Role of glycemic control in elective percutaneous coronary interventions in patients with type 2 diabetes

Aim. To assess the association of glycemic control (achievement of an individual target glycated hemoglobin level) with the outcomes of elective percutaneous coronary interventions in patients with type 2 diabetes (T2D).Material and methods. This cohort observational study included 74 patients with a median age of 61 (57; 64) years. There were 49% of men with a previously established T2D, who had indications for elective primary percutaneous coronary intervention (PCI) for stable coronary artery disease. At inclusion in the study and after 1 month, the concentration of fasting blood glucose, glycated hemoglobin (HbA1c), fructosamine, and serum creatinine were determined. Plasma glucose levels were determined using the hexokinase method. HbA1c level was determined by immunoturbidimetry on a Konelab 30i chemistry analyzer. The concentration of fructosamine was determined by the kinetic colorimetric assay on a Konelab 30i chemistry analyzer. Statistical processing was carried out using the Statistica 10.0 program from StatSoft, Inc. (USA).Results. At the time of enrollment, 31% of participants had not achieved the target glycated hemoglobin level against the background of nonoptimal hypoglycemic therapy in most cases. A total of 18 (25%) following adverse cardiovascular events were registered within 12 months after PCI: 11 (15%) patients developed acute coronary syndrome; among them, 6 (8%) patients had stent restenosis according to coronary angiography, 4 (6%) patients — progression of atherosclerosis, which required repeated PCI with stenting of another vessel, 2 (3%) patients — cerebrovascular accident, and 3 (4%) patients were hospitalized due to de compensated heart failure. According to multivariate logistic regression, only the HbA1c level was a predictor of adverse outcomes during the year after PCI — a 1% increase in HbA1c level increased the risk of adverse outcomes by 1,79 times (odds ratio, 1,79, 95% confidence interval, 1,06-3,02, p=0,028). Poor glycemic control 1 month before PCI increased the risk of cardiovascular events by 4,04 times over the next year, while non-target HbA1c level immediately before PCI increased the risk of adverse outcomes by 4,7 times, and 5 months after PCI, by 7,34 times.Conclusion. The significance of non-target glycated hemoglobin level for adverse outcomes during the year after elective PCI against the background of T2D was established with an increase in the negative effect as long-term (after myocardial revascularization) maintenance of poor glycemic control

НЕСТАБИЛЬНЫЕ АТЕРОСКЛЕРОТИЧЕСКИЕ БЛЯШКИ КОРОНАРНЫХ АРТЕРИЙ У ПАЦИЕНТОВ СО СТАБИЛЬНОЙ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА

Background. Acute coronary syndrome remains the leading cause of death worldwide. The rupture of vulnerable atherosclerotic plaque in the coronary artery is a common pathogenetic mechanism contributing to the onset of acute coronary syndrome. Therefore, one of the main goals of the practical cardiology is to ensure the development of sensitive early diagnostic methods and set preventive and treatment strategies for acute coronary event. Aim To evaluate the incidence of vulnerable plaques in the non-target coronary arteries in patients with stable coronary artery disease.Methods. 58 patients with stable coronary artery disease were included in a prospective observational cohort study. After the target vessel had been stented, virtual histology intravascular ultrasound (VH-IVUS) of the proximal and middle segments (6–8 cm) of one non-target artery (i.e. without any significant stenotic lesions on coronary angiography) was performed.Results. The mean age of patients was 60.4±6.6 years. In addition to the targeted hemodynamically significant lesions subjected to stenting, 56 patients had 58 lesions (96.5%) in the non-target coronary arteries. Of them, 5 lesions (8.6%) were with >70% luminal stenosis (including >70% luminal stenosis + lumen area <4 mm2 in 4 cases), 10 lesions (17.2%) – with minimum lumine area <4 mm2 and without any other signs of vulnerable plaque, 12 lesions (20.7%) – with a large necrotic core and a thin cap (including thin-cap fibroatheroma + >70% luminal stenosis in 2 patients; thin-cap fibroatheroma + lumen area <4 mm2 – 2 cases, thin-cap fibroatheroma + >70% luminal stenosis + lumen area <4 mm2 – 2 cases).Conclusion. In vivo evaluation of the plaques in the non-target vessels ensures the detection of vulnerable plaques in stable patients. The long-term follow-up of the study group allows assessing the risk of developing adverse cardiovascular events in those patients who have vulnerable coronary plaques.Актуальность. Острый коронарный синдром остается ведущей причиной смерти. Патогенетическую основу острого коронарного синдрома в большинстве случаев составляет разрыв нестабильной атеросклеротической бляшки в коронарной артерии. Одной из важных задач практической кардиологии является разработка способов своевременного выявления этих бляшек с целью определения мер профилактики острого коронарного события и выбора оптимальной стратегии лечения.Цель. Определение частоты встречаемости нестабильных бляшек в нецелевых коронарных артериях у пациентов со стабильной ишемической болезнью сердца.Материалы и методы. В проспективное обсервационное когортное исследование включены 58 пациентов со стабильной ишемической болезнью сердца. После стентирования целевого сосуда выполнено внутрисосудистое ультразвуковое исследование с виртуальной гистологией проксимального и среднего сегментов (6–8 см) одной нецелевой артерии, в которой отсутствовали значимые стенотические поражения по данным коронарографии.Результаты. Средний возраст пациентов – 60,4±6,6 лет. Помимо целевых гемодинамически значимых поражений, подвергнутых стентированию, у 56 пациентов выявлено 58 поражений (96,5%) в нецелевых коронарных артериях. Из них 5 поражений (8,6%) стенозировали просвет сосуда более чем на 70% по площади (в том числе из них стеноз по площади >70% + площадь просвета <4 мм2 в 4 случаях), 10 поражений (17,2%) имели минимальную площадь просвета менее 4 мм2 и не имели сочетания с любым другим признаком нестабильной бляшки, 12 поражений (20,7%) имели крупное некротическое ядро с тонкой покрышкой (в том числе тонкокапсульная фиброатерома + стеноз по площади >70% у 2 пациентов; тонкокапсульная фиброатерома + площадь просвета <4 мм2 – 2 случая; тонкокапсульная фиброатерома + стеноз по площади >70% + площадь просвета <4 мм2 – 2 случая).Заключение. Прижизненная оценка состояния бляшек нецелевой коронарной артерии позволяет обнаружить нестабильные бляшки у стабильных пациентов. Отдаленное наблюдение позволит определить риск развития неблагоприятных кардиоваскулярных событий у исследуемых пациентов с выявленными нестабильными коронарными бляшками

НОВАЯ КОРОНАВИРУСНАЯ БОЛЕЗНЬ (COVID-19) И СЕРДЕЧНО- СОСУДИСТЫЕ ЗАБОЛЕВАНИЯ

The management of these patients requires healthcare professionals to have specific knowledge on the characteristics of the viral infection, its clinical signs and symptoms combined with cardiovascular diseases, as well as individual and collective prevention measures. The safety of healthcare professionals and favorable prognosis of patients are of the top priority for the modern healthcare system.The review discusses current challenges associated with the novel coronavirus disease COVID-19 and cardiovascular diseases. The results of few clinical trials and individual case reports have shown the presence of certain problems in treating patients with comorbidity and viral infection. The new data on the drug interactions are reported. Common patterns of typical cardiovascular diseases and COVID-19 are presented. The risk groups with the need for timely diagnosis and intensive cardiac care are identified to prevent adverse outcomes in patients with this comorbidity.В обзоре представлены актуальные проблемы сочетания новой коронавирусной инфекции COVID-19 и сердечно-сосудистых заболеваний. Обсуждаются результаты немногочисленных клинических исследований и отдельных клинических случаев, иллюстрирующих сложности ведения пациентов с вирусной инфекцией и сопутствующей патологией. Обозначены данные по лекарственным взаимодействиям антивирусных и сердечно-сосудистых препаратов. Представлены возможные клинические картины наиболее типичных сочетаний распространенных сердечно-сосудистых заболеваний и COVID-19. Выделены пациенты группы риска с необходимостью оказания интенсивной лечебно-диагностической помощи во избежание неблагоприятного исхода коморбидности

Structure of herd immunity to SARS-COV-2 in the Krasnoyarsk region population in the COVID-19 epidemic

