocardial infarction, stroke, and mortality in patients with different phenotypes of myocardial infarction against the background of chronic obstructive pulmonary disease. Materials and methods: 325 patients with myocardial infarction were examined: 195 patients with infarction against the background of chronic obstructive pulmonary disease and 130 patients without chronic obstructive pulmonary disease. We studied markers of endogenous intoxication: molecules of average mass, hematological indexes of intoxication, blood gas composition, apoptosis, protein peroxidation, lipid and antioxidant protection, inflammation and renal function. Statistical processing of the data was performed using SPSS 26.0 software package. Results: A two-stage cluster analysis formed four clusters, which were labeled as «polymarker-retentive», «necrotic-inflammatory», «hypoxic-inflammatory», and a cluster with no endogenous intoxication syndrome. Among patients with myocardial infarction against the background of chronic obstructive pulmonary disease, the hypoxic-inflammatory phenotype prevailed — in 53.3 % of patients. Necrotic-inflammatory phenotype was noted in 8.2 % of patients, hypoxic-inflammatory — in 36.9% of patients, phenotype with the absence of endogenous intoxication syndrome — in 1.5 % of patients. Recurrent myocardial infarction, stroke and mortality constituted the combined endpoint. The highest incidence of the combined endpoint was observed in the polymarker-retentive infarct phenotype — in 37 (55.2 %) patients. Conclusion: Vascular life-threatening and fatal events (recurrent myocardial infarction, stroke, death from cardiac causes) during 12-month follow-up are most typical for the polymarker-retentive phenotype. The clinical features of this phenotype were the frequent presence of Q-shaped MI, transmural myocardial damage, and the presence of complications in the acute period. COPD in these patients was characterized by a long course, high smoker's index, mostly 3rd degree bronchoobstruction, and frequent exacerbations. The results of this study allow for a personalized approach to the assessment of the annual prognosis in patients with acute myocardial infarction against COPD.

Aim. Study of the association of polymorphic variants of CYP2C19 (G681A), P2RY12 (H1/H2), ITGB3 (T1565C), ITGA2 (C807T), eNOS3 (T786C) genes with high residual platelet reactivity (HRPR) to clopidogrel and acetylsalicylic acid (ASA) at different terms of myocardial infarction (MI).Material and methods. The study included 400 patients with MI aged 31-74 years, 317 (79,3%) men and 83 (20,7%) women. Platelet aggregation performed on days 1-2, 12-14 and 28-30 of MI, and genotyping by the polymerase chain reaction were analyzed using the STATISTICA 10.0 program.Results. Differences were found in ADP-test 1-3 depending on the CYP2C19 (G681A) polymorphism, ADP-test 1 depending on the P2RY12 (H1/H2) polymorphism, ADP-test 2 depending on the ITGB3 (T1565C) polymorphism, ASPI-test 1 depending on the eNOS (T786C) polymorphism. The risk of HRPR to clopidogrel is higher in 681A CYP2C19 allele carriers compared to the G681 carriers throughout the entire observation period: initially odds ratio (OR) of 1,8 (1,14-2,88), p=0,012, on days 12-14 of MI, OR of 1,7 (1,08-2,68), p=0,023 and on days 28-30 of MI, OR of 2,3 (1,42-3,81), p=0,0008. The risk of HRPR to clopidogrel is higher in AA CYP2C19 genotype carriers compared to GG genotype carriers, on days 1-2 of MI (OR 6,5 (1,16-36,4), p=0,033), on days 28-30 of MI (OR 7,8 (1,26-48,0), p=0,027). The risk of HRPR to clopidogrel on days 1-2 of MI is higher in H2 P2RY12 locus carriers compared to H1 locus carriers (OR 1,5 (1,02-2,22), p=0,039). The risk of HRPR to ASA on days 1-2 of MI is higher in the 786C eNOS3 allele carriers compared to T786 allele carriers (OR 1,4 (1,02-1,96), p=0,036). Carriers of haplotypes of minor alleles of CYP2C19 + ITGA2 + P2RY12 + eNOS genes (OR 3,9 (1,13-13,65), p=0,032) and CYP2C19 + ITGA2 + eNOS genes (OR 5,1 (1,7214,96), p=0,0032) have higher risk of HRPR to dual antiplatelet therapy (DAPT) on days 28-30 of MI compared to the rest of patients.Conclusion. The association of HRPR to clopidogrel with the CYP2C19 (G681A) polymorphism was found during the entire observation period, with the P2RY12 (H1/H2) polymorphism on days 1-2 of MI, with the ITGB3 (T1565C) polymorphism on days 10-12 of MI. The association of HRPR to ASA with eNOS (T786C) polymorphism was found on days 1-2 of MI. Minor allele haplotypes of the CYP2C19 + ITGA2 + P2RY12 + eNOS genes and CYP2C19 + ITGA2 + eNOS genes were associated with a higher risk of developing HRPR to DAPT on days 28-30 of MI.

