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Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease. 要求综合医院治疗冠心病患者的死亡原因。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-31 DOI: 10.18087/cardio.2024.5.n2341
I V Samorodskaya, O V Zayratyants, E P Kakorina, T K Chernyavskaya

Aim: Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis.

Material and methods: The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively.

Conclusion: Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

目的:回顾性分析因缺血性心脏病(IHD)而就诊和未就诊的门诊病人(OPMC)的基本死因,并讨论使用匿名但个性化的行政数据库进行分析的可能性:利用莫斯科地区民事登记处中央管理局(莫斯科地区民事登记处统一国家登记处)的电子数据库(包括 2021 年的医学死亡证明书(MDC)),选择所有以《国际疾病分类》第十次修订版(ICD-10)疾病代码(不包括外因、外伤、中毒代码)作为主要死因(PCD)的死亡病例。死者的个人数据与死亡前两年内在莫斯科地区医疗机构就诊的OPMC患者的电子病历数据相结合。除心肌缺血外,还考虑了以下死因代码:恶性肿瘤、COVID-19、糖尿病、脑血管疾病、高血压、慢性阻塞性肺病、酒精相关疾病,以及作为未指定死因的例子,老年病和未指定脑病。结果 在因疾病而死亡的患者中,死于 IHD 的患者占 18.9%,另有 8.4%的患者在 MDC 第二部分中将 IHD 列为合并疾病。在因患心肌缺血而寻求 OPMC 的患者中,有 27.5%的人的心肌缺血比例显示为 PCD,而在未寻求 OPMC 的患者中,这一比例为 17.4%(p <0.0001)。死于心肌缺血并寻求过 OPMC 的患者(平均年龄为 75.59±10.94 岁)比死于心肌缺血但未寻求过 OMPM 的患者(平均年龄为 73.96±10.94 岁;p <0.0001)年长。在寻求和未寻求 OMPM 的患者中,心肌梗死作为 PCD 的频率相同(12%),慢性形式的 IHD 分别为 83.9% 和 79.7%,"未指定 "急性形式的 IHD(代码 I24.8-9)的频率分别为 4.1% 和 8.3%。死于 COVID-19 的比例最高(分别为 21.7% 和 24.3%),死于恶性肿瘤的比例分别为 11.6% 和 12.7%,死于不明脑病的比例分别为 10.6% 和 10.7%:结论:只有25%曾因心肌缺血而就诊的患者死于心肌缺血,其他患者的死因与未就诊的患者相同。通过对行政数据库的分析,可以发现PCD结构中的差异,并引导专家努力协调各种形式的IHD死亡标准。
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引用次数: 0
[Modern Fixed Combinations in the Correction of Arterial Hypertension and Dyslipidemia]. [纠正动脉高血压和血脂异常的现代固定组合疗法]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-31 DOI: 10.18087/cardio.2024.5.n2656
Z M Galeeva, A S Galyavich, L V Baleeva, A A Sabirzyanova, M V Kuznetsov

Based on a clinical case report, the article shows the individual selection of effective therapy for a patient with arterial hypertension and dyslipidemia. Taking into account the risk factors for cardiovascular diseases, Equamer® was selected as a fixed combination of amlodipine + lisinopril + rosuvastatin capsules 10 mg+20 mg+10 mg (Gedeon Richter Plc, Budapest, Hungary). In the patient with hypertension, ischemic heart disease was verified, and stenting of the anterior descending artery was performed. According to the clinical guidelines, when arterial hypertension is associated with ischemic heart disease, the drug therapy of choice should be a combination of dihydropyridine slow calcium channel blockers with an angiotensin-converting enzyme inhibitor. The fixed triple combination of amlodipine, lisinopril, and rosuvastatin is one of the most appropriate in this clinical situation; this combination targets the two major risk factors for cardiovascular diseases, arterial hypertension and dyslipidemia.

文章以临床病例报告为基础,介绍了如何为动脉高血压和血脂异常患者单独选择有效疗法。考虑到心血管疾病的风险因素,Equamer® 被选为氨氯地平+利辛普利+洛伐他汀胶囊 10 毫克+20 毫克+10 毫克(Gedeon Richter Plc,匈牙利布达佩斯)的固定组合。高血压患者经核实患有缺血性心脏病,并进行了前降支动脉支架植入术。根据临床指南,当动脉性高血压伴有缺血性心脏病时,药物治疗应选择二氢吡啶类慢钙通道阻滞剂与血管紧张素转换酶抑制剂的组合。在这种临床情况下,氨氯地平、利辛普利和罗伐他汀的固定三联疗法是最合适的疗法之一;这种疗法针对心血管疾病的两大危险因素--动脉高血压和血脂异常。
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引用次数: 0
[Abstracts of the National Congress with International Participation "Heart Failure 2023". Moscow, December 8-9, 2023]. [2023 年心力衰竭 "国际大会摘要。莫斯科,2023 年 12 月 8-9 日]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-31 DOI: 10.18087/cardio.2024.5.n2657
Article Editorial

Abstracts of the National Congress with International Participation "Heart Failure 2023". Moscow, December 8-9, 2023.

国际参与的 "2023 年心力衰竭 "全国大会摘要。莫斯科,2023 年 12 月 8-9 日。
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引用次数: 0
Predictors of Unfavorable Prognosis in Patients with Heart Failure After Cardioverter-Defibrillator Implantation According to the Prospective Part of the Kuzbass Registry. 根据库兹巴斯登记处的前瞻性部分,心律转复除颤器植入术后心力衰竭患者不良预后的预测因素。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2370
N B Lebedeva, I V Talibullin, P G Parfenov, O L Barbarash

Aim: Identification of clinical and instrumental predictors for non-arrhythmic death in patients with heart failure (HF) and implantable cardioverter-defibrillator (ICD).

