Acute Coronary Syndrome after Percutaneous Coronary Intervention: State of the Problem and Clinical Practice Data

Aim. To study the prevalence, clinical and endovascular predictors, causes and timing of the development of acute coronary syndrome (ACS) in patients who had previously undergone percutaneous coronary intervention (PCI), as well as the clinical features of the disease and lipid spectrum parameters.Material and methods. The prospective study included 768 patients successively hospitalized from 01.01.2019 to 01.01.2020 in the Regional cardiovascular center, undergoing to emergency coronary angiography.Results. The main group included 768 patients who underwent emergency coronary angiography for ACS. 90 of them had previously undergone PCI (11.7%). Men prevailed (66.7%), the average age was 62 years. 25.5% of patients underwent ACS within a year after coronary stenting, the mean time from PCI to ACS was 43 months. Most often, there was ACS without ST segment elevation (80%). The results of a retrospective analysis of the first PCI showed that 89.7% of patients underwent urgent PCI, 77.8% of patients received bare metal stents. In 67.1% of patients, 1 stent was implanted, the average diameter was 3.2 mm, the average length was 22 mm. Thromboaspiration was performed in 12% of cases, predilatation in 25%, and NC postdilation in 41.3% of cases. Complications of PCI developed in 9% of patients. Stent thrombosis was diagnosed in 7.8% of cases, significant restenosis in 35.6%. Repeated stenting due to ACS was performed in 64.4% of patients, of which 74.6% received 1 stent; average diameter 3.4 mm, average length 24.0 mm. Predilatation was performed in 52.9% of cases, thromboaspiration – in 41.2%, and NC-postdilation – in 86.7% of cases. Complications of PCI developed in 10%. In addition, 99% of patients had significant dyslipidemia. The average cholesterol level was 4.91 mmol/L, the average low-density lipoprotein level was 2.94 mmol/L.Conclusion. Patients after PCI are 12% of group with ACS in clinical practice of the Regional Vascular Center. The most common predictor of recurrent atherothrombotic events is bare metal stent implantation as well as dyslipidemia

Comparative prevalence of atopic sensitization in the border areas between Russia and Finland

Current century has been highlighted with rise in allergic pathology, and environment markedly affects it via epigenetic mechanisms. Allergy research in Russia and Finland has been conducted for many years, of larger scale recorded in the latter, still being maintained over time. Atopy prevalence was studied in the border areas in both countries. The level of total, dietary, inhaled IgE level, as well as dietary and inhalation range were examined. The Phadiatop® radio allergen sorbent test was used (UniCAP 1000 v.2; Pharmacia Upjohn, Uppsala, Sweden), with cut-off point: IgE > 110 kUA/l and sIgE > 2.5 kUa/l and 0.35 kUA/l. The study was subdivided into 2 stages conducted during 2003 and 2010/2012 timeframe. Stage 1 was performed with children from Finland (n = 344), Russia (n = 427), aged 7—15 years, whereas stage 2 — 180 subjects (Finland, n = 98, Russia, n = 82). Results. It was found that total IgE level was higher in children from Finland. The inhaled sIgE in 2003 and 2010/2012 was higher among children from Finland, p = 0.019 and p = 0.027, showing temporal elevation. In 2003, dietary sIgE was higher among those from Finland (27.6% and 18.3%), p = 0.142, whereas in 2010/2012 it was decreased by 2- and 3-fold in subjects from Finland and Russia, respectively. In 2003, high atopy rate against dust mites, cats, timothy, birch, and dogs was found in Russia, which was increased at stage 2. Such parameter was most evidently elevated for timothy — by 2-fold, p = 0.176, wormwood — by 2-fold, p = 0.312, equine allergens — by 2-fold, p = 0.563, canine allergens — by 1.5-fold, mite — by 1.5-fold, p = 0.220. In 2003, atopy rate in Finland to canine allergens reached 26.5%, timothy — 24.5%, birch — 20.4%, feline allergens — 20.4%. In 2010, it was noted rise in atopy rate mainly to dust mites — by 2-fold, equine allergens — by 2-fold. In 2003, atopy rate in Russia to egg, milk, and wheat prevailed, whereas in Finland it was mostly found against milk, nuts, wheat, eggs, in both cases declined in dynamics. Interestingly, no sensitization to fish in subjects from Russia and Finland was observed at both stages. Finally, at the stage 2 dietary atopy rate was declined in both countries. Differences in atopic sensitization as well as during 7—9 year follow-up observation were preserved between both subject cohorts from Finland and Russia

Principles of healthcare management for patients with pulmonary hypertension: focus on continuity

In managing care for patients with rare, rapidly progressive pathologies such as pulmonary hypertension (PH) and chronic thromboembolic hypertension (CTEPH), early diagnosis and speed of routing are of particular importance. Reducing the time spent on patient routing reduces the risk of disease progression, the rate of hospitalizations, and thereby the socioeconomic burden of the disease.In the Republic of Karelia, an algorithm for routing patients with PH and CTEPH has been created, which is an example of a successful healthcare management

Efficacy and safety of the use of alirocumab in real clinical practice

Aim. To evaluate the results of two-year use of alirokumab in Karelia Republic. Materials and methods. The observation group consisted of 27 patients (17 patients with familial hypercholesterolemia, 10 patients with the history of myocardial infarction), mean age 53.44.3 years, 70.3% men, follow-up duration from one year to 2.5 years, 18 (66.6%) patients received therapy for more than 2 years. 19 patients received alirocumab at a dose of 75 mg/ml once every 2 weeks, eight at a dose of 150 mg/ml once every 2 weeks. Before the start of therapy, the majority received maximally tolerated statin therapy, 10 patients received statin therapy in combination with ezetemibe, 3 patients received ezetemibe monotherapy due to statin intolerance. The target levels of LDL cholesterol were considered for very high risk patients less than 1.4 mmol/L, high risk less than 1.8 mmol/L, extreme risk less than 1 mmol/L. Results. The reduction of LDL on therapy with alirocumab was 58%; target levels of LDL were achieved in 77.8%. The level of decrease in LDL cholesterol less than 50% was noted only in 7.4% of cases. Patients requiring a large dose of the drug were classified as very high risk, had higher cholesterol and LDL-C levels. The level of Lp(a) decrease on 29.7% by 612 months. No destabilization of coronary heart disease, new cases of stroke were registered. Conclusion. The inclusion of alirocumab in the treatment regimen contributed to the stable course of atherosclerosis-associated diseases, the achievement of LDL cholesterol targets in 77.8% of patients, was not accompanied by side effects during 2.5 years therapy

Проблема остеопороза у больных ревматоидным артритом

Objective. To estimate the frequency and degree of osteopenia and osteoporosis (OP) in patients with rheumatoid arthritis (RA) versus those in patients with osteoarthrosis (OA). Subjects and methods. The study included 150 patients aged above 18 years with the valid diagnosis of RA or OA, in whom the risk factors of OP were assessed. Bone mineral density (BMD) (the relative units were T test) of the lumbar spine in the frontal projection (LII-LIV) and the proximal femur (head, neck, WardXs region, and greater trochanter) were determined in all the patients by dichromatic X-ray absorption on a LUNAR DPX-NT densitometer. Results. A high frequency of osteopenia and OP predominantly due to BMD loss in the WardXs region and lumbar spine was observed in post-menopausal patients with RA. In postmenopausal patients with OP, osteopenia was commonly detectable at the level of the hip or vertebral column and OP was more characteristic for the lumbar portion. Regression analysis showed that among the postmenopausal patients with RA, women over 60 years of age, with low body mass index in the greater trochanter, and high disease activity in the femoral neck were at the highest risk for OP in the femoral neck and lumbar spine. Conclusion. The risk of osteopenia and OP is higher in RA than that in OA, low body mass index, old age, high disease activity, and a more severe disabling functional class RA being the most important risk factorsЦель исследования. Оценка частоты и выраженности остеопении и остеопороза (ОП) у больных ревматоидным артритом (РА) в сравнении с таковыми при остеоартрозе (ОА). Материал и методы. В исследование включено 150 пациенток старше 18 лет с достоверным диагнозом РА или ОА, у которых оценивали факторы риска ОП. У всех больных определяли минеральную плотность костной ткани МПКТ (относительные единицы - Т-критерий) поясничного отдела позвоночника в прямой проекции (LII-LIV) и проксимального отдела бедренной кости (головка, шейка, область Варда и большой вертел) методом дихроматической рентгеновской абсорбциометрии на денситометре LUNAR DPX-NT. Результаты исследования. У больных РА в постменопаузе отмечена большая частота остеопении и ОП, преимущественно за счет потерь МПКТ в области Варда и поясничном отделе позвоночника. У больных ОА в постменопаузе остеопения часто выявлялась на уровне как бедра, так и позвоночника, а ОП был более характерен для поясничного отдела позвоночника. По данным регрессионного анализа, среди пациенток в постменопаузе, страдающих РА, наибольший риск развития ОП в области шейки бедра и поясничном отделе позвоночника имеют женщины старше 60 лет, в области большого вертела и шейки бедра - пациентки с низким индексом массы тела, а в области шейки бедра - с высокой активностью заболевания. Заключение. При РА по сравнению с ОА выше риск развития остеопении и ОП, при этом самыми значимыми факторами риска оказались низкий индекс массы тела, пожилой возраст, высокая активность и более тяжелый функциональный класс Р

Анкилозирующий спондилоартрит в ревматологической практике Карелии

The paper describes the pathological aspects of an inflammatory process in ankylosing spondyloarthritis (AS), the role of muscle spasm in maintaining the intensity of pain syndrome and stiffness, the need for the early diagnosis of AS, and the significance of the early use of nonster-oidal anti-inflammatory drugs in these patients. The results of clinical trials and the authorsX data demonstrate the high efficacy and good tolerance of nimesulide (nise) in AS.Представлены патоморфологические аспекты воспалительного процесса при анкилозирующем спондилоартрите (АС), роль мышечного спазма в поддержании интенсивности болевого синдрома и скованности, необходимость ранней диагностики АС, значение раннего применения нестероидных противовоспалительных препаратов у таких пациентов. Результаты клинических исследований и собственные данные авторов демонстрируют высокую эффективность и хорошую переносимость нимесулида (найз) при АС

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

ASSESSMENT OF RELATIONSHIP FOR GRACE SCORE AND CORONARY LESION SEVERITY IN YOUNG PATIENTS WITH ACUTE CORONARY SYNDROME

Aim. The analysis of relationship between coronary arteries lesion, patients’ age, type of acute coronary syndrome (ACS) and risk level by GRACE.Material and methods. Totally, 179 patients included at the age 24-65 y.o. (mean age 51,2±7,0), hospitalized for ACS. All patients underwent coronary angiography during hospitalization.Results. In ST elevation ACS two-vessel disease was more common (28,6%), comparing to those with non-ST ACS (15,1%), р=0,031. Regardless the correlation of GRACE risk with age, there was no relation of coronary lesion with age in our study. Mean calculated points by GRACE in non-ST ACS were 95,9±3,3, low risk patients predominated (66,2%). Also, among those with low risk by GRACE, in 48,9% coronary arteriogram showed high risk coronary anatomy.Conclusion. Low calculated risk by GRACE in young patients has low predicting ability for severe coronary lesion, which is important to note in management of non-ST elevation ACS