Search

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

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 characterize patients with acute non-ST elevation myocardial infarction (NSTEMI) hospitalized in Russian hospitals, study their anamnestic, demographic and clinical characteristics, treatment features and hospital outcomes, as well as compare data from previous Russian and foreign registries of acute coronary syndrome.Material and methods. Russian Registry of Acute Myocardial Infarction (REGION-IM) is a multicenter prospective observational study. The case report form contains demographic and anamnestic data, as well as the following information about the present MI: timing of symptom onset, first contact with medical personnel and admission to the hospital; data from coronary angiography (CAG) and percutaneous coronary intervention (PCI), therapy, hospitalization outcomes.Results. In total, for the period from November 1, 2020 to June 30, 2023, the study included 3253 patients with STEMI from 73 hospitals (30 vascular surgery departments, 17 of which are equipped with angiographic system, and 43 regional vascular surgery centers) from 45 constituent entities of the Russian Federation. There were 55% of high-risk patients. CAG was performed in 83,73% of patients. In 81%, CAG was performed ≤24 hours from hospitalization. PCI was performed in 62% of patients with NSTEMI. Median onset-to-balloon time was 27 hours [10;77]. The median door-to-balloon time was 5 hours [1;20]. Inhospital mortality was 3%. In the group with CAG, compared with the group without CAG, inhospital mortality was lower (2% and 6%, respectively; p

Aim. To study the features of the use of thrombolytic therapy (TLT) in normotensive patients with pulmonary embolism (PE) in real clinical practice in Russian hospitals.Material and Methods. From 04/1 5/2018 to 04/15/2019 patients hospitalized with a diagnosis of PE consistently were included in the Russian multicenter observational prospective register "SIRENA” (RusSIan REgistry of pulmoNAry embolism).Results. For 12 months in the registry was included 609 patients with a lifetime confirmed diagnosis of PE. TLT was performed in 152 patients with PE (25.0%), of which only 51 (33.8%) were indicated as "high risk" (shock or hypotension). In 101 not high risk patients, the indications for TLT were: severe shortness of breath/respiratory failure - 19 (18.8%), massive venous thrombosis - 7 (6.9%), signs of massive/submassive PE - 10 (9.9%), intermediate-high risk - 14 (13.9%), suspicion of acute coronary syndrome with ST segment elevation - 3 (2.9%), high pulmonary hypertension -2 (2.0%). The other 46 (45.5%) non-high-risk patients had no clear indication of the reasons for TLT in their medical history. To study the features of management of patients with not high-risk PE who received TLT (group 1), a selection of pairs of patients from the "SIRENA” registry, comparable in gender and age, in a ratio of 1:1 of patients with not high-risk PE who did not perform TLT (group 2). Hospital mortality was 4 (4%) patients in the TLT group and 6 (5.9%) patients in group 2 (р=0,748). Logistic regression analysis showed that floating blood clot in the veins of the lower extremities, syncopes in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis, and probability of completion TLT decreased in the presence of a history of bleeding, chronic kidney disease, surgery in the previous 12 months, increase in the size of the right atrium on EchoCG (statistical significance of the model x2=51.574; p

Review of the latest scientific data and the main provisions of clinical guidelines on the use of anticoagulants and antiaggregants in patients with COVID-19 is presented. A separate part of the paper focuses on the use of prasugrel in this group of patients. The main trend in the use of anticoagulants for the prevention of venous thromboembolism in COVID-19 infection can be considered as a decrease in drug activity. Thus, the experts of the American Hematological Society suggest using low doses of oral or parenteral anticoagulants for thromboprophylaxis in hospitalized patients, preferring them to intermediate or high doses. Virtually all experts agree that prophylactic anticoagulant use should be avoided in clinical practice in patients with COVID-19 who are on outpatient treatment (whether it was chosen as an initial tactic or was a continuation of inpatient treatment). The principles for the therapeutic use of anticoagulants in COVID-19 should be based on already existing clinical guidelines for the conditions that require anticoagulants (atrial fibrillation, venous thrombosis or thromboembolism, presence of mechanical valves, etc.). The use of antiaggregants in patients with COVID-19 outside their registered indications is currently continuing to be studied in several clinical trials. That said, as part of dual antiplatelet therapy after percutaneous coronary intervention for COVID-19, it is advisable to continue this treatment without cancelling any of its components without a specific indication. The same is true for prasugrel, which remains one of the first recommended potent P2Y12 inhibitors.