Material and methods: Through a telephone survey and examination of medical records from hospital and polyclinic databases, data were obtained on the alive/dead status and causes of death for 260 patients with heart failure (HF) and ICD included in the Kuzbass Registry of Patients with ICD. The follow-up period was 1.5 years. Clinical and instrumental parameters entered into the registry before the ICD implantation were included in a univariate and multivariate step-by-step analysis using the logistic (for qualitative variables) and linear (for quantitative variables) regression with calculation of regression coefficients and construction of a prognostic regression model. The quality of the created model was assessed using a ROC analysis.

Results: During the observation period, 54 (20.8%) patients died. In 21 (38.8%) patients, death occurred in the hospital and was caused by acute decompensated heart failure in 15 (71.4%) patients, myocardial infarction in 3 (14.3%) patients, stroke in 1 (4.7%) patient, and pneumonia in 2 (9.5%) patients. 33 (61.2%) patients died outside the hospital; the cause of death was stated as the underlying disease associated with acute decompensated heart failure: in 9 (27.2%) patients, dilated cardiomyopathy; in 1 (3.0%) patient, rheumatic mitral disease; and in 23 (69.7%) patients, ischemic cardiomyopathy. According to the univariate regression model, the risk of death in the long-term period was increased by the QT interval prolongation (U 2.41, p = 0.0161); elevated pulmonary artery systolic pressure (U 4.30, p=0.0000) and increased left atrial size according to echocardiography (U 2.98, p=0.0029); stage IIB HF (OR 2.41; 95% CI: 1.26-4.6), NYHA III-IV (OR 3.03; 95% CI: 1.58-5.81); chronic obstructive pulmonary disease (OR 5.24; 95% CI: 2.04-13.45); and lack of optimal drug therapy (ODT) for HF before ICD implantation (OR 2.41; 95% CI: 1.29-4.49). The multivariate analysis identified the most significant factors included in the prognostic regression model: pulmonary artery systolic pressure above 45 mm Hg, social status, chronic obstructive pulmonary disease, and lack of ODT for HF.

Conclusion: To ensure a maximum benefit from ICD, the factors that increase the likelihood of non-arrhythmic death should be considered before making a decision on ICD implantation. Particular attention should be paid to mandatory ODT for HF as the main modifiable risk factor for unfavorable prognosis.

目的:确定心力衰竭(HF)和植入式心律转复除颤器(ICD)患者非心律失常死亡的临床和器质性预测因素:通过电话调查以及检查医院和综合诊所数据库中的医疗记录,获得了库兹巴斯 ICD 患者登记处中 260 名心力衰竭(HF)和 ICD 患者的生死状态和死亡原因数据。随访期为 1.5 年。在植入 ICD 之前登记在册的临床和工具参数被纳入单变量和多变量逐步分析中,使用逻辑回归(定性变量)和线性回归(定量变量)计算回归系数并构建预后回归模型。利用 ROC 分析评估了所建模型的质量:在观察期间,54 名(20.8%)患者死亡。21例(38.8%)患者在医院死亡,其中15例(71.4%)的死亡原因是急性失代偿性心力衰竭,3例(14.3%)的死亡原因是心肌梗死,1例(4.7%)的死亡原因是中风,2例(9.5%)的死亡原因是肺炎。33例(61.2%)患者在院外死亡,死因均为与急性失代偿性心力衰竭相关的基础疾病:9例(27.2%)患者为扩张型心肌病;1例(3.0%)患者为风湿性二尖瓣病;23例(69.7%)患者为缺血性心肌病。根据单变量回归模型,QT 间期延长(U 2.41,P = 0.0161)、肺动脉收缩压升高(U 4.30,P = 0.0000)和超声心动图显示的左心房增大(U 2.98,P=0.0029);IIB 期 HF(OR 2.41;95% CI:1.26-4.6),NYHA III-IV 期(OR 3.03;95% CI:1.58-5.81);慢性阻塞性肺病(OR 5.24;95% CI:2.04-13.45);ICD 植入前缺乏 HF 最佳药物治疗(ODT)(OR 2.41;95% CI:1.29-4.49)。多变量分析确定了预后回归模型中最重要的因素:肺动脉收缩压超过 45 mm Hg、社会地位、慢性阻塞性肺病和缺乏治疗 HF 的 ODT:为确保 ICD 带来最大益处,在决定是否植入 ICD 之前,应考虑增加非心律失常死亡可能性的因素。应特别注意强制性心房颤动 ODT,因为这是导致预后不良的主要可改变风险因素。
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引用次数: 0
Assessment of the Level of Matrix Metalloproteinases, VEGF and MicroRNA-34a in Patients With Non-obstructive and Obstructive Lesions of the Coronary Arteries. 评估冠状动脉非阻塞性和阻塞性病变患者体内基质金属蛋白酶、血管内皮生长因子和 MicroRNA-34a 的水平。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2622
A O Iusupova, O A Slepova, N N Pakhtusov, L V Popova, A A Ageev, A S Lishuta, E V Privalova, N V Khabarova, G М Dadashovа, Yu N Belenkov

Aim: To assess the levels of matrix metalloproteinases (MMP), vascular endothelial growth factor (VEGF), and miRNA-34a expression in patients with ischemic heart disease (IHD) and obstructive and nonobstructive coronary artery (CA) disease.

