Резолюция совещания экспертов Сибирского федерального округа «Эмпаглифлозин и сердечная недостаточность» по результатам исследования EMPEROR-Reduced

The results of the international multicenter study EMPEROR-Reduced have been discussed on October 31, 2020, at the online expert meeting. Considering the positive cardiovascular and renal effects of empagliflozin, the experts have supported the use of empagliflozin in the clinical practice to treat patients with chronic heart failure.На состоявшемся 31 октября 2020 г. онлайн-совещании экспертов рассмотрены итоги международного многоцентрового исследования EMPEROR-Reduced. С учетом выявленных сердечно-сосудистых и почечных эффектов эмпаглифлозина приняты предложения и рекомендации по широкому внедрению результатов исследования в клиническую практику лечения больных хронической сердечной недостаточностью

Резолюция онлайн-совещания экспертов Сибирского, Дальневосточного и Южного федеральных округов по результатам исследования EMPEROR-Reduced «Подходы к терапии сердечной недостаточности со сниженной фракцией выброса: от исследования EMPA-REG Outcome к EMPEROR-Reduced»

At the online meeting of experts held on April 24, 2021, the results of the international multicenter trial EMPEROR-Reduced were considered. Taking into account the beneficial cardiovascular and renal outcomes in patients with chronic heart failure and reduced left ventricular ejection fraction (<40%), and improvement in patient survival rates, a number of proposals and recommendations for widespread implementation of the trial results into practice of treating patients with chronic heart failure were adopted.На состоявшемся 24 апреля 2021 г. онлайн-совещании экспертов рассмотрены итоги международного многоцентрового исследования EMPEROR-Reduced. Принимая во внимание убедительные сердечно-сосудистые и почечные эффекты эмпаглифлозина у пациентов с хронической сердечной недостаточностью и сниженной фракцией выброса левого желудочка (<40%), а также доказанное улучшение выживаемости больных при приеме этого препарата приняты предложения и рекомендации по широкому внедрению результатов исследования в клиническую практику лечения больных хронической сердечной недостаточностью

PREDICTORS OF CORONARY ATHEROSCLEROSIS IN MEN WITH METABOLIC SYNDROME

Aim: The one of the main directions in the prevention of coronary heart disease (CHD) is to improve the technology for the detection of high cardiovascular risk persons for purpose of preventive measures aimed at the prevention of the disease. Object: To determine the most significant collection of risk factors for coronary atherosclerosis in men with metabolic syndrome. Material and Methods: The study involved 82 male patients with metabolic syndrome, divided into 2 groups of CHD after verification. All the patients were determined profile of lipid and carbohydrate metabolism and pro-inflammatory cytokines and adipokines. Results: The patients in the presence of coronary artery disease and MS have higher levels of CRP (p = 0.001 ) , IL -1 ( p = 0.017 ) , IL -6 ( p = 0.001) FNO (p = 0.001 ) , E - selectin ( p = 0.001 ) , and the patients without coronary artery disease have higher apelin levels. Conclusion: A multi-dimensional mathematical model created by us and based on the method of multivariate logistic regression analysis could allow to predict the presence of coronary atherosclerosis in patients with MS based on the analysis of the set of predictors obtained

Physical working capacity and autonomous regulation balance in myocardial infarction patients during long-term out-patient rehabilitation

Aim. To assess the impact of systematic controlled physical training (PT) at the out-patient clinic on physical working capacity (PWC) and autonomous balance in myocardial infarction (MI) patients. Results. PT for 6 and 12 months increased PWC, in correlation with parasympathetic activation and sympathetic inhibition, starting at 6 months and existing for at least 12 months of out-patient rehabilitation in Sub-groups B1 and B2. Long-term adaptation mechanisms provided sustainable benefits in patients trained for 6 months, till 12 months. Conclusion. In out-patient rehabilitation of MI patients, optimal PT duration is 6 months

Physical working capacity and central hemodynamics in patients with myocardial infarction after coronary artery bypass grafting and coronary balloon angioplasty, during out-patient rehabilitation and free-choice workload physical training