Aim. To present the clinical characteristics and in-hospital prognosis in patients with pulmonary embolism (PE) and atrial fibrillation (AF).Material and methods. On the initiative of a working group of physicians, the basic principles of an observational prospective study (SIRENA registry) have been developed.Results. Among the 660 patients included in the registry, AF was diagnosed in almost every fourth patient — in 22,9% of cases (n=151), which reflects its high incidence in relation to PE. The prevalence of AF corresponded to such conditions as heart failure (HF) (23,2%; n=153), diabetes (15,6%; n=103), and hypertension (HTN) (65,7% n=400). The diagnosis of AF in most patients is based on the history data (n=144; 95,4%), while the first registered AF episode was verified in 7 patients (4,6%). Patients with AF were characterized by older age, significantly higher prevalence of HF (51,2%), HTN (80,8%), chronic kidney disease (18,5%), stroke or transient ischemic attack (23,2%). It is important to note the low prevalence of anticoagulant therapy (15,3%) in the group of patients with previously diagnosed AF (n=144). The prevalence of thrombolytic therapy in patients with AF was significantly lower than among patients without AF (13,9 vs 25,8% (p=0,026)), which is due to contraindications and underdiagnosis of PE. Given the predominantly senile age, high comorbidity rate in patients with AF, as well as the absence of outpatient anticoagulant therapy, in-hospital mortality in patients with PE and AF was 31,1%, and significantly differed from that in those without AF 12,6% (p=0,001). In the general group, post-mortem diagnosis of PE was noted in 7,7% of cases (n=51), of which the proportion of patients with AF was 54,9% (n=28). A possible explanation for the underestimation of PE in AF patients was an erroneous explanation of its manifestations (tachypnea, tachycardia, lower limb edema) due to concomitant HF.Conclusion. Suspicion for PE in elderly patients with AF and manifestations of HF decompensation, as well as the timely administration of anticoagulant therapy, will prevent both arterial and venous embolism.

Aim. To validate the SIRENA score in assessing the risk of inhospital mortality in patients with pulmonary embolism (PE) in an independent sample.Material and methods. This retrospective, single-center study was based on the Samara Regional Cardiology Center. The risk of inhospital mortality was assessed using the SIRENA score, which includes such parameters as left ventricular ejection fraction

The results of the international multicenter study EMPEROR-REDUCED were reviewed the on-line scientific meeting of Moscow experts on October 30, 2020. Some proposals and recommendations for further study of the cardiovascular and renal effects of empagliflozin and its use in clinical practice in patients with chronic heart failure with reduced ejection fraction were accepted.

Aim. To study the prognostic value of the ORACLE risk score for assessing the risk of bleeding in patients with acute coronary syndrome (ACS) undergoing anticoagulants for atrial fibrillation using the combined database of the ORACLE II and RECORD 3 registers.Material and methods. This analysis included patients with ACS from 2 observational studies: ORACLE II (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options; n=1803) and the RECORD-3 register (n=2370). In total, the database included 4173 patients, of which 246 (6.08%) received oral anticoagulants for atrial fibrillation. The mean age of patients was 64.7±11.9 years, 2493 (59.7%) were men. Hemorrhagic risk was assessed using the ORACLE, CRUSADE, ORBIT, and HAS-BLED risk score.Results. Patients receiving anticoagulant therapy were older (69.9±11.3 years and 64.0±12.2 years, p

Aim. To evaluate the incidence and severity of acute kidney injury (AKI), as well as its ability to reclassify the risk of premature mortality and association with inhospital mortality in patients with pulmonary embolism (PE) in the Russian population.Material and methods. From April 2018 to April 2019, the SIRENA Russian Multicenter Registry included patients with PE, as well as the deceased, in whom the PE was detected by autopsy. AKI was diagnosed according to current KDIGO guidelines (2012). Creatinine calculated according to the MDRD equation and corresponding to a glomerular filtration rate of 75 ml/min/1,73 m2 (baseline) was taken as the initial one, with subsequent assessment relative to the parameter value upon admission. The risk stratification of early death was carried out in accordance with the current ESC clinical guidelines (2019).Results. A total of 604 patients with PE were examined (men — 293 (49%), women — 311 (51%), mean age — 64±15 years). AKI was diagnosed in 223 (37%) of them. Stage 1 AKI was detected in 146 (65%), 2 — in 55 (25%), 3 — in 22 (10%) patients. Prior chronic kidney disease was recorded in 61 (10%) patients. Seventy-one (12%) patients had a high risk of death, 364 (61%) — intermediate risk, and 164 (27%) — low risk. The AKI incidence increased as the severity of PE increased: at low risk of death — 26%, intermediate — 38%, high — 59% (p

The problem of anticoagulant treatment of elderly patients with atrial fibrillation (AF) is very topical for everyday medical practice because, on the one hand, the proportion of elderly patients among those who have AF is constantly increasing, and, on the other hand, there is no doubt that treatment of elderly patients involves many problems associated with a large number of complications. This material reviews the choice of optimal anticoagulant therapy for older AF patients and focuses on the use of rivaroxaban. Clinical research data show that rivaroxaban is one of the optimal drugs of choice for older patients. Thus, a comparative meta-analysis of the safety of various non-vitamin-K oral anticoagulants (NOAC) in patients of ≥75 years of age (in AF and deep vein thrombosis) showed that administration of rivaroxaban in comparison with warfarin was associated with an almost twofold significantly lower frequency of fatal bleedings (HR 0.53; 95% Cl 0.30-0.93; p = 0.03). According to the ROCKET-AF study, intake of rivaroxaban in elderly patients was comparable in efficiency and safety profile to warfarin. Since renal dysfunction is common in older patients with AF, safety issues are very important. In a ROCKET-AF study, the use of rivaroxaban in patients with moderate renal dysfunction was known to be associated with a lower frequency of fatal bleeding (0.28 vs. 0.74 per 100 patients/ year; HR 0.39; 95% CI 0.15-0.99; p = 0.047) than that of warfarin. Given the high probability of development of exacerbation of IHD in elderly patients with AF, they need an anticoagulant that maximally protects them from acute coronary complications. In the meta-analysis of 28 randomized trials with NOAC, only rivaroxaban was associated with a significant reduction by 22% in the risk of myocardial infarction and acute coronary syndrome compared to other control drugs. In conclusion, it can be stated that rivaroxaban may be a good choice for anticoagulant treatment specifically for elderly patients with AF, especially given its efficacy and safety profile and the adherence of patients to therapy.

This article contains information on the possibilities of using rivaroxaban and other non-vitamin K-associated oral anticoagulants (novel oral anticoagulant (NOAC)) in patients with pulmonary embolism (PE) in both acute and later stages of the disease. In 2019, the European Cardiology Society released updated clinical guidelines, which slightly changed the rules of treatment. The rules state that if the anticoagulant therapy is planned to be started with oral drugs, it is recommended to use one of NOACs. The results of the Einstein-PE randomized clinical study proved the efficacy and safety of rivaroxaban in acute pulmonary embolism. In this study, rivaroxaban showed efficacy for prevention cases of repeated pulmonary embolism that was noninferior to the standard therapy. On top of that, the use of rivaroxaban was associated with fewer large bleeding. The recommended regimen for the use of rivaroxaban in acute pulmonary embolism is 15 mg twice daily for 21 days, then 20 mg once daily for at least 3 months.The article outlines issues related to the need to extend anticoagulant treatment beyond the established standard terms (3-6 months) and issues of choosing a drug for extended treatment. Among other NOACs, rivaroxaban has the most comprehensive evidence base for extended treatment after PE, as its efficacy has been proven in several studies. It is important to note that rivaroxaban is the only NOAC, which was superior not only to placebo (in the EINSTEIN-Extension study), but also to the active drug (more precisely, aspirin in the EINSTEIN-CHOICE study) in preventing the development of re-thromboembolism. At the same time, the safety profile of rivaroxaban was comparable with both placebo and aspirin.The possibility to use NOACs in patients with active oncological disease is one of the new positions in modern clinical guidelines for the treatment of PE. As for rivaroxaban, the reason for this was the results of the SELECT-D study, in which rivaroxaban proved to be more efficient in preventing recurrence compared to the standard treatment with dalteparin, having comparable safety indicators in patients with cancer and PE.Thus, the available data from several clinical studies in patients with PE (in the acute and long-term periods) confirm the possibility of active use of rivaroxaban in this clinical situation.