Material and methods: This cross-sectional observational study included 64 patients with IHD (diagnosis verified by coronary angiography or multislice computed tomography coronary angiography), of which 33 (51.6%) were men aged 64.9±8.1 years. 20 patients had nonobstructive CA disease (stenosis <50%), and 44 had hemodynamically significant stenoses. The control group consisted of 30 healthy volunteers. MMP-1, -9, -13, and -14, miRNA-34a, and VEGF were measured in all patients.

Results: The concentration of MMP-1 was significantly higher in patients with ischemia and nonobstructive CA disease (INOCAD) (p=0.016), and the concentration of MMP-9 was the highest in the group with obstructive CA disease (p<0.001). The concentrations of MMP-13 and MMP-14 did not differ significantly between the groups. The highest VEGF concentrations were observed in the INOCAD group (p<0.001). The expression of miRNA-34a significantly differed between the IHD groups with different types of CA disease and controls (p <0.001). Patients with hemodynamically significant stenosis showed moderate relationships between the concentrations of MMP-14 and VEGF (ρ=0.418; p=0.024), as well as between VEGF and miRNA-34a (ρ=0.425; p=0.022). Patients with INOCAD had a significant negative correlation between the concentrations of MMP-13 and VEGF (ρ= -0.659; p=0.003). Correlation analysis showed in all IHD patients a moderate relationship of the concentrations of MMP-1 and MMP-14 with VEGF (ρ=0.449; p=0.002 and p=0.341; p=0.019, respectively). According to ROC analysis, a MMP-9 concentration above 4.83 ng/ml can be a predictor for the presence of hemodynamically significant CA obstruction in IHD patients; a VEGF concentration higher than 27.23 pg/ml suggests the absence of hemodynamically significant CA stenosis.

Conclusion: IHD patients with INOCAD had the greatest increase in MMP-1, whereas patients with obstructive CA disease had the highest level of MMP-9. According to our data, concentrations of MMP-9 and VEGF can be used to predict the degree of CA obstruction. The expression of miRNA-34a was significantly higher in IHD patients with INOCAD and CA obstruction than in the control group, which suggested a miRNA-34a contribution to the development and progression of coronary atherosclerosis. In the future, it may be possible to use this miRNA as a diagnostic marker for IHD.

目的:评估缺血性心脏病(IHD)、阻塞性和非阻塞性冠状动脉(CA)疾病患者基质金属蛋白酶(MMP)、血管内皮生长因子(VEGF)和miRNA-34a的表达水平:这项横断面观察性研究纳入了64名缺血性心脏病患者(通过冠状动脉造影术或多层计算机断层扫描冠状动脉造影术确诊),其中33人(51.6%)为男性,年龄为(64.9±8.1)岁。20名患者患有非阻塞性CA疾病(狭窄<50%),44名患者有明显的血流动力学狭窄。对照组由 30 名健康志愿者组成。对所有患者的 MMP-1、-9、-13 和-14、miRNA-34a 和血管内皮生长因子进行了测定:缺血和非阻塞性 CA 疾病(INOCAD)患者的 MMP-1 浓度明显更高(p=0.016),阻塞性 CA 疾病组的 MMP-9 浓度最高(p<0.001)。MMP-13和MMP-14的浓度在各组间无明显差异。INOCAD 组的 VEGF 浓度最高(p<0.001)。不同类型 CA 疾病的 IHD 组与对照组之间 miRNA-34a 的表达存在显著差异(p <0.001)。血流动力学明显狭窄的患者的 MMP-14 和血管内皮生长因子浓度(ρ=0.418;p=0.024)以及血管内皮生长因子和 miRNA-34a 浓度(ρ=0.425;p=0.022)之间呈中度关系。INOCAD 患者的 MMP-13 浓度与血管内皮生长因子呈显著负相关(ρ= -0.659;p=0.003)。相关性分析表明,所有 IHD 患者的 MMP-1 和 MMP-14 浓度与血管内皮生长因子呈中度相关(ρ=0.449;p=0.002 和 p=0.341;p=0.019)。根据ROC分析,MMP-9浓度高于4.83纳克/毫升可预测IHD患者是否存在血流动力学意义上的CA阻塞;VEGF浓度高于27.23皮克/毫升则提示不存在血流动力学意义上的CA狭窄:结论:患有 INOCAD 的 IHD 患者的 MMP-1 增加最多,而患有阻塞性 CA 疾病的患者的 MMP-9 水平最高。根据我们的数据,MMP-9 和血管内皮生长因子的浓度可用于预测 CA 阻塞的程度。在患有 INOCAD 和 CA 阻塞的 IHD 患者中,miRNA-34a 的表达明显高于对照组,这表明 miRNA-34a 对冠状动脉粥样硬化的发生和发展有一定的作用。未来,有可能将这种 miRNA 用作 IHD 的诊断标志物。
{"title":"Assessment of the Level of Matrix Metalloproteinases, VEGF and MicroRNA-34a in Patients With Non-obstructive and Obstructive Lesions of the Coronary Arteries.","authors":"A O Iusupova, O A Slepova, N N Pakhtusov, L V Popova, A A Ageev, A S Lishuta, E V Privalova, N V Khabarova, G М Dadashovа, Yu N Belenkov","doi":"10.18087/cardio.2024.4.n2622","DOIUrl":"10.18087/cardio.2024.4.n2622","url":null,"abstract":"<p><strong>Aim: </strong>To assess the levels of matrix metalloproteinases (MMP), vascular endothelial growth factor (VEGF), and miRNA-34a expression in patients with ischemic heart disease (IHD) and obstructive and nonobstructive coronary artery (CA) disease.</p><p><strong>Material and methods: </strong>This cross-sectional observational study included 64 patients with IHD (diagnosis verified by coronary angiography or multislice computed tomography coronary angiography), of which 33 (51.6%) were men aged 64.9±8.1 years. 20 patients had nonobstructive CA disease (stenosis &lt;50%), and 44 had hemodynamically significant stenoses. The control group consisted of 30 healthy volunteers. MMP-1, -9, -13, and -14, miRNA-34a, and VEGF were measured in all patients.</p><p><strong>Results: </strong>The concentration of MMP-1 was significantly higher in patients with ischemia and nonobstructive CA disease (INOCAD) (p=0.016), and the concentration of MMP-9 was the highest in the group with obstructive CA disease (p&lt;0.001). The concentrations of MMP-13 and MMP-14 did not differ significantly between the groups. The highest VEGF concentrations were observed in the INOCAD group (p&lt;0.001). The expression of miRNA-34a significantly differed between the IHD groups with different types of CA disease and controls (p &lt;0.001). Patients with hemodynamically significant stenosis showed moderate relationships between the concentrations of MMP-14 and VEGF (ρ=0.418; p=0.024), as well as between VEGF and miRNA-34a (ρ=0.425; p=0.022). Patients with INOCAD had a significant negative correlation between the concentrations of MMP-13 and VEGF (ρ= -0.659; p=0.003). Correlation analysis showed in all IHD patients a moderate relationship of the concentrations of MMP-1 and MMP-14 with VEGF (ρ=0.449; p=0.002 and p=0.341; p=0.019, respectively). According to ROC analysis, a MMP-9 concentration above 4.83 ng/ml can be a predictor for the presence of hemodynamically significant CA obstruction in IHD patients; a VEGF concentration higher than 27.23 pg/ml suggests the absence of hemodynamically significant CA stenosis.</p><p><strong>Conclusion: </strong>IHD patients with INOCAD had the greatest increase in MMP-1, whereas patients with obstructive CA disease had the highest level of MMP-9. According to our data, concentrations of MMP-9 and VEGF can be used to predict the degree of CA obstruction. The expression of miRNA-34a was significantly higher in IHD patients with INOCAD and CA obstruction than in the control group, which suggested a miRNA-34a contribution to the development and progression of coronary atherosclerosis. In the future, it may be possible to use this miRNA as a diagnostic marker for IHD.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 4","pages":"14-21"},"PeriodicalIF":0.5,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Anthracycline-induced Heart Failure: Treatment and Recovery Prospects]. [蒽环类药物诱发的心力衰竭:治疗和康复前景]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2641
M V Vitsenya, A V Potekhina, A Yu Filatova, O V Stukalova, F T Ageev