The article analyzes the case of the development of ventricular tachycardia and type 2 myocardial infarction (MI) in an 80-year-old patient with a history of coronary artery disease, MI and chronic heart failure. In 2020, the patient was diagnosed with ventricular extrasystole and started antiarrhythmic therapy with diethylamino propionylethoxycarbonylaminophenothiazine 150 mg per day and sotalol 160 mg per day. In 2022, the patient had an episode of clinical death due to ventricular tachycardia with successful resuscitation. A diagnosis of non-ST-elevation acute coronary syndrome was made, coronary angiography was performed, which did not reveal significant coronary stenosis. Upon further examination, the dynamics of biomarkers of myocardial necrosis confirmed the diagnosis of acute MI. In the analyzed case, the development of ventricular tachycardia and MI is most likely associated with the intake of diethylaminopropionylethoxycarbonylaminophenothiazine in combination with sotalol, prescribed in the presence of contraindications to their use.

BACKGROUND: Diabetes mellitus, one of the most common chronic diseases in the world, has a significant aggravating effect on the course of myocardial infarction. Thioctic acid affects the cardiovascular risks of diabetes mellitus and has a protective effect on ischemic myocardium. Human studies to support this effect have not been widely conducted.AIM: To confirm the possibility of using thioctic acid in patients with diabetes mellitus or newly diagnosed diabetes mellitus in combination with diabetic polyneuropathy who have had anterior septal Q wave myocardial infarction to prevent hypertrophy and myocardial remodeling.MATERIALS AND METHODS: The study involved patients with myocardial infarction and type 2 diabetes mellitus, newly diagnosed diabetes mellitus and diabetic polyneuropathy. From the obtained groups, by randomization, subgroups were allocated to which thioctic acid was prescribed at a dosage of 600 mg / day orally for 3 months. To determine the comparability of the groups, a standard set of stationary studies was carried out. At the initial stage and 12 months after the start of the study, the echocardiographic parameters of myocardial hypertrophy and remodeling were monitored.RESULTS: The study involved 125 people, 5 people were excluded due to the development of unwanted adverse reactions. The formed groups were comparable in terms of initial parameters. In the main subgroups, statistically significant dynamics of LV wall hypertrophy and myocardial remodeling were not revealed. In the control subgroup of patients with diabetes mellitus, an increase in the thickness of the IVS was noted by 0.67 mm [95% CI: 0.4–0.94, p = 0.021], LVTZ by 0.8 mm [95% CI: 0.43–1 , 27, p = 0.043], LVMI at 9.2 g / m2 [95% CI: 6.15–12.24, p = 0.05], LVMI at 17.8 g. [95% CI: 11.3–24.3, p = 0.011], an increase in the prevalence of concentric myocardial remodeling by 16.7% (p = 0.026). In the control subgroup of patients with newly diagnosed diabetes mellitus, an increase in the thickness of the IVS was noted by 0.83 mm 95% [CI: 0.43–1.23, p = 0.047], LVMI by 7.9 g / m2 [95% CI: 4 , 47–11.43, p = 0.033], LVM at 16.7 gr. [95% CI: 9.75–23.65, p = 0.023], an increase in the prevalence of concentric myocardial remodeling by 16.7% (p = 0.026). In the main subgroup of patients with diabetes mellitus, a decrease in LVMM by 3.33 g was noted. [95% CI: 1.94–4.72, p = 0.024], LVMI at 4.19 g / m2 [95% CI: 2.18–6.2, p = 0.047].CONCLUSION: The use of thioctic acid on the 3rd day from antero-septal Q wave myocardial infarction in patients with type 2 diabetes, newly diagnosed diabetes mellitus, in combination with diabetic polyneuropathy, at a dosage of 600 mg / day orally, prevents hypertrophy and myocardial remodeling, and also contributes to the positive dynamics of the structure of the ejection fraction.