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR)

Aim. To assess the prevalence of various risk factors (RF) for cardiovascular diseases (CVD) among employees of a multi-field hospital (Moscow City Clinical Hospital № 29).Material and methods. We determined blood pressure, weight, height, waist circumference, blood lipid and glucose levels, and used specially created questionnaire. At least 322 medical workers aged >40 years were examined.Results. The average age of the subjects was 51,6+7,8 years, among them 21% of doctors, 47% of nurses; 91% of women. 50% of subjects had arterial hypertension in the history, 40% — high blood pressure >140/90 mm Hg (56% of them regularly received antihypertensive drugs). The frequency of other RF of CVDs was as follows: low physical activity — 74%, hyperlipidemia — 69%, excessive salt intake — 68%, obesity — 43%, unhealthy diet — 37%, smoking — 25%. Among allemployees taking acetylsalicylic acid, 80% took it without invariable indications for this. Among persons with invariable indications for statins, the drug of this class was taken by 11%. When comparing indicators in women of different ages, it was found that the frequency of behavioral RF (unhealthy diet, excessive salt intake, low physical activity) in women 50 years; smoking in younger women was higher.Conclusion. A survey of medical workers aged >40 years revealed a high frequency of well-known modified RF of CVDs, especially low physical activity, hyperlipidemia, excessive salt intake, and obesity. The prevalence of arterial hypertension, smoking and unhealthy diet in the studied group were also high, but on average did not exceed the same numbers of general Russian population. We determined high frequency of aspirin intake without invariable indications, and low frequency of statins use in individuals with invariable indications, as well as a low efficacy of drug treatment of arterial hypertension.

Aim. To create a new prognostic scale for in-hospital mortality risk assessment in patients with pulmonary embolism (PE).Material and methods. The study was carried out on the basis of Russian register of acute pulmonary embolism SIRENA.Results. Based on the Russian register of acute pulmonary embolism SIRENA (n=609; women — 50,7%; mean age — 63,0±1,5 years), independent predictors of in-hospital death were determined: left ventricular ejection fraction

Aim. To assess the features of diagnosis, treatment and outcomes of pulmonary embolism (PE) in patients of Russian hospitals.Material and methods. The register included all hospitalized patients with PE identified by any diagnostic method. Duration of inclusion was 12 months. In-hospital period management was assessed. Information about the included patients was provided by 20 hospitals from 15 Russian cities.Results. For the period from April 15, 2018 to April 15, 2019, 609 patients were included in the register (women — 50,7%, mean age — 63,0±14,5 years, minimum-maximum — 19-94 years). Among the known risk factors for PE, the most common were lower limb varicose veins (31,4%), heart failure (23,3%), previous deep vein thrombosis (19,4%), cancer (17,1%). The median time from symptom onset to suspicion/confirmation of PE was 4 days (1-3 quartiles — 1-8 days). Shortness of breath, syncope/presyncope, chest pain/discomfort, cough, leg pain or lower extremity asymmetry and hemoptysis were noted in 88,7%, 30,0%, 29,8%, 17,3%, 9,4% and 8,5% of patients, respectively. Echocardiography was performed in 89,5%, and Doppler ultrasound of lower limb veins — in 85,9% of patients. Signs of venous thrombosis were found in 57,8% of patients. Computed tomographic (CT) pulmonary angiography was performed in 89,2% of patients, pulmonary scintigraphy and pulmonary angiography — 0,8% each.Conclusion. Symptoms and main risk factors for PE in Russian patients did not fundamentally differ from those previously known. There was good adherence to modern guidelines for the diagnosis of PE, but adherence to guidelines on drug therapy met requirements only in half of the cases. There was an excessive use of TLT, as well as the use of ineffective methods of administering and monitoring anticoagulant therapy.In total, imaging technologies were used in 90,6% of patients, and signs confirming PE were found in 92,7%. Thrombolytic therapy (TLT) was performed in 25,0%; 92,0% of patients received anticoagulants. At the same time, unfractionated heparin (UFH) was injected subcutaneously in 26,3% of cases, and in one third of patients the drug was injected in doses unadjusted by body weight. In 42,7% of patients received UFH, the target activated partial thromboplastin time was not achieved. With warfarin treatment, the target international normalized ratio was achieved in only 48,4% of patients. Inferior vena cava filter placement and thrombectomy were performed in 1,3% each. During hospitalization (median — 11 days), 9,9% of patients died.

Aim. To study the relationship between comorbidity and acute heart failure (AHF) complicating myocardial infarction (MI).Material and methods. The analysis included 993 patients with MI from the registry of acute coronary syndrome RECORD-3. Killip class II-IV was recorded in every fifth patient (n=205). Hospital mortality was 6,3%. The mean age was 64,3 (63,5-65,0) years (men — 66,1%). All patients were divided into three groups depending on the number of comorbidities (type 2 diabetes, chronic kidney disease, atrial fibrillation, anemia, stroke, hypertension, obesity, peripheral atherosclerosis, thrombocytopenia). The first group included patients with no more than one disease (n=251), the second one — with 2 or 3 diseases (n=480), and the third one — with 4 or more diseases (n=262).Results. AHF detection rate increased in groups with increasing comorbidity: 12,3%, 17,9% and 33,6%, respectively (p