The article presents a clinical case of heart failure associated with the anthracycline-containing antitumor therapy in a breast cancer patient with an initially low risk of developing cardiovascular complications.

文章介绍了一例乳腺癌患者在接受含蒽环类抗肿瘤治疗后出现心力衰竭的临床病例,该患者最初出现心血管并发症的风险较低。
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引用次数: 0
[Changing Concepts About Optimal Target Blood Pressure and the Therapeutic Advantages of Azilsartan for Achieving it]. [关于最佳目标血压的观念转变以及阿齐沙坦在实现目标血压方面的治疗优势]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2646
S R Gilarevsky

The article discusses current issues of the treatment of arterial hypertension. According to presented data, so-called therapeutic nihilism is becoming one of the main barriers to achieving target blood pressure (BP). This nihilism is that despite evidence of the effectiveness of achieving lower BP values, practitioners do not intensify antihypertensive therapy sufficiently to achieve such values. The article specially addresses new criteria for the effectiveness of antihypertensive therapy, which reflect the therapy sustainability. The most commonly used indicator is the duration of the period, during which systolic BP remains in the therapeutic range. The prognostic significance of such indicators is discussed. In these conditions, it is very important to use the most effective antihypertensive drugs for initial antihypertensive therapy, including as a part of combination therapy. This tactic provides more frequent achievement of BP goals without the need for dose adjustment. In this regard, a systematic review was performed, which included sufficiently large randomized studies of the antihypertensive effectiveness of azilsartan medoxomil. This systematic review will provide comprehensive information on a possible role of using the angiotensin II receptor blocker azilsartan as a basic drug for the treatment of a wide range of patients with high BP. Most of the studies included in the systematic review assessed the effectiveness of combination therapy including azilsartan.

文章讨论了当前动脉高血压的治疗问题。根据所提供的数据,所谓的治疗虚无主义正在成为实现目标血压(BP)的主要障碍之一。这种虚无主义是指,尽管有证据表明降低血压值是有效的,但医生并没有为达到这样的血压值而充分加强降压治疗。这篇文章专门讨论了反映治疗可持续性的降压治疗有效性新标准。最常用的指标是收缩压保持在治疗范围内的持续时间。本文讨论了这些指标的预后意义。在这些情况下,使用最有效的降压药物进行初始降压治疗非常重要,包括作为联合疗法的一部分。这种方法可以更频繁地达到血压目标,而无需调整剂量。为此,我们进行了一项系统综述,其中包括对阿齐沙坦酯的降压效果进行的足够大的随机研究。该系统综述将提供全面的信息,说明将血管紧张素 II 受体阻滞剂阿齐沙坦作为基础药物治疗各类高血压患者可能发挥的作用。纳入系统综述的大多数研究都评估了包括阿齐沙坦在内的联合疗法的有效性。
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引用次数: 0
Primary Data on ATTR-Amyloidosis Prevalence Among Elderly Patients With Left Ventricular Hypertrophy in Russia. 俄罗斯左心室肥大老年患者中 ATTR 淀粉样变性患病率的原始数据。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2611
T V Nikiforova, K V Charaya, D Yu Shchekochikhin, Z M Magomedova, M S Enokyan, A N Volovchenko, A H Khamzatkhanova, T A Starovoytova, A A Bogdanova, A V Karalkin, S P Pasha, E S Pershina, A E Grachev, I V Zhirov, D A Andreev

Aim: To estimate the prevalence of amyloid cardiomyopathy (CM) caused by transthyretin amyloidosis (ATTR) and immunoglobulin light chain (AL) amyloidosis among patients aged >65 years with interventricular septal (IVS) hypertrophy of ≥14 mm.