Cardiac complications of non-cardiac surgeries are an actual and unresolved interdisciplinary problem of clinical medicine today. The incidence of cardiovascular events after non-cardiac surgery is higher than in the general population and does not tend to decrease. The risk of cardiac complications in cancer surgery is the highest. Evidence-based approaches to risk assessment and prevention of cardiovascular events in surgical patients with malignant neoplasms have not been developed. In current clinical guidelines on the prevention, prognosis and treatment of cardiac complications of non-cardiac surgeries, the aspects of this problem in surgical oncology are not considered separately.The aim of this review was to analyze the current sources of literature on the prediction of cardiovascular complications in surgical treatment of cancer patients. The distinctive features of cancer surgery and additional factors causing an increased risk of adverse cardiac outcomes in patients with malignant neoplasms are described. The article presents the results of large cohort studies on the search for reliable predictors of cardiac complications in non-cardiac surgery and on the development of stratification scales and algorithms for preoperative risk assessment. Particular attention is paid to the possibilities and prospects of using these predictive tools in the surgical treatment of cancer. The surgical risks of interventions for malignant neoplasms are described, as well as methods for calculating cardiac risk and functional status assessment that have been validated in oncological patients cohorts. The data of recent studies on the role of serum biomarkers of myocardial damage and increased cardiovascular risk (cardiac troponins and brain natriuretic peptide) in predicting postoperative cardiac events in non-cardiac surgery are presented. Further prospects for the inclusion of biomarkers in risk stratification systems in patients with malignant neoplasms are discussed.

The need for adaptation of existing cardiac rehabilitation programs for elderly myocardial infarction patients is dictated both by theprogressive aging of the Russian population and by the higher prevalence of cardiovascular diseases among them, including coronaryheart disease in the form of a previous myocardial infarction. The necessary condition for successful realization of the set task is to takeinto account the identified features of myocardial infarction patients of older age group, who are admitted for cardiac rehabilitation.Aim. To give a comparative characteristic of patients with myocardial infarction of older and middle age groups admitting to the thirdstage of cardiac rehabilitation in the Ivanovo State Medical Academy clinic (ISMA).Material and methods. 85 patients with myocardial infarction were examined, they were admitted from primary vascular centers fora three-week course of cardiac rehabilitation at the ISMA clinic. According to the WHO age periodization, 2 groups were identified: 40middle-aged patients (Group 1); 45 elderly patients (Group 2). An individual cardiac rehabilitation program was developed for eachpatient, which included daily controlled physical training, dosed walking, staircase walking at individually calculated pace, correctionof the revealed cardiovascular risk factors, information support, adequate drug therapy, correction of psychological disorders if needed.Clinical features of the disease course, tolerance to physical activity were analyzed in both groups.Results. The characteristic features of MI patients of the older age group in comparison with the middle-aged patients admitted to thethird stage of cardiac rehabilitation in the ISMA clinic are: dominance of non-working pensioners; high polymorbidity; higher frequencyof development of repeated MI without ST-segment elevation on ECG; predominance of complicated formation of left ventricularaneurysms and heart rhythm disturbances forms of MI; low frequency coronary revascularization in the acute period of the courseof the disease; prevalence of persons with signs of diastolic heart failure with preserved or slightly reduced left ventricular ejectionfraction; lower exercise tolerance. After completion of cardiac rehabilitation course in patients of older age group the increase in 6MWTdistance covered was 18%, while in middle-aged group it was only 8.3%. The implementation of the three–week rehabilitation programled to an increase in the number of patients with 1 FC of coronary heart disease due to a decrease in the number of patients with 3 and4 FC of coronary heart disease in the middle-aged group and 4 FC of coronary heart disease in the elderly.Conclusion. The identified features specify the necessity to include methods of concomitant pathology correction, individual approachto the choice of physical activity programs based on a thorough clinical assessment, including risk stratification of post-rehabilitationcomplications and rehospitalizations in the cardiac rehabilitation program. A three-week program of the third stage of cardiacrehabilitation of MI patients increases exercise tolerance to a greater extent in elderly patients compared with middle-aged patients.