Purpose. Determination of the SARS-CoV-2 population humoral immunity among the population of the Krasnoyarsk Territory during the COVID-19 epidemic.Materials and methods. The study was carried out as a part of project for assessing population immunity to SARS-CoV-2 among the population of Russian Federation using unified methodology developed by Rospotrebnadzor, with the participation of the Research Institute for Epidemiology and Microbiology named by Pasteur, and taking into account the recommendations of the WHO. The work involved 2907 volunteers, selected by the online survey and randomization by age and territory. All volunteers were divided into 7 age groups: 1–17, 18–29, 30–39, 40–49, 50–59, 60–69, 70 and older (70+), including a total 246–449 people. Population immunity testing was carried out during the formation of groups (1st stage), and then twice more, with the interval of 6–8 weeks. Serum was obtained from venous blood samples obtained from volunteers, in which antibodies to the SARS-CoV-2 nucleocapsid were determined by the enzyme immunoassay. The results were analyzed by methods of nonparametric statistics: median, interquartile range, rank correlation coefficient were calculated in the Excel statistical package. The confidence interval to seroprevalence indicators (95% CI) was calculated using the WinPepi statistical package (version 11.65). The statistical significance of the differences was assessed with a probability level of p ≤ 0.05.Results. The seroprevalence of the population of the Krasnoyarsk Territory during the 5-month period of seromonitoring had increased 3.3 times from 12.8% (95% CI 11.3–14.4) to 41.7% (95% CI 39.4–4.0) , while the grouping by age had not revealed any peculiarities throughout the study. The trend towards a decrease in the incidence was formed on the 6th week of 2021. The seroprevalence of convalescents after COVID-19 during the initial testing was 61.5% (95% CI 40,6–79.8), among those who were in contact with patients with COVID-19 or convalescents –23.8% (95% CI 13.9–36.2) . Among the volunteers, 347 seropositive persons were identified, 324 of which were observed asymptomatic course.Conclusion. The structure of the population humoral immunity to SARS-CoV-2 of he population of the Krasnoyarsk Territory has been investigated. It was found that an increase in seroprevalence to 41.7% (95% CI 39.4–4.0) was accompanied by a decrease in morbidity

Новости конгресса Американского колледжа кардиологов в 2020 году

The American College of Cardiology and the World Heart Federation jointly hosted Abt t           the 69th Congress of the American College of Cardiology (АСС) that took place in March 28-30, 2020. It was the first remote annual meeting due to the COVID-19 pandemic. However, it didn’t prevent healthcare professionals from 135 countries to participate in the virtual meeting. The employees of the Research Institute for Complex Issues of Cardiovascular Diseases and the Department of Cardiology and Cardiovascular Surgery of the Kemerovo State Medical University took active part in the virtual live sessions and reports in this article novel evidences from recently completed international clinical trials that were presented at the 69th Congress. The Congress organizers opened a free access to the video, abstracts, slides and workshops in 10 main clinical learning pathways till June 2020.28-30 марта 2020 г. состоялся 69-й конгресс Американского колледжа кардиологов (AmericanCollegeofCardiology, АСС) совместно со Всемирным конгрессом кардиологов. Впервые в истории ACC заседания прошли в формате онлайн в связи с пандемией коронавируса COVID-19. Однако это не помешало специалистам из 135 стран присоединиться к виртуальной встрече. Сотрудники НИИ КПССЗ и кафедры кардиологии и сердечно-сосудистой хирургии КемГМУ участвовали в интернет-сессиях и представляют в данной статье наиболее важные результаты исследований, впервые озвученные в рамках 69-го конгресса АСС. Организаторы конгресса открыли бесплатный доступ к материалам конференции по десяти основным направлениям до июня 2020 г

Innovation, technology and user experience in museums: insights from scientific literature

Museums play an important role in preserving the heritage and cultural legacy of humanity, however, one of their main weaknesses in regards the user is their static nature. At present, and in the face of the development of diverse technologies and the ease of access to information, museums have upgraded their implementation of technologies aimed at improving the user experience, trying more and more to access younger audiences with a sensitivity and natural capacity for the management of new technologies. This work identifies trends in the use of technological tools by museums worldwide and the effect of these on the user or visitor experience through a review of scientific literature. To complete the work, we performed a search of the publications in the Scopus® referencing database, and downloaded, processed, and visualized the data using the VOSviewer® tool. The main trends identified in this context of analysis are related to the role of museums with the development and improvement of the user experience; orientation to young audiences and innovation driven by the user through Interactive Systems, digital games, QR Codes, apps, augmented reality, virtual reality and gamification, among others. The objective of the implementation of new technologies in the context of museums is to satisfy the needs of contemporary communication, for all types of content and aimed at an increasingly digital audience, in order to ensure positive interaction and feedback from ideas with social and cultural changes