Material and methods: From January through August 2023, 60 patients (mean age 7.2±7.3 years, 34 (56.67%) men) were enrolled. Patients meeting the inclusion criteria underwent an echocardiographic study with determining the myocardial longitudinal strain, myocardial scintigraphy with 99mTc-pyrfotech, myocardial single-photon emission computed tomography, measurement of N-terminal fragment of brain natriuretic peptide and troponin I, and the immunochemical study of serum and urine proteins with measurement of free light chains. In the presence of grades 2 and 3 radiopharmaceutical uptake according to scintigraphy, a molecular genetic study was performed for differential diagnosis of wild-type transthyretin amyloidosis (wtATTR) and hereditary/variant (hATTR) ATTR-CM.

Results: According to data of myocardial scintigraphy with 99mTc-pyrfotech, grade 3 uptake in the absence of monoclonal secretion was detected in 5 (8.3%) cases and grade 2 radiotracer uptake in the absence of monoclonal secretion was detected in 6 (10%) patients. Myeloma complicated by AL amyloidosis and primary AL amyloidosis were found in 5 (8.3%) patients.

Conclusion: Among patients aged ≥65 years with IVS hypertrophy ≥14 mm, amyloid CM was detected in 20% of cases (12 patients), including 5 cases (8.3%) of AL amyloidosis and 7 cases (11.7%) of ATTR amyloidosis.

目的:估算年龄为65岁、室间隔(IVS)肥厚≥14 mm的患者中由转甲状腺素淀粉样变性(ATTR)和免疫球蛋白轻链(AL)淀粉样变性引起的淀粉样心肌病(CM)的患病率:自2023年1月至8月,共纳入60例患者(平均年龄为7.2±7.3岁,男性34例(56.67%))。符合纳入标准的患者均接受了超声心动图检查,包括心肌纵向应变测定、99m锝-吡咯伏特心肌闪烁扫描、心肌单光子发射计算机断层扫描、脑钠肽 N 端片段和肌钙蛋白 I 的测定,以及血清和尿液蛋白的免疫化学检查和游离轻链的测定。如果闪烁扫描出现 2 级和 3 级放射性药物摄取,则进行分子遗传学研究,以鉴别诊断野生型转甲状腺素淀粉样变性(wtATTR)和遗传性/变异型(hATTR)ATTR-CM:根据99m锝-pyrfotech心肌闪烁扫描数据,5例(8.3%)患者在无单克隆分泌的情况下出现3级摄取,6例(10%)患者在无单克隆分泌的情况下出现2级放射性示踪剂摄取。有5例(8.3%)患者的骨髓瘤并发AL淀粉样变性和原发性AL淀粉样变性:结论:在年龄≥65岁、IVS肥大≥14毫米的患者中,20%的病例(12例)检测到淀粉样CM,包括5例(8.3%)AL淀粉样变性和7例(11.7%)ATTR淀粉样变性。
{"title":"Primary Data on ATTR-Amyloidosis Prevalence Among Elderly Patients With Left Ventricular Hypertrophy in Russia.","authors":"T V Nikiforova, K V Charaya, D Yu Shchekochikhin, Z M Magomedova, M S Enokyan, A N Volovchenko, A H Khamzatkhanova, T A Starovoytova, A A Bogdanova, A V Karalkin, S P Pasha, E S Pershina, A E Grachev, I V Zhirov, D A Andreev","doi":"10.18087/cardio.2024.4.n2611","DOIUrl":"10.18087/cardio.2024.4.n2611","url":null,"abstract":"<p><strong>Aim: </strong>To estimate the prevalence of amyloid cardiomyopathy (CM) caused by transthyretin amyloidosis (ATTR) and immunoglobulin light chain (AL) amyloidosis among patients aged &gt;65 years with interventricular septal (IVS) hypertrophy of ≥14 mm.</p><p><strong>Material and methods: </strong>From January through August 2023, 60 patients (mean age 7.2±7.3 years, 34 (56.67%) men) were enrolled. Patients meeting the inclusion criteria underwent an echocardiographic study with determining the myocardial longitudinal strain, myocardial scintigraphy with 99mTc-pyrfotech, myocardial single-photon emission computed tomography, measurement of N-terminal fragment of brain natriuretic peptide and troponin I, and the immunochemical study of serum and urine proteins with measurement of free light chains. In the presence of grades 2 and 3 radiopharmaceutical uptake according to scintigraphy, a molecular genetic study was performed for differential diagnosis of wild-type transthyretin amyloidosis (wtATTR) and hereditary/variant (hATTR) ATTR-CM.</p><p><strong>Results: </strong>According to data of myocardial scintigraphy with 99mTc-pyrfotech, grade 3 uptake in the absence of monoclonal secretion was detected in 5 (8.3%) cases and grade 2 radiotracer uptake in the absence of monoclonal secretion was detected in 6 (10%) patients. Myeloma complicated by AL amyloidosis and primary AL amyloidosis were found in 5 (8.3%) patients.</p><p><strong>Conclusion: </strong>Among patients aged ≥65 years with IVS hypertrophy ≥14 mm, amyloid CM was detected in 20% of cases (12 patients), including 5 cases (8.3%) of AL amyloidosis and 7 cases (11.7%) of ATTR amyloidosis.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 4","pages":"54-60"},"PeriodicalIF":0.5,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease. 在评估稳定型冠心病预后时采用 ABCDE 方案进行负荷超声心动图检查。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2572
O A Zhuravleva, T R Ryabova, A V Vrublevsky, N N Svyazova, N Y Margolis, A A Boshchenko

Aim: To assess the role of clinical indicators and parameters of stress echocardiography performed according to an extended protocol as predictors for the occurrence of a composite cardiovascular endpoint (CCVEP) in IHD.

Material and methods: The study included 186 patients (60.2% men, mean age 60.6±9.9 years) with an established (n=73; 39.2%) and suspected (60.8%) diagnosis of IHD. Stress EchoCG with adenosine triphosphate (38.2%), transesophageal pacing (15.1%), dobutamine (2.6%), and bicycle ergometry on a recumbent ergometer (44.1%) was performed. The stress EchoCG protocol included assessment of regional wall motion abnormalities (WMA), B-lines, LV contractile reserve (CTR), coronary reserve (CR), and heart rate reserve. The median follow-up period was 13 [9; 20] months. The composite CCVEP included death from cardiovascular diseases and their complications, acute coronary syndrome, and revascularization and was defined at the first of these events. Statistical analysis was performed with the Statistica 16.0 and SPSS Statistics 23.0 software packages. Differences were considered statistically significant at p<0.05.

Results: Invasive or noninvasive coronary angiography was performed in 90.3% of patients; obstructive coronary disease (stenosis ≥50%) was detected in 67.9% of cases. During the follow-up period, 58 (31.2%) patients had cardiovascular complications. The risk of developing CCVEP was associated with the pretest probability (PTP) of ischemic heart disease (odds ratio, OR, 1.05; 95% confidence interval, CI, 1.02-1.08), dyslipidemia (DLP) (OR 0.40; 95% CI 0.20-0.82), carotid atherosclerosis (OR 0.39; 95% CI 0.18-0.86), LV ejection fraction (OR 0.96; 95% CI 0.93-0.99), appearance at peak stress of new significant (2 LV segments or more) regional WMAs (OR 0.32; 95% CI 0.18-6.55), decreased LV CTR (OR 0.46; 95% CI 0.27-0.79) and CR (OR 0.33; 95% CI 0.18-0.61); p<0.05 for all. In a multivariate analysis with Cox regression, the model with clinical indicators included PTP of IHD (OR 1.04; 95% CI 1.01-1.07; p=0.01) and DLP (OR 0.14; 95% CI 0.02-1.01; p=0.05) as predictors. The model with stress EchoCG parameters included the appearance of new significant WMAs (OR 0.33, 95% CI 0.16-0.65; p=0.001) and reduced <2.0 CR (OR 0.44; 95% CI 0.24-0.82; p=0.01). A comparative analysis of Kaplan-Meier curves confirmed statistically significant differences in the dynamics of the CCVEP occurrence depending on the absence or presence of hemodynamically significant WMAs and/or reduced CR during stress EchoCG (p<0.01).

Conclusion: Reduced LV CR and WMA during stress EchoCG in patients with suspected or confirmed IHD are significant independent predictors for the CCVEP occurrence. Among clinical indicators, PTP of IHD and DLP are of the greatest importance for prognosis.

