Early Postinfarction Angina Research Articles

THE ADVANTAGES OF SYDNONIMINES COMPARED TO NITRATES IN THE TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AND CORONARY INSUFFICIENCY

One of the primary challenges in treating patients with coronary artery disease and coronary insufficiency using nitrates is the development of tolerance. Nitrate tolerance is a condition in which the duration and intensity of anti-anginal and anti-ischemic effects decrease, despite maintaining a high concentration of the drug in the blood. In cases of developing tolerance, a continual increase in the nitrate dose is necessary to achieve the previous effect. To eliminate developed nitrate tolerance, discontinuing nitrates for 3-5 days is typically sufficient. Currently, molsidomine is employed as an alternative to nitrates, with sydnonimines emerging as a noteworthy substitute. Among sydnonimines, molsidomine (marketed as Sydnopharm, Dilasidom, Corvaton) stands out as the most effective. Despite its chemical distinction from nitrates, molsidomine operates through a similar mechanism. Functioning as a nitric oxide donor, this antianginal drug avoids the development of tolerance even with prolonged use. Molsidomine, akin to nitrates, acts as a vasodilator, exhibiting efficacy as an anti-ischemic and anti-anginal medication when administered in appropriate doses. Upon entering the human body, molsidomine undergoes hepatic metabolism, transforming into an active derivative compound known as SIN-1. This metabolite, upon entering the bloodstream, further converts into an active form (SIN-1A). From this active metabolite, the nitric oxide (NO) group is released, influencing the activation of guanylate cyclase. This activation prompts guanosine triphosphate to convert into cyclic guanosine triphosphate, ultimately contributing to the synthesis of proteins that bind calcium. This cascade of events results in the vasodilatory effect of molsidomine. Indications for molsidomine include stable angina pectoris, acute coronary syndrome, early post-infarction angina, congestive heart failure, portal hypertension, pulmonary hypertension, and Aerz's disease. Possible side effects following the therapy with molsidomine (dizziness, headache, and diplopia) occur much less frequently compared to nitrates. After using nitrates, such a side effect as methemoglobinемia may occur. Therapy with molsidomine does not lead to the development of this side effect.

Clinical and prognostic value of leptin resistance in the hospital period of myocardial infarction

Aim. To evaluate the prevalence of leptin resistance (LR) and its clinical and prognostic value in association with metabolic disorders and features of the proinflammatory state in the hospital period of myocardial infarction.Materials and methods. The study included 114 men diagnosed with ST segment elevation myocardial infarction (MI). On day 1 and 12 of MI, the levels of leptin and leptin receptor were measured in patients, and the free leptin index (FLI) was calculated. Leptin resistance (LR) was recorded at leptin > 6.45 ng / ml and FLI > 25. A comparative analysis of clinical and anamnestic characteristics, biochemical parameters, and cardiovascular prognosis was carried out between patients with and without LR. Statistical data processing was carried out using the Statistica 10.0 software package and SPSS 17.0 for Windows.Results. The prevalence of LR in the hospital period of MI was 64%. LR was associated with cardiovascular pathology in the family history, arterial hypertension, dyslipidemia, and obesity. The presence of LR was accompanied by a significant increase in the level of glucose, free fatty acids (FFA), and interleukin (IL)-6 on day 1 of MI and by a significant rise in insulin, C-peptide, tumor necrosis factor (TNF)-alpha, and plasminogen activator inhibitor-1 (PAI-1) throughout the hospital stay. Patients with LR were characterized by multi-vessel and more severe lesions of the coronary bed and were more often subject to early post-infarction angina, recurrent MI, rhythm and conduction disturbances during hospital stay for MI.Conclusion. Patients with MI are characterized by high prevalence of LR during the hospital stay. LR is associated with cardiovascular risk factors, metabolic disorders, formation of insulin resistance, and increased proinflammatory and prothrombogenic factors. The identified features in the presence of LR probably contribute to the development of adverse cardiovascular events in the hospital period of MI.

Emergency endovascular treatment of cardioembolic stroke in the early post-infarction period with subsequent direct myocardial revascularization

Introduction. Ischemic stroke (IS) remains one of the significant problems of modern medicine to this day. Cardioembolic stroke (CEI) accounts for 20 % of all cases of IS and is characterized by acuteness, severity of the disease and high mortality.Aim of study. An observation is presented in patient Sh., 51 years old, who was urgently transferred from another medical institution on the 3rd day after the development of acute recurrent anterior myocardial infarction with ST segment elevation complicated by early post-infarction angina pectoris. During the additional examination, in addition to severe multifocal atherosclerosis and multivessel coronary artery disease, a floating thrombus in the cavity of the left ventricle was detected. At the stage of preparing the patient for coronary artery bypass grafting, the patient developed stroke. Thrombextraction from the basilar artery (BA) was performed urgently. As a result, a complete regression of neurological symptoms was achieved. This made it possible to continue the preparation and successfully perform coronary artery bypass grafting. The patient was discharged on the 10th day after the operation, the entire hospitalization period was 28 bed-days.Discussion. In the presented case, a patient with a clinic of unstable angina pectoris, severe multifocal atherosclerosis, and multivessel coronary artery disease was in a specialized multidisciplinary hospital at the time of the development of stroke. The well-coordinated work of the multidisciplinary team, the possibility of performing thromboaspiration in the shortest possible time allowed not only to save the patient's life and achieve complete regression of neurological symptoms, but also to improve the quality of life through surgical treatment of coronary heart disease.

ЛЕПТИНОРЕЗИСТЕНТНОСТЬ И ЕЕ КЛИНИКО-ПРОГНОСТИЧЕСКУЮ ЗНАЧИМОСТЬ ВО ВЗАИМОСВЯЗИ С МЕТАБОЛИЧЕСКИМИ НАРУШЕНИЯМИ В ГОСПИТАЛЬНОМ ПЕРИОДЕ ИНФАРКТА МИОКАРДА

Introduction. Leptin resistance (LR) is characterized by a weakening of the positive metabolic effect of leptin, despite its elevated level, while maintaining some of the pleiotropic effects, including those on the cardiovascular system. However, since most of the data have been obtained in cellular and animal models, the role of LR in cardiovascular diseases remains unclear. The lack of precise diagnostic criteria for assessing LR limits the study of this phenomenon. As a result, data on the incidence and contribution of LR in MI are critically scarce today, in addition, they are extremely contradictory. Purpose: to evaluate the prevalence of LR and its clinical and prognostic significance in conjunction with metabolic disorders in the hospital period of myocardial infarction (MI). Materials and methods. The study included 114 men with an established diagnosis of ST elevation MI. Patients on the 1st and 12th day of MI measured the concentration of leptin, the leptin receptor. The free leptin index (FLI) was calculated as the ratio of leptin concentration (ng/mL) to the concentration of soluble leptin receptor (ng/mL) multiplied by 100. LR was recorded at leptin > 6.45 ng/mL and LL >25. Assessment of glucose, lipid spectrum (total cholesterol, TAG, LDL-C, VLDL-C, HDL-C, FFA) in blood serum was performed using standard test systems from Thermo Fisher Sientific on an automatic biochemical analyzer Konelab 30i (Finland) , the content of C-peptide and insulin were determined using enzyme immunoassay (Monobind, USA) according to the protocol established by the manufacturer. To determine insulin resistance (IR), the QUICKI index was calculated, the severity of IR was assessed according to A. Katz et al. A comparative analysis of clinical and anamnestic characteristics and cardiovascular prognosis between patients with and without PR was carried out. Data analyzed using Statistica 10.0. Results. In patients with MI in the whole group in the hospital period, there was an increased content of leptin relative to the reference interval of 2.0-5.6 ng/ml. On the 1st and 12th days of the disease, the leptin concentration in patients with MI was 11.6 [6.6;20.5] ng/ml and 11.5 [5.4;13.9] ng/ml, respectively. . The content of the leptin receptor did not go beyond the established reference interval. LSI on the 1st day of the disease was 32.7 [14.3; 70.5], on the 12th day - 31.9 [16.2; 64.5]. The prevalence of LR in the hospital period for MI was 64%. LR was associated with CVD risk factors - hereditary burden for cardiovascular pathology (p=0.02), arterial hypertension (p=0.01), dyslipidemia (p=0.001), obesity (p=0.001). When assessing the metabolic profile, a statistically significant increase in the content of glucose (p=0.02), insulin (p=0.02) and C-peptide (p=0.03) on the 1st day of MI, insulin (p=0 .01) and C-peptide (p=0.03) on the 12th day of the disease, a decrease in the QUICKI index (p=0.03) throughout the hospital period in patients with PR compared with patients without PR. In the group of patients with PR, 45 people (61.8%) had a moderate and severe degree of IR, in patients without PR - in 12 patients (29.2%). When conducting a correlation analysis, a significantly significant direct relationship was found between the level of insulin on the 12th day of MI and LSI (r=0.509, p=0.02), as well as an inverse correlation between the QUICKI index on the 12th day and LSI (r= -0.367, p=0.01). Among the studied parameters of lipid metabolism, only the content of FFA on the 1st day of the disease in the group of patients with LR was higher than in the group without LR (p=0.03). Patients with LR were more often prone to early postinfarction angina (p=0.03), recurrent MI (p=0.001), rhythm and conduction disturbances (p=0.03) during the hospital period of MI. Prognostic significance in relation to the risk of adverse cardiovascular events in the hospital period of MI, according to logistic regression analysis, had LSI both on the 1st and 12th days of the disease, as well as FFA levels on the 1st day of the disease. Conclusion. Patients with MI are characterized by a high prevalence of LR in the hospital period. LR is associated with CVD risk factors, metabolic disorders, and IR formation. The identified features in the presence of LR can probably contribute to the development of adverse cardiovascular events in the hospital period of MI.