ИНФАРКТ МИОКАРДА ВТОРОГО ТИПА: СОВРЕМЕННЫЕ ОСОБЕННОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ

Aim. To determine the frequency of detection of patients with myocardial infarction (MI) type 2 and their features in real clinical practice.Methods. A prospective study of 204 patients diagnosed with acute coronary syndrome (ACS) was performed. Diagnosis of ACS at admission followed by a confirmed diagnosis of MI during the hospital period according to the Fourth Universal Definition of MI. The following were analyzed: anthropometric parameters, clinical and anamnestic characteristics of patients, results of laboratory research methods, determination of biochemical markers of myocardial necrosis, results of instrumental diagnostic methods and coronary angiography. The annual follow-up stage was carried out in the form of a telephone survey of patients with a follow-up of dynamic features during the year after ACS (presence of endpoints: repeated coronary events, death, repeated hospitalizations, adherence to medical recommendations, therapy taken by the patient).Results. Type 2 MI was diagnosed in 22 (10.8%) cases. The results of coronary angiography demonstrated the absence of coronary artery (CA) in 16 (72.7%) patients of this group or the presence of stenoses of less than 50% without indications of the presence of thrombosis. Chronic occlusion of the infarct-unrelated coronary artery was found in 6 (27.3%) patients. Patients with type 2 MI were comparable in age with the group of patients with type 1 MI. Differences were female predominance (p = 0.029), fewer smokers (p = 0.037) and more frequent history of atrial fibrillation (AF) (p = 0.003). The most frequent provoking factors of type 2 MI were determined: sinus tachycardia in 3 (13.6%) patients, flutter paroxysm or AF with tachysystole for the ventricles in 4 cases (18.2%).Conclusion. A less favorable course of the disease was found in patients with type 1 MI. A feature of the post-infarction period in this case was the greatest number of recurrent MI and deaths during the year compared with patients after type 2 MI, which were characterized by a predominance of women, a smaller number of smokers and people with dyslipidemia, as well as a more frequent indication of the presence of AF.Основные положенияВыявлены особенности отдаленного постинфарктного периода у больных инфарктом миокарда 2-го типа в виде благоприятного течения при сравнении с больными ИМ 1-го типа. Определены различия клинико-анамнестических данных пациентов с ИМ 1-го и 2-го типа. Аннотация:Цель. Определить частоту выявления пациентов с инфарктом миокарда (ИМ) 2-го типа и их особенностей в реальной клинической практике.Материалы и методы. Проведено проспективное исследование 204 пациентов с диагнозом «острый коронарный синдром (ОКС)». В исследование вошли лица с установленным при поступлении ОКС и последующим диагнозом ИМ, подтвержденным в госпитальном периоде согласно Четвертому универсальному определению ИМ. Проанализированы антропометрические показатели, клинико-анамнестические характеристики пациентов, результаты лабораторных методов исследования, биохимические маркеры некроза миокарда, результаты инструментальных методов диагностики и коронароангиографии. Годовой этап наблюдения осуществлялся в виде телефонного опроса пациентов с целью отслеживания динамических особенностей в течение года после перенесенного ОКС (наличия конечных точек: повторных коронарных событий, летального исхода, повторных госпитализаций по причине кардиальных и внекардиальных событий; приверженности врачебным рекомендациям и принимаемой терапии).Результаты. Диагноз ИМ 2-го типа установлен в 22 (10,8%) случаях. Результаты коронарографии продемонстрировали отсутствие поражения коронарных артерий у 16 (72,7%) больных этой группы или наличие стенозов менее 50% без указаний на тромбоз. Хроническая окклюзия инфаркт-несвязанной коронарной артерии обнаружена у 6 (27,3%) пациентов. Пациенты с ИМ 2-го типа оказались сопоставимы по возрасту с группой больных ИМ 1-го типа. Отличия заключались в преобладании лиц женского пола (p = 0,029), меньшем количестве курящих пациентов (p = 0,037) и более частом указании на наличие фибрилляции предсердий в анамнезе (p = 0,003). Определены факторы, наиболее часто провоцирующие ИМ 2-го типа: синусовая тахикардия – у 3 (13,6%) пациентов, пароксизм трепетания или фибрилляции предсердий с тахисистолией желудочков – в 4 (18,2%) случаях.Заключение. Выявлено менее благоприятное течение заболевания у пациентов, перенесших ИМ 1-го типа. Особенностью постинфарктного периода в данном случае стало наибольшее количество повторных ИМ и летальных исходов в течение года по сравнению с пациентами после ИМ 2-го типа, которые характеризовались преобладанием женщин, меньшим количеством курящих и лиц, имеющих дислипидемию, а также более частым указанием на наличие фибрилляции предсердий