目的:评估根据扩展方案进行的应力超声心动图检查的临床指标和参数作为预测心血管疾病综合终点(CCVEP)发生的作用:研究纳入了 186 名确诊(73 人,占 39.2%)和疑似确诊(60.8%)为 IHD 的患者(60.2% 为男性,平均年龄为 60.6±9.9 岁)。采用三磷酸腺苷(38.2%)、经食道起搏(15.1%)、多巴酚丁胺(2.6%)和卧式测力计上的自行车测力法(44.1%)进行了应激 EchoCG。负荷 EchoCG 方案包括评估区域室壁运动异常 (WMA)、B 线、左心室收缩储备 (CTR)、冠状动脉储备 (CR) 和心率储备。中位随访时间为 13 [9; 20] 个月。复合 CCVEP 包括心血管疾病及其并发症导致的死亡、急性冠状动脉综合征和血管重建,并在首次发生这些事件时定义。统计分析使用 Statistica 16.0 和 SPSS Statistics 23.0 软件包进行。P<0.05为差异有统计学意义:90.3%的患者进行了有创或无创冠状动脉造影;67.9%的病例发现了阻塞性冠状动脉疾病(狭窄≥50%)。在随访期间,58 例(31.2%)患者出现了心血管并发症。CCVEP的发病风险与缺血性心脏病的检测前概率(PTP)(比值比,OR,1.05;95% 置信区间,CI,1.02-1.08)、血脂异常(DLP)(OR,0.40;95% 置信区间,0.20-0.82)、颈动脉粥样硬化(OR,0.39;95% 置信区间,0.18-0.86)、左心室射血分数(LV ejection fraction,LV射血分数)(比值比,OR,1.05;95% 置信区间,1.02-1.08)、左心室射血分数(LV ejection fraction,LV射血分数)(比值比,OR,0.40;95% 置信区间,0.20-0.82)相关。86)、左心室射血分数(OR 0.96;95% CI 0.93-0.99)、压力峰值时出现新的显著(2 个左心室节段或更多)区域 WMA(OR 0.32;95% CI 0.18-6.55)、左心室 CTR 下降(OR 0.46;95% CI 0.27-0.79)和 CR(OR 0.33;95% CI 0.18-0.61);所有指标的 p<0.05。在Cox回归的多变量分析中,临床指标模型包括IHD的PTP(OR 1.04;95% CI 1.01-1.07;P=0.01)和DLP(OR 0.14;95% CI 0.02-1.01;P=0.05)作为预测因素。应激 EchoCG 参数模型包括出现新的显著 WMA(OR 0.33,95% CI 0.16-0.65;p=0.001)和 <2.0 CR 减少(OR 0.44;95% CI 0.24-0.82;p=0.01)。Kaplan-Meier曲线的比较分析证实,CCVEP发生的动态变化在统计学上存在显著差异,这取决于应激EchoCG时是否存在血流动力学意义上的WMA和/或CR降低(p<0.01):结论:疑似或确诊 IHD 患者应激 EchoCG 时左心室 CR 和 WMA 降低是 CCVEP 发生的重要独立预测因素。在临床指标中,IHD 的 PTP 和 DLP 对预后最为重要。
{"title":"Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease.","authors":"O A Zhuravleva, T R Ryabova, A V Vrublevsky, N N Svyazova, N Y Margolis, A A Boshchenko","doi":"10.18087/cardio.2024.4.n2572","DOIUrl":"https://doi.org/10.18087/cardio.2024.4.n2572","url":null,"abstract":"<p><strong>Aim: </strong>To assess the role of clinical indicators and parameters of stress echocardiography performed according to an extended protocol as predictors for the occurrence of a composite cardiovascular endpoint (CCVEP) in IHD.</p><p><strong>Material and methods: </strong>The study included 186 patients (60.2% men, mean age 60.6±9.9 years) with an established (n=73; 39.2%) and suspected (60.8%) diagnosis of IHD. Stress EchoCG with adenosine triphosphate (38.2%), transesophageal pacing (15.1%), dobutamine (2.6%), and bicycle ergometry on a recumbent ergometer (44.1%) was performed. The stress EchoCG protocol included assessment of regional wall motion abnormalities (WMA), B-lines, LV contractile reserve (CTR), coronary reserve (CR), and heart rate reserve. The median follow-up period was 13 [9; 20] months. The composite CCVEP included death from cardiovascular diseases and their complications, acute coronary syndrome, and revascularization and was defined at the first of these events. Statistical analysis was performed with the Statistica 16.0 and SPSS Statistics 23.0 software packages. Differences were considered statistically significant at p&lt;0.05.</p><p><strong>Results: </strong>Invasive or noninvasive coronary angiography was performed in 90.3% of patients; obstructive coronary disease (stenosis ≥50%) was detected in 67.9% of cases. During the follow-up period, 58 (31.2%) patients had cardiovascular complications. The risk of developing CCVEP was associated with the pretest probability (PTP) of ischemic heart disease (odds ratio, OR, 1.05; 95% confidence interval, CI, 1.02-1.08), dyslipidemia (DLP) (OR 0.40; 95% CI 0.20-0.82), carotid atherosclerosis (OR 0.39; 95% CI 0.18-0.86), LV ejection fraction (OR 0.96; 95% CI 0.93-0.99), appearance at peak stress of new significant (2 LV segments or more) regional WMAs (OR 0.32; 95% CI 0.18-6.55), decreased LV CTR (OR 0.46; 95% CI 0.27-0.79) and CR (OR 0.33; 95% CI 0.18-0.61); p&lt;0.05 for all. In a multivariate analysis with Cox regression, the model with clinical indicators included PTP of IHD (OR 1.04; 95% CI 1.01-1.07; p=0.01) and DLP (OR 0.14; 95% CI 0.02-1.01; p=0.05) as predictors. The model with stress EchoCG parameters included the appearance of new significant WMAs (OR 0.33, 95% CI 0.16-0.65; p=0.001) and reduced &lt;2.0 CR (OR 0.44; 95% CI 0.24-0.82; p=0.01). A comparative analysis of Kaplan-Meier curves confirmed statistically significant differences in the dynamics of the CCVEP occurrence depending on the absence or presence of hemodynamically significant WMAs and/or reduced CR during stress EchoCG (p&lt;0.01).</p><p><strong>Conclusion: </strong>Reduced LV CR and WMA during stress EchoCG in patients with suspected or confirmed IHD are significant independent predictors for the CCVEP occurrence. Among clinical indicators, PTP of IHD and DLP are of the greatest importance for prognosis.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 4","pages":"22-30"},"PeriodicalIF":0.5,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical, Anamnestic, and Demographic Characteristics of Patients with Myocardial Infarction in Russian Federation According to the Russian Registry of Acute Myocardial Infarction - REGION-IM. 根据俄罗斯急性心肌梗死登记处 - REGION-IM 统计的俄罗斯联邦心肌梗死患者的临床、病理和人口特征。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2625
S A Boytsov, R M Shakhnovich, S N Tereschenko, A D Erlikh, D V Pevsner, Yu K Rytova, R G Gulyan, I A Markov, L V Shchepinova, M A Fomina, A S Kletkina, T V Grigoreva, V I Dagaeva, L S Devyatova, L Yu Chesnokova, E S Semenova, Ya A Kamenetz

Aim: Based on data from the Russian REGION-MI registry, to characterize patients with myocardial infarction (MI) hospitalized in Russian hospitals, describe their historical, demographic, and clinical characteristics, and compare the results with the data of previous Russian and international registries of acute coronary syndrome.

Material and methods: REGION-MI is a multicenter prospective observational study. The follow-up period was divided into three stages: during the hospital stay, at 6 and 12 months after the inclusion in the registry. Demographic and historic data and information about the present case of MI were entered into the patient's individual record card.