The concentration of catecholamines, having positive inotropic and chronotropic effects on heart function, increases under the actionof strong stimuli. This mechanism of influence is very important in terms of the development of both coronary and non-coronarymyocardial damage. However, further studies have revealed an important role of catecholamines in the regulation of hemostasisprocesses, which is very relevant in patients with coronary heart disease, as it increases the risk of myocardial infarction.Aim. Based on the literature data, to study the role of catecholamines in the regulation of the hemostasis system as a risk factor forcomplications in coronary heart disease.Material and methods. We analyzed literature sources in the computer databases «Cyberlennica», «PubMed», «eLibrary» usingthe search words: «сatecholamines – hemostasis», «сatecholamines – platelets», «сatecholamines – leukocytes», «coronary heartdisease – сatecholamines», «coronary heart disease – hemostasis», «coronary heart disease – platelets». The analyzed literaturedescribes the results of original studies that characterize the multifactorial influence of catecholamines on the hemostasis system inthe coronary heart disease: the effects of these hormones as an important activator of the platelet hemostasis, the role of plateletsin activating the coagulation component of hemostasis and its specific features, the importance of leukocytes, erythrocytes,endothelium, changes in the lipid profile in disorders of the blood coagulation process. Therefore, regular monitoring of itscondition, timely pharmacological correction is necessary to ensure effective relapse prevention and reduce the risk of complicationsand fatal outcome.Conclusion. Regular monitoring of the hemostasis system and timely pharmacological correction are necessary to ensure effectiverelapse prevention and reduce the risk of complications and fatal outcome in patients with coronary heart disease.

Background: The extent of myocardial damage largely determines both in-hospital and long-term mortality in patients with acute coronary syndrome. According to the literature, the in-hospital and long-term mortality rates in patients with unstable angina (UA) are lower than those in the patients with myocardial infarction (MI). Aim: To evaluate the in-hospital and long-term mortality rates and their predictors in patients undergoing in-patient treatment for acute coronary syndrome (MI and UA) in the regional cardiovascular center with the service territory of 1 million persons. Materials and methods: This retrospective registry study enrolled 1130 patients (715 [63.3%] men, 415 [36.7%] women) who were treated for UA and MI in the regional cardiovascular center in 2019. Based on the discharge diagnosis, the patients were divided into two groups: patients with MI (n = 766) and those with an UA episode (n = 364). The in-hospital and delayed mortality rates, as well as their predictors, were analyzed in both groups. The mean duration of the follow-up was 17.8 3.6 months. Results: The in-hospital mortality in patients with confirmed MI was 11.1% (85 patients) versus 0.27% (1 patient) in the UA patients (p 0.001). The independent predictors of in-hospital mortality in MI patients were a decreased left ventricular ejection fraction (LV EF) (odds ratio (OR) 0.9021, 95% confidence interval (CI) 0.82090.9914, p = 0.0324), chronic kidney disease C3a and above (OR 9.3205, 95% CI 2.670632.5283, p = 0.0005), and the extension of coronary involvement at coronary angiography (OR 1.3526, 95% CI 1.06670.0127, p = 0.0127). The long-term mortality in MI patients was 10.4% (72 patients) with no significant difference from that in UA patients (9.9%, 36 patients, p = 0.76). The independent predictors of long-term mortality after MI were older age (OR 1.12, 95% CI 1.011.22, p = 0.0052), chronic kidney disease C3a and above (OR 2.3375, 95% CI 1.13924.7963, p = 0.0206), decreased EF (OR 0.8895, 95% CI 0.730.99, p = 0.0364), atrial fibrillation on admission (OR 3.1462, 95% CI 1.35107.3268, p = 0.0079), and diabetes mellitus (OR 2.3163, 95% CI 1.25524.2744, p = 0.0072). In the UA patients, the predictors of the long-term mortality were a decrease in LV EF (OR 0.9139, 95% CI 0.86830.9619, p = 0.0006) and in blood hemoglobin level (OR 0.9729, 95% CI 0.95440.9917, p = 0.0050). Conclusion: The in-hospital mortality in UA patients is lower than that in MI patients, with comparable long-term mortality. This indicates the need of active follow-up of the patients with past UA, irrespective of the endovascular assessment and intervention.

