66Российский кардиологический журнал № 3 (131) | 2016 66Aim. to study prognosis factors for early postinfarction angina (EPA) in myocardial infarction (MI) and decreased functioning of kidneys, and long-term survival in this group of patients. Material and methods. Into the retrospective study, 179 patients included, of hospitalized to Moscow clinics, with verified diagnosis MI. decreased kidney function was defined as GFR <59 mL/min/1,73 m 2 . the endpoint was death and complications during hospitalization and all follow up. time mediana was 18 months. Results. totally, 29 cases registered (17,4%) of EPA in MI and known GFR (n=167). Patients with EPA were significantly older (72±11 y. and 62±12 y., respectively, р=0,0001) and among those males predominated (p=0,001). Atrial fibrillation (AF) and diabetes (dM) among EPA patients were significantly more prevalent. In decreased renal function group, EPA was found in 45,5 (n=25), in normal GFR -in 3,5% (n=4, p=0,0001), and the risk of EPA in decreased GFR below 59 mL/ По мнению большинства авторов, ранняя постин-фарктная стенокардия (РПС) является одним из осложнений инфаркта миокарда (ИМ), которая характеризуется крайне неблагоприятным прогнозом [1]. При возникновении РПС летальность возрастает в 3-4 раза в течение 14 месяцев, достигая 50% [2]. При этом наибольший риск кардиальных катастроф наблюдается в первые 3 месяца, а летальность в пер-вый год после ИМ составляет 17-50% [3]. В ходе дли-тельного наблюдения за пациентами с РПС, было выявлено до 40% летальных исходов, в связи с чем многочисленные исследования и существующие рекомендации рассматривают РПС в качестве одного из клинических показаний для проведения чрескож-ного коронарного вмешательства (ЧКВ) [4,5]. Так, ранняя ЧКВ у пациентов с РПС более благоприятна по сравнению с медикаментозной терапией, при этом риск осложнений и поздних рестенозов оказывается сопоставим с риском при стабильной стенокардии [6]. Пациенты с РПС, лечившиеся консервативно, ФАКТОРЫ
Aim To develop a model for evaluating the risk of stroke in patients after exacerbation of ischemic heart disease who were admitted to the hospitals included into a vascular program.Materials and methods This study included 1803 patients with acute coronary syndrome (ACS) from four institutions of Moscow, Kazan, Astrakhan, and Krasnodar where the vascular program was established. Mean age of patients was 64.9±12.78 years, 62,1 % of them were men. The patients were followed up for one year after the discharge from the hospital. External validation of the developed prognostic model was performed on a cohort of patients with ACS included into the RECORD-3 study.Results During the follow-up period, 42 cases of ischemic stroke were observed. The risk of ischemic stroke was associated with the presence of atrial fibrillation (odd ratio (OR) 2.640; р=0.037), diabetes mellitus (OR 2.718; р=0.041), and chronic heart failure (OR 7.049; р=0.011). Protective factors were high-density lipoprotein cholesterol >1 mmol/l (OR 0.629; р=0.041), percutaneous coronary intervention during an index hospitalization (OR 0.412; р=0.042), anticoagulant treatment (OR 0.670; р=0.049), and achieving the blood pressure goal (OR 0.604; р=0.023). The prognostic model developed on the basis of regression analysis showed a good predictive value (area under the ROC curve, 0.780), sensitivity of 80 %, and specificity of 64.6 %. The diagnostic value of other scales for risk assessment was somewhat lower. The area under the ROC curve was 0.692±0.0245 for the GRACE scale and 0.708±0.0334 for CHA2DS2‑VASc. In the external validation of the scale based on data of the RECORD-3 study, the diagnostic value was lower although satisfactory as well (area under the ROC curve, 0.651); sensitivity was 78.9 %, and specificity was 52.3 %.Conclusion The study resulted in development of a simple clinical scale, which will probably allow identifying groups at risk of stroke more precisely than with standard scales.
Objective. The aim of the study was to assess the possible association of visit-to-visit blood pressure (BP) variability and the risk of adverse outcomes in hypertensive (HTN) patients after acute coronary syndrome.Design and methods. We analyzed data of 1,456 patients (mean age 65,6 ± 12,2 years, 875 (60,1 %) men) discharged from the hospital after acute coronary syndrome and followed up for 1 year in 4 vascular centers in Moscow, Astrakhan, Kazan and Krasnodar in 2014–2017. BP, heart rate, and adverse events were recorded on the day of discharge and on days 25, 90, 180 and 360 after discharge. The visit-to-visit BP variability was assessed by the VIM coefficient (variation independent of mean).Results. The systolic BP variability was 7,81 ± 0,226 mm Hg, diastolic BP variability was 9,89 ± 0,577 mm Hg during follow-up. In total, 110 deaths from any cause, 63 coronary deaths, 130 repeated non-fatal coronary events, 33 ischemic strokes were recorded. A decrease in BP variability was associated with the dihydropyridine calcium antagonists (10,21 ± 6,45 and 7,99 ± 4,70 mm Hg, p = 0,024) and thiazide diuretics (10,34 ± 6,59 and 7,63 ± 9,63 mm Hg, p = 0,049). Multivariate analysis showed that high long-term variability of BP is a more significant factor associated with the overall mortality rate than the initial severity of HTN and even the fact of achieving target BP. The risk of ischemic stroke in patients with HTN was associated with factors such as atrial fibrillation, heart failure, a history of stroke, and high visit-to-visit BP variability.Conclusions. Visit-to-visit BP variability is an important characteristic of BP control and is associated with the risk of death from any causes and stroke in patients with coronary heart disease.
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