Results: The median age of all patients was 63 years; 68% of patients were men. The mean age of women was older than that of men. Among all MI cases, 70% were ST-segment elevation myocardial infarction (STEMI). Patients with non-ST-segment elevation myocardial infarction (NSTEMI) were older and had more comorbidities than patients with STEMI. The median time from the first symptoms to ECG recording was two hours, and from the first symptoms to CAG 7 hours. CAG was performed in 91% of patients with STEMI and 84% of patients with NSTEMI. Stenting was performed in 69% of patients. Although many patients had a complicated cardiovascular history, at the time of admission only 31.5% of patients were taking at least one drug from the groups of antiplatelets, oral anticoagulants, statins, and beta-blockers.

Conclusion: Patients with MI in the Russian Federation are younger than patients with MI in European countries. Among the clinical and historical characteristics, conspicuous is the presence of modifiable risk factors in many patients, as well as the presence of a previous diagnosis of ischemic heart disease. Furthermore, a small proportion of patients took statins, antiplatelet agents or anticoagulants at the outpatient stage, which indicates a great reserve of both primary and secondary prevention of cardiovascular diseases in the Russian Federation. The delayed seeking medical help is also noticeable, which indicates the need for increasing the public awareness of the symptoms of MI and the importance of timely hospitalization.

目的:根据俄罗斯REGION-MI登记处的数据,描述在俄罗斯医院住院的心肌梗死(MI)患者的特征,描述他们的历史、人口统计学和临床特征,并将结果与之前俄罗斯和国际急性冠状动脉综合征登记处的数据进行比较:REGION-MI 是一项多中心前瞻性观察研究。随访期分为三个阶段:住院期间、纳入登记册后的 6 个月和 12 个月。人口统计学数据、历史数据和本次心肌梗死病例的相关信息都被输入了患者的个人记录卡:所有患者的中位年龄为 63 岁,68% 的患者为男性。女性的平均年龄大于男性。在所有心肌梗死病例中,70%为ST段抬高型心肌梗死(STEMI)。与 STEMI 患者相比,非 ST 段抬高型心肌梗死(NSTEMI)患者年龄更大,合并症更多。从首发症状到心电图记录的中位时间为两小时,从首发症状到CAG的中位时间为7小时。91%的STEMI患者和84%的NSTEMI患者接受了CAG治疗。69%的患者接受了支架植入术。虽然许多患者有复杂的心血管病史,但入院时只有31.5%的患者至少服用了一种抗血小板药物、口服抗凝剂、他汀类药物和β-受体阻滞剂:结论:俄罗斯联邦的心肌梗死患者比欧洲国家的心肌梗死患者更年轻。在临床和病史特征方面,许多患者存在可改变的风险因素,以及曾被诊断为缺血性心脏病。此外,一小部分患者在门诊阶段服用了他汀类药物、抗血小板药物或抗凝剂,这表明俄罗斯联邦在心血管疾病的一级和二级预防方面都有很大的储备。延迟就医的现象也很明显,这表明有必要提高公众对心肌梗死症状的认识以及及时住院治疗的重要性。
{"title":"Clinical, Anamnestic, and Demographic Characteristics of Patients with Myocardial Infarction in Russian Federation According to the Russian Registry of Acute Myocardial Infarction - REGION-IM.","authors":"S A Boytsov, R M Shakhnovich, S N Tereschenko, A D Erlikh, D V Pevsner, Yu K Rytova, R G Gulyan, I A Markov, L V Shchepinova, M A Fomina, A S Kletkina, T V Grigoreva, V I Dagaeva, L S Devyatova, L Yu Chesnokova, E S Semenova, Ya A Kamenetz","doi":"10.18087/cardio.2024.4.n2625","DOIUrl":"10.18087/cardio.2024.4.n2625","url":null,"abstract":"<p><strong>Aim: </strong>Based on data from the Russian REGION-MI registry, to characterize patients with myocardial infarction (MI) hospitalized in Russian hospitals, describe their historical, demographic, and clinical characteristics, and compare the results with the data of previous Russian and international registries of acute coronary syndrome.</p><p><strong>Material and methods: </strong>REGION-MI is a multicenter prospective observational study. The follow-up period was divided into three stages: during the hospital stay, at 6 and 12 months after the inclusion in the registry. Demographic and historic data and information about the present case of MI were entered into the patient's individual record card.</p><p><strong>Results: </strong>The median age of all patients was 63 years; 68% of patients were men. The mean age of women was older than that of men. Among all MI cases, 70% were ST-segment elevation myocardial infarction (STEMI). Patients with non-ST-segment elevation myocardial infarction (NSTEMI) were older and had more comorbidities than patients with STEMI. The median time from the first symptoms to ECG recording was two hours, and from the first symptoms to CAG 7 hours. CAG was performed in 91% of patients with STEMI and 84% of patients with NSTEMI. Stenting was performed in 69% of patients. Although many patients had a complicated cardiovascular history, at the time of admission only 31.5% of patients were taking at least one drug from the groups of antiplatelets, oral anticoagulants, statins, and beta-blockers.</p><p><strong>Conclusion: </strong>Patients with MI in the Russian Federation are younger than patients with MI in European countries. Among the clinical and historical characteristics, conspicuous is the presence of modifiable risk factors in many patients, as well as the presence of a previous diagnosis of ischemic heart disease. Furthermore, a small proportion of patients took statins, antiplatelet agents or anticoagulants at the outpatient stage, which indicates a great reserve of both primary and secondary prevention of cardiovascular diseases in the Russian Federation. The delayed seeking medical help is also noticeable, which indicates the need for increasing the public awareness of the symptoms of MI and the importance of timely hospitalization.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 4","pages":"3-13"},"PeriodicalIF":0.5,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Kardiologiya
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