In recent years, researchers’ attention has been directed to the WNT signaling pathway study, which regulates embryogenesis processes and is involved in pathological condition development. The role of morphogenic proteins of WNT signaling pathway in the cardiovascular pathology genesis is practically not clear. The research aim was a comprehensive study of the main proteins of WNT signaling pathway (β-catenin, sclerostin, GSK-3α, GSK-3β, WIF-1 and DVL-1) in the blood serum of 353 patients with coronary artery disease acute forms who were treated at the Orel regional vascular center from 2019 to 2021, and 50 healthy individuals. A comprehensive analysis included an assessment of clinical, laboratory and instrumental parameters in the framework of current clinical guidelines, as well as an immunological examination to determine the morphogenic proteins of WNT signaling by enzyme immunoassay. The results showed a wide variability in the values of morphogenic proteins of WNT signaling pathway in the patient’s blood serum. The levels of β-catenin, WIF-1 and DVL-1 significantly exceeded those obtained in healthy individuals, while the concentrations of sclerostin and GSK-3β did not differ significantly from them. The level of GSK-3α of patients was twice lower than in healthy individuals. The highest sclerostin concentrations were found in patients with existing calcification of the aortic valve leaflets and aortic walls. Acute coronary syndrome unfavorable course was observed in patients with both extremely high and extremely low WIF-1 levels. Significant correlations were established between the level of morphogenic proteins of WNT signaling pathway and lipid metabolism, as well as myocardial remodeling. The obtained data on changes in the protein production of WNT signaling pathway allow us to expand our understanding of the molecular aspects of the immunopathogenesis of myocardial remodeling in coronary artery disease, increase the predictive potential for cardiovascular disease diagnosis and determine the vector for further development of cardioimmunology determination.

Delaminating intramyocardial hematoma (DIMH) is a rare and potentially life-threatening complication of acute myocardial infarction. Currently, only isolated reports of cases of myocardial dissection have been published, and until recently, the diagnosis of DIMH was carried out during autopsy or surgery. The article describes echocardiographic criteria and discusses some aspects of the therapy of this pathology. The description of clinical cases of noninvasive diagnosis of DIMH in men aged 60 and 62 years hospitalized with the clinic of decompensation of chronic heart failure is given. This complication in the presented patients was diagnosed using transthoracic echocardiography, thanks to which it was possible to identify the dissection of the myocardium, as well as to trace the dynamics of the organization of an intramyocardial hematoma into a parietal thrombus. Various approaches to patient management are demonstrated: conservative tactics allowed to successfully stabilize the course of chronic heart failure in the first patient, while the condition of the other required the transplantation of a donor heart a few months after discharge from the hospital.

In recent years, the attention of scientists has been actively focused on studying the role of endocan as a biological marker of endothelial dysfunction in cardiovascular diseases. Until recent years, endocan has been studied in acute kidney injury, chronic kidney disease, and renal replacement therapy. Endocan, formerly known as endothelial cell-specific molecule-1, is a soluble dermatan sulfate proteoglycan expressed and secreted into the circulation from endothelial cells. Currently available studies demonstrate the diagnostic and prognostic value of endocan evaluation in cardiovascular pathology. It is expected that further scientific and clinical studies will demonstrate the possibilities of using endocan as an additional laboratory tool for diagnosing and assessing the prognosis in patients with a cardiac profile. Drug regulation of endocan concentration and expression may be a promising target for the treatment of cardiac and vascular pathology.

Aim. To evaluate the markers of changing dynamics recorded by digital processing of routine ECG using own diagnostic complex software “Smart-ECG” in patients with ST-segment elevation myocardial infarction (STEMI) based on the results of a 40-day follow-up. Materials and methods. The main group consisted of 20 patients with STEMI according to the ESC guidelines (2017) (mean age of males 56.11 ± 11.62, n = 10; mean age of females 58.22 ± 13.11, n = 10). ECG were analyzed using own developed diagnostic complex software “Smart-ECG” on the 1st, 10th, 40th day after STEMI. The first derivative of T wave – ratio of maximum velocity (MVR), inclination angle (β) and inclination height (H) of ST segment was calculated. The control group – 20 apparently healthy people. Results. MVR indicators decreased by 61.90 %, 68.20 % and 51.48 % on the 1st, 10th and 40th day, respectively, after STEMI as compared to those of the control group (p < 0.01). At the moment of the maximum ST segment elevation, the height (H) of ST inclination was 347.7 % increased (p < 0.01); on the 40th day, H was 25 % increased, close to control indicators, with ST segment shift to isoline (р > 0.05). During the acutest period, the angle β increased by 172.2 % (p < 0.01) and then decreased by 15.8 % at the recovery phase, but insignificantly. Conclusions. Self-developed medical software “Smart-ECG” for qualitative evaluation of ECG is an effective tool to diagnose pathological changes in the myocardium, makes it possible to improve the specificity, sensitivity and prognostic significance of ECG in STEMI. The significant decrease in MVR has been detected at all stages of STEMI, which was associated with a violation of electrogenesis in the repolarization phase; the critical increase in ST slope indicators (angle β and height H) on the 1st day has been found as a characteristic of ST elevation, as well as its decrease on the 40th day as a sign of reduced potential difference between healthy and damaged areas of the myocardium during the recovery stage.

Information on the essential aspects of prevalence, etiology and pathogenesis of coronary heart disease, which is the leading cause of death in the world, is given in this article. It is emphasized that the incidence of ischemic coronary events is the result of a complex sequence of pathogenetic links, which involves the formation of atherosclerotic lesions and destabilization as the primary provoking factor. Purpose - the attraction of the medical community attention to the problem of ischemic heart disease in children. A clinical case of recurrent myocardial infarction in a child who was examined and treated at the MNPE «Ivano-Frankivsk Regional Children’s Clinical Hospital of the Ivano-Frankivsk Regional Council», is described here. The key points of the patient’s complaints, anamnesis of life and this disease are described, the data of the objective condition at the hospitalization and during dynamic observation of the child, which showed the signs of left ventricular overload, coronary blood flow disorder, dilatation of the left heart ventricles, decreased left ventricular contractility. The data of the main indices of laboratory and instrumental methods of research, including X-ray diagnostic methods, performed not only on the basis of the department, but also in the Scientific-Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine (Kyiv). The treatment of this clinical case in the child is described in this article. The data of dynamic observation are given. The discussion and conclusions emphasize the problem of coronary insufficiency in pediatrics, which requires clinical understanding, the choice of the correct diagnostic algorithm and qualified medical care. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child’s parents was obtained for the research conduction. No conflict of interests was declared by the authors.

Aim. To summarize and broaden the idea about mechanisms of acute coronary insufficiency development and pathophysiological features of myocardial reperfusion injury. Today, in the event of acute coronary syndrome, according to the latest recommendations for myocardial revascularization, percutaneous coronary intervention should be performed to determine the anatomy of coronary artery lesions and further percutaneous therapy. But in some patients, after blood flow restoration, reperfusion injury occurs, which is primarily related to the duration of ischemia, infarct size, and the myocardial resistance to ischemia. Treatment of myocardial infarction, like any treatment method, has evolved. In the 60s of the previous century, it included morphine, oxygen, warfarin and bed rest for 4–6 weeks. Then, during the 70s, it consisted of morphine, oxygen, lidocaine, warfarin, bed rest for 2–3 weeks and possibly coronary angiography for the further bypass surgery. The late 1970s saw the rapid progress in thrombolysis, first intravenous and then intracoronary. And starting in the early 1980s, since G. Hartzler performed the first balloon angioplasty for acute coronary artery occlusion, the stage of mechanical myocardial reperfusion has come. At the same time, knowledge about the pathophysiology of acute coronary ischemia was deepened. The World Health Organization developed ECG criteria for acute myocardial infarction using population-based studies in the 1950s–1970s, and additional four normative European regulations since then were issued defining concepts, key points of diagnosis and possible complications of myocardial infarction. Conclusions. The development of myocardial ischemic-reperfusion injury is a staged process that has a complex pathogenesis, its own clinical manifestations, and an association with more negative long-term outcomes of myocardial infarction treatment. Its main components are myocardial swelling involving cardiomyocytes, endotheliocytes, and the interstitial space; downregulation of cytoskeleton and disruption of sarcolemma integrity; increased vascular wall permeability; spasm of arterioles; intravascular accumulation of platelets and leukocytes, and the resultant the most severe form of myocardial damage is intramyocardial hemorrhage. Clinically, this is manifested by the no-reflow phenomenon following percutaneous coronary intervention.

Objectives. To assess the influence of classical and new risk factors, as well as comorbid pathology on the development of MACE (major adverse cardiac events) in urban unorganized population. Material and methods. In 2007/2008 – 2020/2021 the 5-year and 13-year prospective randomized studies of 3,500 people of the urban unorganized population of Vitebsk were conducted. Four screenings were carried out: in 2007/2008, 2010/2011, 2012/2013 and 2020/2021. During the survey, the socio-demographic data were recorded, all subjects were examined with the WHO questionnaires, the anthropometry data were taken into account, instrumental and laboratory examination methods were used. Results. According to the 5-year prospective study the development of MACE was connected with the age (p

The work of the national network of vascular centers of the Russian Federation (RF), based on the Clinical recommendations of the Russian Society of Cardiology and the procedure for providing medical care to patients with cardiovascular diseases, has led to significant positive results in the treatment of patients with acute coronary syndrome (ACS) in the country, although a number of targets have not yet been reached. The purpose of the publication is to demonstrate the trend in therapeutic approaches to the management of patients with ACS in 2020-2022. in Russia and analysis of their effectiveness. Quantitative and qualitative indicators of the treatment of patients with ACS for the presented analysis were obtained on the basis of monitoring data from the Russian Ministry of Health for 2018-2021. presented: Monitoring of measures to reduce mortality from coronary heart disease, letters of the Ministry of Health of Russia dated March 13, 2015 No. 17-6 / 10 / 1-177 and dated July 24, 2015 No. 17-9 / 10 / 2-4128, within which data collection carried out monthly, on the portal of the Federal State Budgetary Institution "TsNIIOIZ" of the Ministry of Health of Russia - Automated system for monitoring medical statistics and the register REGION-IM (Russian Register of Acute Myocardial Infarction) - a multicenter prospective observational cohort study for 2020-2022, organized by the Federal State Budgetary Institution "National Medical Research Center of Cardiology named after Academician E.I. Chazov" of the Ministry of Health of Russia. In Russia with a diagnosis of ACS in 2020 and 2021 403,931 and 397,930 patients were hospitalized, respectively. The decrease in the number of patients diagnosed with ACS admitted to Russian hospitals by 22.32% was mainly due to a significant decrease in hospital admissions of patients diagnosed with non-ST elevation ACS (non-STE-ACS) (by 29.03%). At the same time, the admission of patients with ST elevation myocardial infarction (STEMI) decreased only by 6.02%. Compared to 2018-2019, in 2020-2022. increased mortality in primary percutaneous coronary intervention (PCI) (by 9.6%) and in the general STEMI group (by 12.3%); significantly increased mortality both in the general group of NSTE-ACS (by 48%) and during PCI for patients with non-STE-ACS (by 28.6%); there was an increase in the average annual number of primary PCI (by 12.6%); an absolute and relative increase in the number of PCI in non-STE-ACS was revealed (by 2.7 and 37.1%, respectively). In the country's hospitals, by the time of discharge, 95% of patients receive statins, beta-blockers – 87%, ACE inhibitors – 80%, acetylsalicylic acid – 82%, P2Y12 inhibitors – 98% of patients, regardless of the type of ACS. In Russia in 2020-2022 unfavorable tendencies in the provision of care to patients with ACS include: increased mortality in primary PCI and in the general STEMI group; increased mortality both in the general group of non-STE-ACS and during PCI for patients with non-STE-ACS. The positive results of the work of the national network of vascular centers include: absolute, relative and estimated increase in the number of primary PCI; absolute and relative increase in the number of PCI in non-STE-ACS; a high level of prescribing drugs with a proven positive effect on the prognosis.