Aim. To investigate parameters of physical working capacity (PWC) and central hemodynamics in myocardial infarction (MI) patients who underwent coronary artery bypass grafting (CABG), coronary balloon angioplasty (CBA), or no vascular intervention. Material and methods. All 125 MI patients (mean age 51.6±1.8 years) underwent bicycle stress test and echocardiography (EchoCG) at baseline, and after 3, 6, and 12 months of the follow-up. The main group (n=90) was divided into three subgroups: A – after CABG, B – after CBA, and C – without any vascular intervention. All patients from the main group attended bicycle training sessions, with free-choice workload regimen. Results. In subgroup A, PWC had increased by Month 6 and remained at this level up to Month 12; regression of left ventricular remodeling (LVR) was also observed. In subgroups B and C, PWC increased during the whole rehabilitation period. According to dynamic EchoCG, in subgroup B, LVR was delayed, and in subgroup C, LFR had regressed by Month 3 and remained at that level up to Month 12. Conclusion. Bicycle training in free-choice workload regimen improved PWC and facilitated LFR regression

PILOT RESULTS OF THE CHRONIC ISCHEMIC HEART DISEASE REGISTRY IMPLEMENTATION IN ALTAISKY KRAI

Aim. Implement the chronic ischemic heart disease (CHD) registry in Altaisky Krai as a system for CHD patients monitoring, and the first results of its work.Material and methods. As a basement for the registry development we used actual Federal and regional registries. In the Altaisky Krai the Registry was started in 16 piloting healthcare institutions, and the center of data processing was KSBHI Altaisky Krai cardiological dispensary and KSBHI Krai Clinical Hospital. Into the Registry we included all patients with CHD who received a specialized cardiological care in these institutions, not related to the type of a care. We used research methods as following: empirical, theoretical, statistical. Results. The system let us to evaluate and influence the qualitative and quantitative parameters of cardiological care system in Altaisky Krai. The availability of cardiological care became better for rural regions, and the volumes of specialized care, including higher technologies as "Cardiovascular Surgery" line, were increased; it became possible to screen cardiovascular diseases at their earlier stages and hence to decrease mortality. The CHD registry provides opportunity to assess the epidemiological issues by CHD in Altaisky Krai and to reveal the defects of cardiovascular care at its stages.Conclusion. The necessity to the monitoring system implementation to all healthcare institutions of the Altaisky Krai for more effective and on- time work with the patients demanding specialized medical care, including high technologies

REGISTRY MANAGEMENT PROGRAM FOR ISCHEMIC HEART DISEASE IN ALTAISKY KRAY

Aim. To evaluate  the  results  of the  program  for management of ischemic  heart disease registry in Altaisky kray in 2011-2015 y.Material and methods. The system was developed and implemented in 2011 as a pilot project,  with software named  “Monitoring + [Registry of CIHD]”. The project was planned  as  retro-,  prospective  observational  cohort  study.  The registry was primarily tested on  the  bases of Regional  Clinical Hospital and  Altai Regional Cardiological Dispensary.  From the beginning of 2014, other 28 institutions were involved into  the  registry.  The  work is  being  done  continuously,  with patients admission and investigation if fulfill the registry criteria. For statistics the descriptory methods  were applied.Results  and  discussion. From 2011  to 2015,  the  data  of 12886  patients  was entered to the registry, with the diagnosis  “ischemic heart disease”. Mean age — 65,1±9,9  y.o. Region capital citizens were 35,5% of the registry, and inhabitants of the  Region — 64,5%.  Two thirds were males.  By the  anamnesis data,  there  was significantly more  persons after  myocardial  infarction  — 7094  (p<0,01).  Hightechnology care under “Cardiovascular surgery” unit was provided to 6115 (47,4%) patients.  Medication treatment was done according  to guidelines and standards for ischemic heart  disease patients  management. With the implementation  of registry, availability of cardiovascular care for rural inhabitants improved: three times increased the volumes of outpatient stage high-technology care, and cardiosurgery increased 1,8 times. The decrease of cardiovascular mortality during last 5 years reached 18,6%. Conclusion. A  universal  approach has  been  formulated  for a  unified base  of patients  suffering  from ischemic  heart  disease, that  makes  it to  follow-up the epidemiological situation in districts of Region by disease, to find out the risk factors and correct them. With the Registry of CIHD, it is possible to analyze the performance of cardiological care, to influence on its qualitative and quantitative parameters. The necessity  is shown, for the development  of this monitoring system in all treatmentprevention  institutions of the Region for equality in specialized  care  accessibility, including high-technology care

Place of Prasugrel, P2Y12 receptor antagonist, in an early invasive treatment of patients with acute coronary syndrome (according to the results of multicenter randomized controlled trial ISAR-REACT 5)

The conclusion of the Expert Council reports an agreement on the place of the P2Y12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events

A Survey of Empirical Results on Program Slicing

International audienceBACKGROUND:Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS:This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS:Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION:Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding