Predictors of post-infarction left ventricular aneurysm

Post-infarction left ventricular aneurysm (LVA) is a complication of myocardial infarction (MI), which is of great clinical importance due to high mortality. Data on its incidence are contradictory. The aim of the review was to highlight the existing and novel predictors of post-infarction LVA, the identification of which will help in identifying high-risk patients in order to optimize their treatment and rehabilitation. Known predictors of post-infarction LVA include pain-to-balloon time, age, female sex, recurrent MI, coronary angiography parameters, echocardiography, and electrocardiography. Increased levels of leukocytes, C-reactive protein, growth differentiation factor, stimulating growth factor, interleukin-1β, interleukin-6, tumor necrosis factor-α, matrix metalloproteinases, proprotein convertase subtilisin-kexin type 9, N-terminal pro-brain natriuretic peptide >400 pg/ml indicate the risk of pathological left ventricular remodeling and LVA. In this connection, there is a need to assess the incidence of post-infarction LVA and a comprehensive assessment of its predictors in patients with MI

Myocardial infarction in combination with anaphylactic shock (Kounis syndrome): a case report

Introduction. Allergic reactions and side effects are a common consequence of drug use and account for ~5% of all hospital admissions. The co-occurrence of ana phylactic shock and acute myocardial infarction (AMI) is called Kounis synd rome (KS).Brief description. The article analyzes the case of ceftriaxone-induced KS in a 56-year-old female patient with a history of anaphylactic shock after ampicillin therapy. The patient was treated on an outpatient basis due to an acute upper respiratory infection. The patient was diagnosed with acute bronchitis, in connection with which antibiotic therapy with azithromycin was started. Due to inefficiency the drug was canceled and ceftriaxone 1 g in 3,5 ml of 1% lidocaine solution 2 times a day was prescribed. After the first intramuscular injection, the patient developed anaphylactic shock, which was stopped by intravenous administration of prednisolone 120 mg, dexamethasone 8 mg and adrenaline hydrochloride 1,0 ml. Almost immediately, the ST segment elevation was recorded, in connection with which thrombolytic therapy with fortelyzin 15 mg was performed. Coronary angiography revealed thrombotic occlusion of the left anterior descending artery in the upper segment. Further examination verified AMI in the patient.Discussion. This case of AMI is pathogenetically associated with anaphylactic shock. However, the available data on the state of patient coronary system and no data on the morphologic characteristics of thrombus do not make it possibelr to define a type of KS.Conclusion. This clinical case indicates the need for a thorough allergic anamnesis collection by physicians of any specialty and prescribing medications taking it into account

Modern Anticoagulant Therapy for Atrial Fibrillation: Patient Adherence in Clinical Practice

Aim. To assess the adherence of doctors and patients to anticoagulant therapy for atrial fibrillation (AF).Materials and methods. An observational prospective study included 99 patients with AF at high risk of thromboembolic complications in Ryazan and Omsk. To study adherence, a questionnaire for quantitative assessment of treatment adherence ("QAA-25") was used. The questionnaire allows you to assess adherence by three main parameters separately: adherence to drug therapy, lifestyle modification and medical support. For the purposes of the study, adherence rates of less than 75% were regarded as insufficient, 75%. % or more as sufficient. To assess food preferences and determine the risk of changes in the activity of warfarin, a questionnaire of food preferences was used. The questionnaire allows you to assess the risk of alimentary increase (≥30 points) and decrease (≥60 points) of warfarin activity, as well as the overall risk of alimentary change (≥90 points) of warfarin activity in each patient, taking into account the volume and frequency of consumption of products that affect the activity of warfarin.Results. After the first visit, 99% of respondents received anticoagulant treatment. Rivaroxaban was the leader in prescribability among anticoagulants (36.7%). About a third of respondents were prescribed apixaban by a doctor (30.6%) and dabigatran  (17.3%)  and  warfarin  (19.4%)  were prescribed almost twice as rarely as rivaroxaban. Respondents with the highest rates of adherence to drug therapy, lifestyle modification and medical support are AF patients taking apixaban. The respondents who were prescribed rivaroxaban had the lowest level of adherence to drug therapy and lifestyle modification. And the lowest level of commitment to medical support is among respondents who have been prescribed warfarin. The number of people with a sufficient level of commitment did not reach half. Only 43.9% were ready to take prescribed medications and slightly more than a third (34.7%) agreed to come to appointments for a long time. But, despite the importance of lifestyle modification in patients with AF, only 16.3% of respondents said they were ready to give up bad habits, lose weight and lead a more active lifestyle. The proportion of people with sufficient adherence to drug therapy was the smallest in the group taking rivaroxaban (25.7%). The least number of respondents with sufficient commitment to medical support in the group taking dabigatran (25%). Only one in ten patients (11.1%) taking warfarin had a sufficient level of commitment to lifestyle modification. 15% of the study participants had an increased risk of alimentary changes in the activity of warfarin.Conclusion. Assessment of adherence to anticoagulant therapy by doctors in two regional centers (Omsk and Ryazan) showed high prescribability of preventive antithrombotic therapy, which corresponds to modern therapeutic approaches. At the same time, patients demonstrated rather low levels of adherence to drug therapy, lifestyle modification, and medical support

CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA)

Aim. To study a pattern of concomitant cardiovascular diseases (CVDs) and to estimate particularities and quality of medical antihypertensive therapy in hypertensive patients in real outpatient practice with a help of the Registry in Ryazan region.Material and methods. A total of 3690 patients with hypertension, ischemic heart disease, chronic heart failure and atrial fibrillation, who had attended general practitioners and cardiologists of 3 outpatient clinics in Ryazan city, were enrolled in the outpatient Registry of cardiovascular diseases (RECVASA). The diagnosis of hypertension was recorded in 3648 of 3690 (98.9%) outpatient charts, 28.1% of the subjects were men and 71.9% - women.Results. A total of 2907 (79.7%) of 3648 patients had combination of hypertension with other CVDs. Combination of 3-4 cardiovascular diagnoses was registered in 63.8% of the cases. 11.5% and 9.5% of the patients had a history of myocardial infarction and cerebral stroke, respectively. Diagnosis of hypertension was verified in 448 of 450 randomized hypertensive patients (99.6%). The incidence of prescription of one and two antihypertensive drugs (AHDs) was 25% and 39%, respectively, of 3 AHDs – 21%, 4 and more – 2%. AHDs were not prescribed in 13% of hypertensive patients. The mean number of prescribed AHDs was 1.73. The mean incidence rate of target blood pressure achievement was 26.1%. We have noted insufficient ACE inhibitors/angiotensin receptor blockers (ARB) and beta-blockers prescription in different concomitant CVDs. Patients with 3-4 cardiovascular diagnoses were more often prescribed combined antihypertensive treatment. Prescription of ACE inhibitors/ARB, beta-blockers and thiazide diuretics combination was preferable in 74.1% of the cases, when taking into account absolute and relative contraindications for betablockers use – in 64.0%. 15.2% of the hypertensive patients used reimbursed drugs for CVDs at the moment of the Registry enrollment as compared with 39.2% in previous years (p<0.05).Conclusion. The RECVASA study data allowed revealing high incidence of concomitant CVDs in hypertensive patients, insufficient use of combined antihypertensive treatment, including AHDs with proved favorable influence on prognosis. Achievement of concordance of medical treatment to national and international guidelines, taking into account concomitant CVDs, and optimization of patients’ coverage with reimbursed drugs are the main reserves for antihypertensive treatment quality improvement

Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION)

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance

Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries)

Aim. To study comorbidity, drug therapy and outcomes in patients with atrial fibrillation (AF) included in the outpatient and hospital RECVASA registries.Material and methods. Patients with AF (n=3169; age 70.9±10.7 years; 43.1% of men) in whom comorbidity, drug therapy, short-term and longterm outcomes (follow-up period from 2 to 6 years) were included in hospital registers RECVASA AF (Moscow, Kursk, Tula), as well as outpatient registers RECVASA (Ryazan) and RECVASA AF-Yaroslavl.Results. Outpatient registries (n=934), as compared to hospital registries (n=2235), had a higher average age of patients (73.4±10.9 vs 69.9±10.5; p<0.05), the proportion of women ( 66.2% vs 53.0%; p<0.0001) and patients with combination of 3-4 cardiovascular diseases (CVD), including AF (98.0% vs 81.7%, p<0.0001), and also with chronic noncardiac diseases (81.5% vs 63.5%, p<0.0001), the risk of thromboembolic complications (CHA2DS2-VASc 4.65±1.58 vs 4.15±1.71; p<0.05) and hemorrhagic complications (HAS-BLED 1.69±0.75 vs 1.41±0.77; p<0.05), as well as a lower frequency of prescribing appropriate pharmacotherapy for CVD (55.6% vs 74.6%, p<0.0001). During the observation period, 633 (20.0%) patients died, and in 61.8% of cases - from cardiovascular causes. The mortality rate in one year in Moscow was 3.7%, in Yaroslavl - 9.7%, in Ryazan - 10.7%, in Kursk - 12.5% (on average for four registers - 10.3%). A higher risk of death (1.5-2.7 times) was significantly associated with age, male sex, persistent AF, history of myocardial infarction (MI) and acute cerebrovascular accident (ACVE), diabetes mellitus, chronic obstructive disease lungs (COPD), heart rate>80 bpm, systolic blood pressure <110 mm Hg, decreased hemoglobin level. A lower risk of death (1.2-2.4 times) was associated with the prescription of anticoagulants, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), betablockers, statins. The number of cases of stroke and MI was, respectively, 5.1 and 9.4 times less than the number of deaths from all causes. The higher risk of stroke in patients with AF during follow-up was significantly associated with female sex (risk ratio [RR]=1.61), permanent AF (RR=1.85), history of MI (RR=1.68) and ACVA (RR=2.69), HR>80 bpm (RR=1.50). Anticoagulant prescription in women was associated with a lower risk of ACVA (if adjusted for age: RR=0.54; p=0.04), in contrast to men (RR=1.11; p=0.79).Conclusion. The majority of patients with AF registries in 5 regions of Russia had a combination of three or more cardiovascular diseases (73.9%), as well as chronic non-cardiac diseases (68.8%). The frequency of proper cardiovascular pharmacotherapy was insufficient (68.6%), especially at the outpatient stage (55.6%). Over the observation period (2-6 years), the average mortality per year was 10.3%, but at the same time it differed significantly in the regions (from 3.7% in Moscow to 9.7-12.5% in Yaroslavl, Ryazan and Kursk). Cardiovascular causes of deaths occurred in 62%. A higher risk of death (1.5-2.7 times) was associated with a history of stroke and MI, diabetes mellitus, COPD, heart rate>80 bpm, systolic blood pressure <110 mm Hg, decreased hemoglobin level. However, the risk of death decreased by 1.2-2.4 times in cases of prescription of anticoagulants, ACE inhibitors / ARBs, beta-blockers and statins. The risk of ACVA and MI was the highest in the presence of the history of this event (2.7 and 2.6 times, respectively). Anticoagulant prescription was significantly associated with a reduced risk of stroke in women

Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries)

Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p<0.05). 703 patients with a combination of AF and CAD had the previous myocardial infarction (MI; age was 72.3±9.5 years; 55.2% of men; CHA2DS2-VASc – 4.57±1.61; HAS-BLED – 1.65±0.76), and 1794 patients didn't have previous MI (age was 72.2±10.0 years; 38.4% of men; CHA2DS2-VASc – 4.30±1.50; HAS-BLED – 1.58±0.78). The proportion of men was 1.4 times higher among those with the previous MI. Patients with a combination of AF and CAD significantly more often (p <0.0001) than in the absence of CAD received a diagnosis of hypertension (93.8% and 78.6%), chronic heart failure (90.1% and 51.2%), diabetes mellitus (21.4% and 13.8%), chronic kidney disease (24.8% and 17.7%), as well as anemia (7.0% and 3.0%; p=0.001). Patients with and without the previous MI had the only significant difference in the form of a diabetes mellitus higher incidence having the previous MI (27% versus 19.2%, p=0.0008). The frequency of proper cardiovascular pharmacotherapy was insufficient, mainly in the presence of CAD (67.8%) than in its absence (74.5%), especially the prescription of anticoagulants (39.1% and 66.2%; p <0.0001), as well as in the presence of the previous MI (63.3%) than in its absence (74.3%). The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death (risk ratio [RR]=1.58; 95% confidence interval [CI] was 1.33-1.88; p <0.001 and RR=1.59; 95% CI was 1.33-1.90; p <0.001), as well as with a higher risk of developing a combined cardiovascular endpoint (RR=1.88; 95% CI was 1.17-3 , 00; p <0.001 and RR=1.75; 95% CI was 1.44-2.12; p<0.001, respectively).Conclusion. 78.8% of patients from AF registries in 5 regions of Russia were diagnosed with CAD, of which 28.2% had previously suffered myocardial infarction. Patients with a combination of AF and CAD more often than in the absence of CAD had hypertension, chronic heart failure, diabetes, chronic kidney disease and anemia. Patients with the previous MI had higher incidence of diabetes than those without the previous MI. The frequency of proper cardiovascular pharmacotherapy was insufficient, and to a greater extent in the presence of CAD and the previous MI than in their absence. All-cause mortality was recorded in patients with a combination of AF and CAD more often than in the absence of CAD. All-cause mortality and the incidence of nonfatal myocardial infarction were higher in patients with AF and the previous MI than in those without the previous MI. The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death, as well as a higher risk of developing a combined cardiovascular endpoint

Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p<0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±0.76; p<0.05). Patients with a combination of AF and CHF significantly more often (p<0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p<0.001) and less often paroxysmal (22.5% and 46.2%; p<0.001) form  of  arrhythmia.  Ejection  fraction  ≤40%  (9.3%  and  1.2%;  p<0.001),  heart  rate  ≥90/min  (23.7% and 19.3%; p=0.008) and blood pressure ≥140/90 mm Hg (59.9% and 52.2%; p<0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% and  49, 0%; p<0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p<0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p<0.001).Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. The  incidence of mortality from all causes, the development of non-fatal myocardial infarction   and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА МУЛЬТИМОРБИДНОСТИ, МЕДИКАМЕНТОЗНОГО ЛЕЧЕНИЯ И ИСХОДОВ У БОЛЬНЫХ С СОЧЕТАНИЕМ ПЕРЕНЕСЕННОГО ОСТРОГО НАРУШЕНИЯ МОЗГОВОГО КРОВООБРАЩЕНИЯ И ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПРИ НАЛИЧИИ ИЛИ ОТСУТСТВИИ АНАМНЕЗА ИНФАРКТА МИОКАРДА (ДАННЫЕ РЕГИСТРОВ РЕГИОН)

AIM. Within the framework of outpatient and hospital registers of REGION (REGIster of patients who have undergone acute cerebrovascular accident) to carry out a comparative assessment of demographic and clinical-anamnestical characteristics, medical treatment and outcomes in clinical practice in patients with a combination of undergone acute cerebrovascular accident (ACVA) and atrial fibrillation (AF) in the presence or absence of myocardial infarction (MI) in the medical history.MATERIAL AND METHODS. Outpatient registers REGION (Ryazan) and hospital register REGION (Moscow) included 1886 patients who have undergone ACVA (age 70.6 ± 12.5 years, 41.9% of men), of them 516 (27.4%) people with AF. Comparison groups included 152 (8.1%) patients with a combination of ACVA, AF and MI in medical history (ACVA + AF + MI group) and 364 (19.3%) patients with ACVA, AF without MI (ACVA + AF without MI group). The presence of cardiovascular diseases (CVD), concomitant diseases, drug therapy and outcomes were analyzed.RESULTS. In the group of ACVA + AF + MI patients, compared to the ACVA + AF without MI group, the share of patients with AH (100% and 97.2%), IHD (100% and 87.1%), CHD (68.4% and 57.1%), repeated ACVA (36.9% and 23.9%), diabetes mellitus in women (39.5% and 20.4%) was statistically significantly higher. In the comparison groups, the share of smokers (13.3% and 15.5%), patients with burdened heredity of early development of CVDs (2.1% and 1.1%) and hypercholesterolemia (41.1% and 50.0%) did not differ significantly, however, in the group of ACVA + AF + MI, in comparison with the group of ACVA + AF without MI, there was a higher risk on the CHA2DS2-VASc scale (5.26 ± 1.32 and 4.09 ± 1.44; p < 0.001) and HAS-BLED scale (1.91 ± 0.76 and 1.62 ± 0.79; p < 0.01). Patients with AF of REGION register, both with and without MI, had insufficient frequency of proper medical prescriptions for CVDs (46.6% and 38.9% on average), especially prescription of anticoagulants (19.1% and 21.4%), statins in case of IHD (33.6% and 27.4%) and beta-adrenoblockers in case of CHD (39.4% and 35.6%).  During the four-year period of observation, in comparison with post-stroke patients without a history of MI, the mortality rate for all causes was 1.5 times higher (56.6% and 37.6%, p = 0.0001), the incidence of non-fatal MI was higher (2.0% and 0.3%,p = 0.04). CONCLUSION. Patients with a combination of ACVA, AF and MI history are a very high risk group for adverse outcomes observed on an outpatient stage. For these patients it is very important to improve the quality of drug therapy and the effectiveness of secondary prophylaxis.ЦЕЛЬ. В рамках амбулаторных и госпитального регистров РЕГИОН (РЕГИстр больных, перенесших Острое Нарушение мозгового кровообращения) провести сравнительную оценку демографических и клинико-анамнестических характеристик, медикаментозного лечения и исходов в клинической практике у больных с сочетанием перенесенного острого нарушения мозгового кровообращения (ОНМК) и фибрилляции предсердий (ФП) при наличии или отсутствии инфаркта миокарда (ИМ) в анамнезе.МАТЕРИАЛ И МЕТОДЫ. В амбулаторные регистры РЕГИОН (Рязань) и в госпитальный регистр РЕГИОН (Москва) включено 1886 пациентов, перенесших ОНМК (возраст 70,6 ± 12,5 лет, 41,9% мужчин), из них с ФП 516 (27,4%) человек. Группы сравнения составили 152 (8,1%) пациента с сочетанием перенесенного ОНМК, ФП и ИМ в анамнезе (группа ОНМК + ФП + ИМ) и 364 (19,3%) больных с ОНМК, ФП без анамнеза ИМ (группа ОНМК + ФП без ИМ). Проанализированы наличие сердечно-сосудистых заболеваний (ССЗ), сопутствующих заболеваний, медикаментозная терапия и исходы.РЕЗУЛЬТАТЫ. В группе пациентов ОНМК + ФП + ИМ, по сравнению с пациентами группы ОНМК + ФП без ИМ, была статистически значимо выше доля лиц с АГ (100% и 97,2%), ИБС (100% и 87,1%), ХСН (68,4% и 57,1%), повторного ОНМК (36,9% и 23,9%), сахарного диабета у женщин (39,5% и 20,4%). В группах сравнения доля курящих (13,3% и 15,5%), пациентов с отягощенной наследственностью раннего развития ССЗ (2,1% и 1,1%) и гиперхолестеринемией (41,1% и 50,0%) существенно не различалась, однако в группе ОНМК + ФП + ИМ, по сравнению с группой ОНМК + ФП без ИМ, был выше риск по шкале СHA 2DS2–VASc (5,26 ± 1,32 и 4,09 ± 1,44; p < 0,001) и шкале HAS-BLED (1,91 ± 0,76 и 1,62 ± 0,79; p < 0,01). У больных с ФП регистра РЕГИОН, как с перенесенным ИМ, так и без ИМ, частота должных медикаментозных назначений по поводу ССЗ была недостаточной (в среднем 46,6% и 38,9%), особенно назначения антикоагулянтов (19,1% и 21,4%), статинов при ИБС (33,6% и 27,4%) и бета-адреноблокаторов при ХСН (39,4% и 35,6%). За четырехлетний период наблюдения у больных группы ОНМК + ФП + ИМ, по сравнению с постинсультными пациентами без анамнеза ИМ, смертность от всех причин была в 1,5 раза выше (56,6% и 37,6%, p = 0,0001), чаще развивался нефатальный ИМ (2,0% и 0,3%, р = 0,04).ЗАКЛЮЧЕНИЕ. Больные с сочетанием перенесенных ОНМК, ФП и анамнеза ИМ являются группой очень высокого риска неблагоприятного исхода при наблюдении на амбулаторном этапе. Для данных пациентов крайне важным является повышение качества медикаментозной терапии и эффективности вторичной профилактики