Aim. To create a prediction score for assessing the mortality risk 6 months after hospitalization with acute coronary syndrome (ACS).Material and methods. Based on the results of ACS RECORD-3 register (Russia), we determined independent mortality predictors 6 months after ACS by performing multivariate regression analysis in patients discharged alive from the hospital with known outcomes.Results. The following predictors were obtained during the analysis: non-prescription of aspirin at discharge (odds ratio (OR) 5,8; 95% confidence interval (CI) 2,315,0; p

Prevention of activation of blood coagulation is a cornerstone of treatment strategies in patients with acute coronary syndrome (ACS). Medications that are used for this purpose help stop building up of blood clots in the area of damaged atherosclerotic plaque and prevent the development or recurrence of coronary artery occlusion. At the same time, the antithrombotic action should be versatile and prevent both thrombocyte and thrombotic mechanisms of blood clotting. The reduced platelet aggregation is achieved by prescription of aspirin with ticagrelor, clopidogrel or prasugrel as early as possible (and, if necessary, addition of platelet IIb/IIIa receptor blockers). Parenteral anticoagulants – unfractionated heparin (UFH), low molecular weight heparins (LMWH), fondaparinux are used to prevent the thrombin formation in the early periods of ACS. At the same time, the current clinical guidelines for the treatment of ACS with ST elevation recommend to use UFH in patients undergoing primary percutaneous coronary intervention (PCI), enoxaparin in patients receiving thrombolytic therapy with a fibrin-specific agent, and fondaparinux in streptokinase thrombolytic therapy [1]. The current guidelines for treatment of ACS without ST elevation (ACSwSTe) argue that fondaparinux should be preferred to other anticoagulants [2]. It came into use for the treatment of ACS later than any other anticoagulants, ranks higher in the ACSwSTe guidelines, and, therefore, deserves a separate discussion.

Aim. In the article, the analysis of the Russian independent registry presented on acute coronary syndrome (ACS) — RECORD-3, aimed for evaluation of adverse outcomes rate by 12 months after ACS, as the long term management of ACS patients.Material and methods. To analysis, 966 patients included (43% of all discharged). By most anamnesitcal and clinical data, as by management specifics, patients groups that were and those that were not assessed for 12 month outcomes, did not differ significantly.Results. The rate of fatal outcomes developed post discharge during 12 months after ACS, was 8,4% (4,8% in ACS with ST elevation (STEACS) and 10,5% in ACS non-ST elevation (NSTEACS); р=0,0012), summated events death+myocardial infarction (MI) + stroke was 12,8% (8,4% in STEACS and 15,4% in NSTEACS; р=0,0012). Mortality in 12 months from the onset of ACS was 15,8% (18,3% in STEACS and 14,2% in NSTEACS; р=0,077), summated events death+MI+stroke in 12 months from the onset of ACS was 19,9% (21,4% in STEACS and 18,9% in NSTEACS; р=0.32). The proportion of patients that continued to follow the prescribed at discharge aspirin, clopidogrel, ticagrelor, ACE inhibitor/angiotensine receptor blocker (ARB), beta-blocker and statin was, respectively, 83,4%, 47,8%, 28,1%, 66,8%, 77,3% and 68,7%. The relation was evaluated, of the “completeness of treatment” in 6 months post ACS with the rate of fatal outcomes in 12 months. In patients, who in 6 months post ACS continued to take ≥2 groups of medications (double antiplatelet therapy, beta-blocker, ACE inhibitor/ARB, statin) the rate of fatal outcomes during 12 months was significantly higher comparing to those who were taking ≤1 group (1,4% vs. 4,9%; р=0,01). Multifactorial regression showed the independent predictors of fatal outcomes post discharge in 12 months. These were coronary arteriography in-patient (odds ratio (OR) 0,11; 95% confidence interval (95% CI) 0,02-0,56; р=0,008), age ≥75 y. o. (OR 5,48; 95% CI 1,57-19,30; р=0,008), ST elevation on baseline ECG ≥1 mm (OR 3,43; 95% CI 1,02-11,48; р=0,046).Conclusion. The analysis of data of the Russian registry RECORD-3 showed that the prevalence of fatal outcomes developed in 12 months after ACS, post discharge from hospital, was 8,4%, and the prevalence of fatal outcomes from the ACS onset — 15,8%. Best adherence to treatment in 12 months was found for aspirin (83,4%), worst — for ticagrelor (28,1%). Independent predictors of fatal outcomes in 12 months post discharge were age ≥75 y. o., not performed coronary arteriography in-patient, and ST elevation on baseline ECG ≥1 mm.

Erlikh A. D. on behalf of the RECORD-3* working teamAim. Evaluation of 6-month observation of acute coronary syndrome (ACS) patients included into the ACS registry RECORD-3.Material and methods. To the registry RECORD-3, all ACS patients were being included if hospitalized during 1 month in 2015 (march-april) in 47 centers among 37 Russia cities. Follow-up lasted for 6 months with telephone calls, in 35 centers.Results. Among all participants (n=2370), 6-month outcomes were collected in 1433 (64%). By most demographic, anamestic and clinical characteristics the group of those failed to collect data was comparable with the others. Frequency of fatal outcomes after discharge in 6 months post ACS was 4,2%, new myocardial infarction (MI) — 3,2%, stroke — 0,7%. Frequency of combination events (death+MI), death+ MI+stroke reached 5,7% and 8,5%, respectively. Coronary intervention in 6 months was done in 12,0% (2/3 underwent PCI, 1/3 — bypass surgery). In 19% cases the intervention was urgent. There were no statistically significant differences by the prevalence of adverse events and bypass surgery among those with diagnosed MI in-patient and non-MI, as between ACS with ST elevation (STEACS) or no (NSTEACS), excluding the prevalence of fatal outcomes: 2,8% in STEACS and 5,0% in NSTEACS (p=0,038). The grade of frequency decline of prescribed medication intake by 6 months reached 12% for aspirin, 29% for clopidogrel, 33% for ticagrelor, 29% for oral anticoagulants, 28 for ACEi/ARB, 19% for beta-blockers, 21% for statins.Conclusion. By multifactorial regression analysis, the independent predictors of fatal outcomes were found, that developed in 6 months post discharge.

Material and methods. The data used, from the acute coronary syndrome registry RECORD-3, in the emergency cardiology department of Tomsk SRI of Cardiology, together with another 51 center in Russia. Based on the absence of presence of NOCA, patients with ST elevation myocardial infarction, who had undergone coronary arteriography, were selected to two independent groups: 27 with NOCA and 571 with OCA.Results. There were no significant differences in the clinical portrait of NOCA and OCA patient. However, palpitation followed angina attack in NOCA patients. In the NOCA, there was significantly lower number of persons with diagnostically relevant raise of cardio specific enzymes. Indirectly, it points on temporary ischemia with no necrosis, or that the area of necrotic myocardium is not large. In NOCA patients, statistically more significantly were absent reciprocal ECG changes. Endpoints as mortality and novel heart failure development had tendency to statistically more significant decrease of prevalence in NOCA patients. As final diagnosis at discharge, in NOCA patients more often another diagnosis was mentioned (including unstable angina, etc.), but not myocardial infarction. The key issues in hospital management of these two groups were identical, except more often prescription of dihydropiridine calcium channel blockers to NOCA patients, and rarer prescription of antiplatelet drugs at discharge.Conclusion. Regardless the fact that prognosis in ACS with NOCA and intact arteries is better than in OCA, it is necessary to analyze thoroughly pathogenesis of the disease in every case, as in this category of patients especially, it is most heterogenic. As these patients have comorbid factors, it is necessary to select the leading one, and to intensify efforts on this factor directly.

Aim. To evaluate gender differences in the disease course and in treatment at inpatient stage of management of ST elevation acute coronary syndrome (STEACS) patients by the data from the Russian Registry of Acute Coronary Syndromes “RECORD-3”.Material and methods. The study was conducted based on the data from Russian registry “RECORD-3”, in 47 institutions of 37 cities of Russia. The Registry included all consequtive patients with ACS, hospitalized in the participated institutions during march-april 2015, totally 2370 ACS patients. From the general group, patients were selected with the admission diagnosis STEACS (n=864). Mean age of STEACS patients was 62,6±12,4 y. Among them, 712 (82,4%) were primarily hospitalized into centers with invasive methods available, others (n=152, 17,6%) to non-invasive. The analysis was conducted, of the in-patient stage of patients, including reperfusion methods, and analysis of medication therapy.Results. More than a half of patients (68%) with STEACS were males, and hospitalized women were 10 years older. Females with ACS were at baseline clinically more complicated with arterial hypertension (AH), angina, chronic heart failure (CHF), diabetes 2 type, and atrial fibrillation in anamnesis. Higher number of acute heart failure was found (HF) (Killip II-IV) in females with ACS. There were no gender differences by the time of onset of pain to admittance and of doorballoon time. However coronary and ventriculography (CVG), percutaneous interventions (PCI), thrombolysis were done significantly (p=0,0001) rarer in females than in males. Higher mortality was found in females with STEACS comparing to males. There was higher rate of mortality in STEACS of females comparing to males (17,5% vs. 6,3%, p=0,0001). Monofactorial analysis revealed factors related to non-direction of patients to coronary arteriography: older age (more than 60 y. o.), female gender, cardiovascular comorbidity, acute heart failure at admittance. Conclusion. By the results of data analysis of “RECORD-3”, there were special characteristics of STEACS patients revealed for females: mean age is 10 years older than males; higher rate of cardiovascular comorbidity; reperfusion performed more rare, including outpatient stage of management. All these lead to significantly worse outcomes.

The current clinical guidelines for the treatment of patients with acute coronary syndrome (ACS) claim that simultaneous use of two drugs that inhibit platelet activity is mandatory for most patients. This approach known as dual antiplatelet therapy (DAT), in view of the similarity of the mechanisms of the disease development, should be used in both ACS with ST elevation (STE-ACS) and in ACS without ST elevation (non-STE-ACS). In both cases, DAT should combine acetylsalicylic acid (ASA) with a P2Y12 receptor antagonist (ticagrelor, prasugrel or clopidogrel). For Russia, where prasugrel is not registered, the most preferable DAT is the combination of ASA with ticagrelor which has outperformed clopidogrel in terms of efficacy in the PLATO trial. [1]

Aim. To evaluate the management and outcomes in acute coronary syndrome patients (ACS) comorbid with atrial fibrillation (AF) during in-patient period and in 12 months from ACS onset.Material and methods. Into multicenter prospective registry (CCH № 29 of Moscow), beginning December 2013, during 12 months, all consecutive patients included, with ACS, and AF on baseline ECG. Follow-up was continued during hospitalization and in 12 months from ACS (phone call).Results. Totally, 234 patients included. Mean age 72,0±11,6 y.o., 65+73,5%, females — 68,8%, anamnesis of myocardial infarction (MI) — 35,9%, diabetes — 23,9%, known AF before ACS — 65,0%, non-ST-elevation ACS — 97,9%, Killip >I — 7,3%, ST depression on baseline ECG — 89,9%, high troponin level — 59,0%, GRACE risk of fatal outcome >140 points. — 75,2%, median CHA2 DS2 -Vasc — 5 pts. At discharge from hospital, 44% patients received double antiplatelet treatment (DAT), 38% — aspirin with oral anticoagulant (OAC), 33% — warfarin, 23% — new OAC (NOAC). During hospitalization (median 14 days) 7 patients died (3,0%). In 12 months the outcomes were followed in 210 patients (89,8%). By 12 months from ACS onset, 18,1% patients died, and in 12 months but after discharge — 15,3%. New MI after discharge had 1,5%, stroke — 2,5%, and bleeding — 3,5% patients. The part of fatal outcomes in 12 months did not differ in DAT or aspirin with OAC groups (12,1% vs 12,8%; p=0,88). The “remained” prescription rate (i.e. adherence) in 12 months after ACS was maximum for aspirin, OAC and NOAC (71%, 58%, 63%, resp.) and minimum for DAT and aspirin with OAC (20% and 27%, resp.). The independent predictors of death after discharge from hospital up to 12 months from ACS onset were the baseline hemoglobin 140 pts. (OR 6,88; 95% CI 1,44-32,80; р=0,015) and non-prescription of aspirin in discharge (OR 3,21; 95% CI 1,20-8,61; р=0,02).Conclusion. The results of observational study of ACS and AF patients, admitted to Moscow city “non-invasive” clinic, showed high rate of fatal outcomes in 12 months after ACS (18,1%), low adherence to the prescribed treatment after discharge. Also, in the group studied, there were predictors of fatal outcomes in 12 months after ACS.

