RESISTANCE TO ACETYLSALICYLIC ACID AND PREVALENCE OF THROMBOSIS IN PATIENTS WITH STABLE ANGINA

Aim. To estimate the prevalence of atherothrombotic complications depending on platelet sensitivity to acetylsalicylic acids (ASA) in patients with stable angina.Material and methods. 96 patients with stable angina of II-III functional classes received basic therapy included ASA (125 mg daily) to prevent atherothrombotic complications. Platelet ability to aggregation was assessed with laser aggregometer. Resistance to ASA was determined, if cumulative index of platelet aggregation (after stimulation with ADF, 5 µmol\l) remain on the level of 50-70% in spite of ASA. Atherothrombotic complications (cardiovascular death, myocardial infarction, unstable angina, cerebral stroke) were registered during 24-36 months.Results. Resistance to ASA was detected in 24% of patients. Atherothrombotic complications were registered in 66% of patients with ASA resistance (myocardial infarction or unstable angina were observed in 14 patients of 21 ones) and in 27% of patients with sensitivity to ASA (myocardial infarction or unstable angina were observed in 19 of 70 ones). Besides, resistance to ASA was associated with high rate of thrombosis of installed stents or coronary artery bypasses.Conclusion. In patients with unstable angina insufficient inhibition of platelet aggregation with ASA is associated with 2, 45 times increase in risk of atherothrombotic complications and higher rate of thrombosis of installed stents or coronary artery bypasses.</p

Assessment of repolarization heterogeneity in myocardial infarction patients by QT interval time variability (dispersion) and dynamics of the first electrocardiogram derivative

Aim. To assess the parameters of QT interval variability and time dynamics of T wave velocity characteristics in patients with ST segment elevation myocardial infarction (STEMI). Material and methods. In total, 116 patients with acute MI (mean age 54,9±8,5 years), who underwent urgent thrombolytic therapy (TLT) with alteplase and were admitted to the emergent cardiology department, were followed up. MI diagnosis was verified according to the recommendations by the Society of Cardiology of the Russian Federation (2007) and the criteria of the universal MI definition (2007). In all patients, an electrocardiogram (ECG) was recorded for 5 minutes, with the assessment of the QT interval time variability, data processing, and creation of the first ECG derivative. Results. The first ECG derivative demonstrates two positive waves in the T wave area of the initial ECG. Waves T1 and T2 reflect smoothed modules of the initial T wave increase and decrease velocity, respectively. Therefore, in STEMI patients, the parameters of the time dynamics of T wave velocity could be assessed by the markers of time heterogeneity of myocardial repolarization. In anterior MI, compared to posterior MI, a significant increase in heart-rate adjusted QT interval dispersion (DQTec/VRV) was registered. In patients with effective vs. ineffective TLT, such parameters as variability range (VR (T2/T1)) and DQTec/VRV were significantly different. The first parameter reflects the time dynamics of wave T morphology, while the second characteristic denotes QT interval variability, adjusted for heart rate and the extent of sinus arrhythmia. Conclusion. The proposed parameters of QT interval time variability and time dynamics of wave T velocity characteristics could be used for the risk stratification in MI patients. This method is faster and less expensive than coronary angiography, as a standard visualization procedure

Blood pressure control in primary care patients with arterial hypertension: analysing the Hypertension Register data

Aim. (1) To investigate clinical characteristics of primary care patients with arterial hypertension (AH), according to the achievement of target blood pressure (BP) levels; (2) to assess the effectiveness of therapeutic measures aimed at achieving target BP and maintaining its long-term control. Material and methods. This retrospective analysis included the data from ambulatory medical records of 5558 AH patients, who attended primary care centres in 2007. Clinical characteristics were compared in patients with achieved vs. non-achieved target BP levels. According to the national AH guidelines (2004), the completeness of examination, pharmaceutical therapy tactics, and frequency of the follow-up were assessed in both groups. Results. Based on the 2007 data, target BP levels were maintained in 28% of AH patients. Mean BP level was 144/87 mm Hg. Patients with optimal BP levels, compared to their peers with inadequate BP control, had significantly (p&lt;0,001) higher prevalence of angina pectoris (40,4% vs. 30,1%, respectively) or previous myocardial infarction (19,4% vs. 8,4%), as well as higher frequency of lipid profile assessment, creatinine measurement, and echocardiography. Mean number of prescribed antihypertensive medications was 2,08 vs. 1,60, respectively. Mean number of clinical visits per year was 4,07 vs. 2,99, while mean interval between the visits reached 72,3 vs. 62,7 days, respectively. Regardless of the target BP achievement, the quality of diagnostic and therapeutic management did not comply with the recommended standards. Conclusion. Patients with optimal BP control were characterised by a more severe clinical course, as well as by a wider scope and higher frequency of diagnostic and therapeutic procedures. At the primary care level, the quality of AH diagnostics and treatment did not comply with the recommended standards; therefore, mean BP levels in the AH Register sample were higher than the target ones

RISK OF RECURRENT THROMBOTIC EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME AND HIGH PLASMA LEVELS OF D-DIMER

Aim. To study the association of plasma D-dimer levels and the risk of thrombotic events in patients hospitalised with acute coronary syndrome (ACS).Material and methods. The study included 70 patients, aged 34-88 years, who were admitted to the Acute Coronary Care Unit with the ACS diagnosis.Results. During the follow-up period, thrombotic events were registered in 12 patients (17%). Three patients with myocardial infarction (MI) suffered recurrent MI. Nine patients were rehospitalised with the unstable angina (UA) diagnosis. All participants were divided into quartiles by the levels of D-dimer (25% percentile 136 ng/ml; median 1250 ng/ml; and 75% percentile 2930 ng/ml). High plasma levels of D-dimer (third quartile) were associated with a 1,5-fold increase in the risk of recurrent thrombotic events among ACS patients.Conclusion. In ACS patients, plasma D-dimer levels could be regarded as one of the additional risk factors of thrombotic events

ASSESSMENT OF MYOCARDIAL REPERFUSION QUALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ST SEGMENT ELEVATION, BASED ON THE CRITERIA BY THE AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION

Aim. To use the criteria by the American College of Cardiology/American Heart Association (ACC/AHA), in order to assess the quality of myocar-dial reperfusion in Russian patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS).Material and methods. We analysed the clinical data of 25682 patients with STE-ACS, who were treated (2010–2011) in Russian hospitals participating in the Russian ACS Registry. The following ACC/AHA indicators (2008) were used: “time to thrombolysis” — the percentage of STE-ACS patients who received thrombolysis within 30 minutes after admission; “time to primary percutaneous coronary intervention (PCI)” — the per-centage of STE-ACS patients in whom primary PCI started within 90 minutes after admission; and “reperfusion” — the percentage of STE-ACS patients who underwent any reperfusion intervention within 12 hours after the chest pain onset.Results. Among 25682 STE-ACS patients, any reperfusion intervention (PCI and/or thrombolysis, in any order) were performed in 12043 (46,9%). Among 7437 STE-ACS patients who underwent thrombolysis, 5119 (69%) met the inclusion criteria. In this group, the indicator “time to thrombolysis” was met in 3342 patients (65,3%). Among 5405 STEACS patients who underwent PCI, 3993 (73,9%) met the inclusion criteria. In these patients, the indicator “time to primary PCI” was met in 2797 (70%). Finally, among 25135 (97,9%) patients with STE-ACS who were included in the analyses, the indicator “reperfusion” was met in 9800 (38,9%).Conclusion. The main problem of the health care for Russian patients with STE-ACS is the limited reperfusion coverage. However, the reperfusion quality could be regarded as satisfactory