Left ventricular thrombus (LVT) is a serious risk factor for systemic embolism development. Despite the evident danger of this condition, current guidelines describe management of patients with this potentially fatal complication very briefly. LVT can complicate myocardial infarction where its incidence is around 10%, as well as various forms of cardiomyopathies and novel coronavirus infection. According to clinical guidelines vitamin K antagonists (VKAs) should be used as treatment of choice for thrombus resolution. However, experts point out that this therapy lacks necessary evidential base and bears certain difficulties because of pharmacokinetic and pharmacodynamical properties of VKAs. These drawbacks are absent in direct oral anticoagulants (DOACs), the possibility of using which in LVT is being actively studied. As for now, published results of 3 randomised clinical trials have demonstrated similar safety and efficacy profiles of DOACs and VKAs. Similarly, the majority of retrospective cohort studies did not observe significant differences between two groups, where some of them have shown superiority of DOACs especially in terms of earlier thrombus resolution. Nevertheless, some studies have found DOACs ineffective and even potentially unsafe regarding systemic embolism. Existing data does not allow to form an unambiguous conclusion about the equivalence of DOACs and VKAs for LVT resolution. Large randomised clinical trials are needed to determine efficacy and safety of such treatment in these patients.

Hyperuricemia is most often combined with lipid metabolism disorders, modifiable risk factors for coronary heart disease, stroke, abdominal obesity, type 2 diabetes mellitus, arterial hypertension, urolithiasis, chronic kidney disease. Current data indicate the presence of pro-inflammatory, pro-oxidant and vasoconstrictive effects of uric acid, which may contribute to the development of cardiometabolic disorders. Normal serum uric acid levels are 360 mmol / l) and high cardiovascular risk. The data available today allow us to consider the target serum uric acid level

A heart attack is often a very drastic, sometimes even traumatic, life event for patients, which is frequently associated with fear of death. Not only is the body under enormous stress, a heart attack also means stress for the psyche. “Stressful life events are part of human existence and are compensated for with individual coping strategies or defense mechanisms. However, if the strain is overwhelming or the possible solutions are subjectively exhausted, pathological reactions may occur.”(1) From a psychosomatic perspective, an acute myocardial infarction is a “significant biographical breaking point with far-reaching psychological consequences.”(2) This pilot study investigates whether a psychocardiological intervention integrated into standard therapeutic care in the form of a structured conversation with a biopsychosocial model (in the sense of the WHO understanding of health), adapted to the patient’s level of need, can have a positive effect on quality of life and on psychological comorbidity in the short- and long-term course of recovery. 45 patients with acute myocardial infarction (13 female, 32 male), who were randomly assigned to two intervention groups, were followed for six months after the cardiac event with individualized and collaborative psychocardiological interventions and tested for mental illness. The results of the study show that such individualized care with additional screening for psychological comorbidities in the early phase after a myocardial infarction can significantly help patients to help themselves, provide early indications of the presence of a psychological disorder, and accelerate the initiation of adequate treatment. The integration of a psychocardiological component into the standard therapy of myocardial infarction patients in the early phase after the cardiac event seems to be a valuable contribution to the therapy and should receive encouragement in the future. Furthermore, this pilot study offers new and interesting approaches for future research.