Aim. To assess the prognostic performance of the GRACE scale extended by cystatin C levels in the prediction of ischemic and hemorrhagic in-hospital complications among patients with acute coronary syndrome (ACS). Material and methods. In 160 ACS patients, admitted to the Moscow City Clinical Hospital No. 29 and included in the hospital register, blood levels of cystatin C were measured within the first 24 hours from admission. All patients were treated conservatively. The in-hospital risk of mortality and bleeding was assessed. The cut-off level of cystatin C was 1,53 mg/l. Results. High levels of cystatin C, high GRACE scale risk, and their combination were associated with a significant increase in the in-hospital risk of hemorrhagic and ischemic complications. Independent mortality predictors included GRACE levels (odds ratio, OR, 1,05; 95% confidence interval (CI) 1,02-1,08; p=0,002) and cystatin C levels (OR 1,01; 95% CI 1,00-1,02: p=0,025). Major and moderate bleeding complications were independently predicted by fibrinolysis (OR 9,86; 95% CI 1,74-55,20; p=0,01), leukocyte levels (OR 1,34; 95% CI 1,11-1,62: p=0,002), and haemoglobin levels (OR 0,96; 95% CI 0,91-0,99; p=0,043), as well as the combination of high GRACE risk levels and elevated cystatin C levels (OR 11,78; 95% CI 1,95-71,06; p=0,007). Adding cystatin C to the high GRACE risk improved the prognostic specificity by approximately 20% and did not affect the prognostic sensitivity in the prediction of in-hospital risk of major and moderate bleeding complications. Conclusion. The combination of high GRACE risk levels and elevated cystatin C levels was an independent predictor of major and moderate in-hospital bleeding complications, but not in-hospital death. Adding cystatin C to the GRACE scale by approximately 20% increased its specificity for the prediction of in-hospital risk of major and moderate bleeding complications.

Aim. To analyse the treatment characteristics and specifics in patients with acute coronary syndrome (ACS) and anaemia, based on the data from the Russian ACS registry (RECORD). Material and methods. The recruitment of the patients (November 2007 – February 2008) was performed, using the independent Russian ACS register RECORD. Results. The study included 796 patients (mean age 64,7±12,1 years; 57,2% men). ACS with ST segment elevation (ST ACS) was registered in 246 patients (30,1%), while ACS without ST segment elevation (non-ST ACS) was observed in 550 patients (69,9%). Anaemia at admission was registered in 228 participants (29,0%). The anaemia group had a higher proportion of elderly patients – those with diabetes mellitus, heart failure in anamnesis and at admission, and high risk by the GRACE scale. These patients were less often hospitalised in “invasive” hospitals. In hospital, anaemic patients less often received clopidogrel and underwent reperfusion in ST ACS or invasive procedures in non-ST ACS. Low baseline levels of haemoglobin (

Aim. To compare the clinical characteristics, in-hospital treatment, and treatment outcomes in men and women included in the independent Russian RECORD Registry of acute coronary syndrome (ACS) (n=796; 57,2% men and 42,8% women). Material and methods. The Registry covered 2007–2008 and included 18 clinical hospitals in 13 Russian cities. The mean age of male participants was 60,6±11,3 years; the proportion of the patients aged ≥65 years was 32,3%. Female participants were significantly older, with the majority of women being 65 years or older (66,6% vs. 32,3% of those aged below 65 years; p

The article provides an overview of the relevance of the use of dual antiplatelet therapy (DAT) in patients with acute coronary syndrome (ACS) without lifting ST (ACSwl ST ) receiving conservative treatment. Compared with those patients with ACSwl ST who underwent percutaneous coronary intervention, conservative treatment, patients traditionally have more comorbidities, risk factors and prognosis is worse. It is in this subgroup of patients to improve outcomes most important to carry out the most correct treatment of ACS, most strictly corresponding to current clinical guidelines. In particular this applies to that therapy, with which you can try to influence the mechanism of development of ACS, namely antirombocit therapy. The results of a clinical study PLATO showed that the use as a DAT combination with acetylsalicylic acid (ASA) and ticagrelor due to a decrease in the incidence of cardiovascular death, heart attack or stroke (primary adverse events) as compared to the combination of ASA and clopidogrel. The results of further analysis of PLATO study showed that when comparing the groups of patients with ACSwl ST treatment of invasive and conservative, noted a similar proportional reduction in the incidence of primary adverse events when using ticagrelor compared to clopidogrel group (hazard ratio of 0.86 compared with 0.85; p-value for interaction 0.89), which is consistent with the overall results of the study. Among patients with ACSwl ST treated conservatively, receiving ticagrelor as compared with clopidogrel was associated with a significantly smaller number of all deaths (relative risk, 0.73; 95 CI 0.57-0.93). The frequency of the "big" bleeding among patients treated conservatively with ACSwl ST treated with ticagrelor and clopidogrel did not differ significantly. PLATO study results identified the mandatory use of ticagrelor as DAT in patients with ACSwl ST regardless of the chosen treatment strategy.