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    Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. International CLARIFY registry

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    ĐœĐŸĐ¶Đ»ĐžĐČĐŸŃŃ‚Ń– Đ°ĐœŃ‚Đ°ĐłĐŸĐœŃ–ŃŃ‚Ń–ĐČ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœŃƒ ĐČ Đ»Ń–ĐșуĐČĐ°ĐœĐœŃ– хĐČĐŸŃ€ĐžŃ… Đ· ĐłĐŸŃŃ‚Ń€ĐžĐŒ Ń–ĐœŃ„Đ°Ń€ĐșŃ‚ĐŸĐŒ ĐŒŃ–ĐŸĐșарЮа Đ· ДлДĐČацією ST бДз Đ„ĐĄĐ і ĐżĐŸŃŃ‚Ń–ĐœŃ„Đ°Ń€ĐșŃ‚ĐœĐŸŃ— Đ„ĐĄĐ Đ· ĐœĐžĐ·ŃŒĐșĐŸŃŽ фраĐșцією ĐČĐžĐșОЎу

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    Aim. In order to study the possibilities of aldosterone antagonists in the treatment of patients with acute myocardial infarction with ST elevation without chronic heart failure and post-MI chronic heart failure with low ejection fraction recent researches on this problem were reviewed. The literature data and the results of multicenter randomized controlled trials (RCTs), which will expand not only the understanding of the mechanisms of action of aldosterone receptor antagonists, but also new areas of their application in clinical practice, were analyzed.Conclusions. Randomized studies have shown that the efficiency of the selective aldosterone antagonist eplerenone has advantages over spironolactone in the improvement of prognosis in post-MI patients with LV systolic dysfunction and/or clinical signs of heart failure.ĐĄ Ń†Đ”Đ»ŃŒŃŽ ĐžĐ·ŃƒŃ‡Đ”ĐœĐžŃ ĐČĐŸĐ·ĐŒĐŸĐ¶ĐœĐŸŃŃ‚Đ”Đč Đ°ĐœŃ‚Đ°ĐłĐŸĐœĐžŃŃ‚ĐŸĐČ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœĐ° ĐČ Đ»Đ”Ń‡Đ”ĐœĐžĐž Đ±ĐŸĐ»ŃŒĐœŃ‹Ń… с ĐŸŃŃ‚Ń€Ń‹ĐŒ ĐžĐœŃ„Đ°Ń€ĐșŃ‚ĐŸĐŒ ĐŒĐžĐŸĐșарЮа с ŃĐ»Đ”ĐČацОДĐč ST бДз Đ„ĐĄĐ Đž ĐżĐŸŃŃ‚ĐžĐœŃ„Đ°Ń€ĐșŃ‚ĐœĐŸĐč Đ„ĐĄĐ с ĐœĐžĐ·ĐșĐŸĐč фраĐșцОДĐč ĐČŃ‹Đ±Ń€ĐŸŃĐ° ĐżŃ€ĐŸĐžĐ·ĐČĐ”ĐŽĐ”Đœ ĐŸĐ±Đ·ĐŸŃ€ ĐžŃŃĐ»Đ”ĐŽĐŸĐČĐ°ĐœĐžĐč ĐżĐŸŃĐ»Đ”ĐŽĐœĐžŃ… лДт, ĐżĐŸŃĐČŃŃ‰Đ”ĐœĐœŃ‹Ń… ĐŽĐ°ĐœĐœĐŸĐč ĐżŃ€ĐŸĐ±Đ»Đ”ĐŒĐ”. Â ĐŸŃ€ĐŸĐ°ĐœĐ°Đ»ĐžĐ·ĐžŃ€ĐŸĐČĐ°ĐœŃ‹ ĐŽĐ°ĐœĐœŃ‹Đ” Đ»ĐžŃ‚Đ”Ń€Đ°Ń‚ŃƒŃ€Ń‹ Đž Ń€Đ”Đ·ŃƒĐ»ŃŒŃ‚Đ°Ń‚Ń‹ ĐŒĐœĐŸĐłĐŸŃ†Đ”ĐœŃ‚Ń€ĐŸĐČых Ń€Đ°ĐœĐŽĐŸĐŒĐžĐ·ĐžŃ€ĐŸĐČĐ°ĐœĐœŃ‹Ń… ĐșĐŸĐœŃ‚Ń€ĐŸĐ»ĐžŃ€ĐŸĐČĐ°ĐœĐœŃ‹Ń… ĐžŃŃĐ»Đ”ĐŽĐŸĐČĐ°ĐœĐžĐč (РКИ), ĐșĐŸŃ‚ĐŸŃ€Ń‹Đ” ĐżĐŸĐ·ĐČĐŸĐ»ŃŃ‚ расшороть ĐœĐ” Ń‚ĐŸĐ»ŃŒĐșĐŸ прДЎстаĐČĐ»Đ”ĐœĐžŃ ĐŸ ĐŒĐ”Ń…Đ°ĐœĐžĐ·ĐŒĐ°Ń… ĐŽĐ”ĐčстĐČоя Đ°ĐœŃ‚Đ°ĐłĐŸĐœĐžŃŃ‚ĐŸĐČ Ń€Đ”Ń†Đ”ĐżŃ‚ĐŸŃ€ĐŸĐČ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœĐ°, ĐœĐŸ Đž ĐœĐŸĐČых ĐŸĐ±Đ»Đ°ŃŃ‚ŃŃ… ох ĐżŃ€ĐžĐŒĐ”ĐœĐ”ĐœĐžŃ ĐČ ĐșĐ»ĐžĐœĐžŃ‡Đ”ŃĐșĐŸĐč праĐșтоĐșĐ”. В Ń€Đ°ĐœĐŽĐŸĐŒĐžĐ·ĐžŃ€ĐŸĐČĐ°ĐœĐœŃ‹Ń… ĐžŃŃĐ»Đ”ĐŽĐŸĐČĐ°ĐœĐžŃŃ… ĐŽĐŸĐșĐ°Đ·Đ°ĐœĐŸ, Ń‡Ń‚ĐŸ ĐżĐŸ ŃŃ„Ń„Đ”ĐșтоĐČĐœĐŸŃŃ‚Đž сДлДĐșтоĐČĐœŃ‹Đč Đ°ĐœŃ‚Đ°ĐłĐŸĐœĐžŃŃ‚ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœĐ° ŃĐżĐ»Đ”Ń€Đ”ĐœĐŸĐœ ĐžĐŒĐ”Đ”Ń‚ ĐżŃ€Đ”ĐžĐŒŃƒŃ‰Đ”ŃŃ‚ĐČĐ° пДрДЎ ŃĐżĐžŃ€ĐŸĐœĐŸĐ»Đ°ĐșŃ‚ĐŸĐœĐŸĐŒ ĐČ ŃƒĐ»ŃƒŃ‡ŃˆĐ”ĐœĐžŃ ĐżŃ€ĐŸĐłĐœĐŸĐ·Đ° у ĐżĐŸŃŃ‚ĐžĐœŃ„Đ°Ń€ĐșŃ‚ĐœŃ‹Ń… ĐżĐ°Ń†ĐžĐ”ĐœŃ‚ĐŸĐČ Ń ŃĐžŃŃ‚ĐŸĐ»ĐžŃ‡Đ”ŃĐșĐŸĐč ĐŽĐžŃŃ„ŃƒĐœĐșцОДĐč ЛЖ Đž/ОлО ĐșĐ»ĐžĐœĐžŃ‡Đ”ŃĐșĐžĐŒĐž ĐżŃ€ĐžĐ·ĐœĐ°ĐșĐ°ĐŒĐž СН.З ĐŒĐ”Ń‚ĐŸŃŽ ĐČĐžĐČŃ‡Đ”ĐœĐœŃ ĐŒĐŸĐ¶Đ»ĐžĐČĐŸŃŃ‚Đ”Đč Đ°ĐœŃ‚Đ°ĐłĐŸĐœŃ–ŃŃ‚Ń–ĐČ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœŃƒ у ліĐșуĐČĐ°ĐœĐœŃ– хĐČĐŸŃ€ĐžŃ… Đ· ĐłĐŸŃŃ‚Ń€ĐžĐŒ Ń–ĐœŃ„Đ°Ń€ĐșŃ‚ĐŸĐŒ ĐŒŃ–ĐŸĐșарЮу Đ· ДлДĐČацією ST бДз Đ„ĐĄĐ і ĐżĐŸŃŃ‚Ń–ĐœŃ„Đ°Ń€ĐșŃ‚ĐœĐŸŃ— Đ„ĐĄĐ Đ· ĐœĐžĐ·ŃŒĐșĐŸŃŽ фраĐșцією ĐČĐžĐșОЎу ĐżŃ€ĐŸĐČĐ”ĐŽĐ”ĐœĐžĐč ĐŸĐłĐ»ŃĐŽ ĐŽĐŸŃĐ»Ń–ĐŽĐ¶Đ”ĐœŃŒ ĐŸŃŃ‚Đ°ĐœĐœŃ–Ń… Ń€ĐŸĐșіĐČ, просĐČŃŃ‡Đ”ĐœĐžŃ… ĐŽĐ°ĐœŃ–Đč ĐżŃ€ĐŸĐ±Đ»Đ”ĐŒŃ–. ĐŸŃ€ĐŸĐ°ĐœĐ°Đ»Ń–Đ·ĐŸĐČĐ°ĐœŃ– ĐŽĐ°ĐœŃ– Đ»Ń–Ń‚Đ”Ń€Đ°Ń‚ŃƒŃ€Đž та Ń€Đ”Đ·ŃƒĐ»ŃŒŃ‚Đ°Ń‚Đž Đ±Đ°ĐłĐ°Ń‚ĐŸŃ†Đ”ĐœŃ‚Ń€ĐŸĐČох Ń€Đ°ĐœĐŽĐŸĐŒŃ–Đ·ĐŸĐČĐ°ĐœĐžŃ… ĐșĐŸĐœŃ‚Ń€ĐŸĐ»ŃŒĐŸĐČĐ°ĐœĐžŃ… ĐŽĐŸŃĐ»Ń–ĐŽĐ¶Đ”ĐœŃŒ (РКД), яĐșі ĐŽĐŸĐ·ĐČĐŸĐ»ŃŃ‚ŃŒ Ń€ĐŸĐ·ŃˆĐžŃ€ĐžŃ‚Đž ĐœĐ” Ń‚Ń–Đ»ŃŒĐșĐž уяĐČĐ»Đ”ĐœĐœŃ ĐżŃ€ĐŸ ĐŒĐ”Ń…Đ°ĐœŃ–Đ·ĐŒĐž Юії Đ°ĐœŃ‚Đ°ĐłĐŸĐœŃ–ŃŃ‚Ń–ĐČ Ń€Đ”Ń†Đ”ĐżŃ‚ĐŸŃ€Ń–ĐČ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœŃƒ, алД Đč ĐŸĐșрДслОтО ĐœĐŸĐČі ĐŸĐ±Đ»Đ°ŃŃ‚Ń– їх Đ·Đ°ŃŃ‚ĐŸŃŃƒĐČĐ°ĐœĐœŃ ĐČ ĐșĐ»Ń–ĐœŃ–Ń‡ĐœŃ–Đč праĐșтоці. В Ń€Đ°ĐœĐŽĐŸĐŒŃ–Đ·ĐŸĐČĐ°ĐœĐžŃ… ĐŽĐŸŃĐ»Ń–ĐŽĐ¶Đ”ĐœĐœŃŃ… ĐŽĐŸĐČĐ”ĐŽĐ”ĐœĐŸ, Ń‰ĐŸ Đ·Đ° ДфДĐșтоĐČĐœŃ–ŃŃ‚ŃŽ сДлДĐșтоĐČĐœĐžĐč Đ°ĐœŃ‚Đ°ĐłĐŸĐœŃ–ŃŃ‚ Đ°Đ»ŃŒĐŽĐŸŃŃ‚Đ”Ń€ĐŸĐœŃƒ Đ”ĐżĐ»Đ”Ń€Đ”ĐœĐŸĐœ ĐŒĐ°Ń” пДрДĐČагО пДрДЎ ŃĐżŃ–Ń€ĐŸĐœĐŸĐ»Đ°ĐșŃ‚ĐŸĐœĐŸĐŒ ĐČ ĐżĐŸĐ»Ń–ĐżŃˆĐ”ĐœĐœŃ– ĐżŃ€ĐŸĐłĐœĐŸĐ·Ńƒ у ĐżĐŸŃŃ‚Ń–ĐœŃ„Đ°Ń€ĐșŃ‚ĐœĐžŃ… ĐżĐ°Ń†Ń–Ń”ĐœŃ‚Ń–ĐČ Đ· ŃĐžŃŃ‚ĐŸĐ»Ń–Ń‡ĐœĐŸŃŽ ĐŽĐžŃŃ„ŃƒĐœĐșцією Лй та/Đ°Đ±ĐŸ ĐșĐ»Ń–ĐœŃ–Ń‡ĐœĐžĐŒĐž ĐŸĐ·ĐœĐ°ĐșĐ°ĐŒĐž СН.

    Features of aldosterone antagonists in the treatment of patients with acute myocardial infarction with ST elevation without chronic heart failure and post-MI chronic heart failure with low ejection fraction

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    Aim. In order to study the possibilities of aldosterone antagonists in the treatment of patients with acute myocardial infarction with ST elevation without chronic heart failure and post-MI chronic heart failure with low ejection fraction recent researches on this problem were reviewed. The literature data and the results of multicenter randomized controlled trials (RCTs), which will expand not only the understanding of the mechanisms of action of aldosterone receptor antagonists, but also new areas of their application in clinical practice, were analyzed. Conclusions. Randomized studies have shown that the efficiency of the selective aldosterone antagonist eplerenone has advantages over spironolactone in the improvement of prognosis in post-MI patients with LV systolic dysfunction and/or clinical signs of heart failure

    Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry

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    Background and Aims: It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods: CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results: Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions: SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors
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