Twenty-year changes in the clinical and echocardiographic characteristics of patients with early postinfarction remodeling after primary ST-segment elevation myocardial infarction

Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk).Material and methods. The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10th day. Depending on the increase in LV end-diastolic volume (EDV) by >15% by the 7-10th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-).Results. Patients of the 2nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p<0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p>0,05) and an increase in LVEF (p=0,03) before discharge.Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

Association between Frontal QRS-T Angle and Major Adverse Cardiovascular Events among Patients with Acute Myocardial Infarction: A Cross-sectional Study

Introduction: Acute myocardial infarction has reached epidemic proportions in the Indian population. The premature onset of acute myocardial infarction has shifted the focus of research. An abnormal frontal QRS-T angle can be used as a marker of acute myocardial infarction and can also predict Major Adverse Cardiac Events (MACE) such as heart failure, complex ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation), early post-infarction angina, mechanical complications, and cardiac death resulting from acute myocardial infarction. Predicting the likelihood of serious adverse cardiovascular events and mortality in patients who have experienced an acute myocardial infarction aids in developing immediate and short-term treatment plans. Aim: To assess the association between the Frontal QRS-T angle and MACE among patients with Acute Myocardial Infarction (MI). Materials and Methods: A cross-sectional study was conducted on adult patients admitted with a diagnosis of acute MI at the Department of Medicine, BLDE (Deemed to be University) Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 95 patients were enrolled in the study and classified into two groups: Group A (n=68) with a frontal QRS-T angle of <100 degrees, and Group B (n=27) with a frontal QRS-T angle of >100 degrees. The patients were monitored for the emergence of serious MACE such as heart failure, pulmonary oedema, cardiogenic shock, arrhythmias, and death while they were in the hospital. Statistical analysis was performed using the Chisquare test, Independent t-test, and Mann-Whitney U test as applicable. A p-value of <0.05 was considered statistically significant. Results: The most common age group in Group A was 60-70 years, while in Group B it was 50-60 years. A total of 95 patients with acute MI were enrolled and divided into two groups. Out of 95 patients, 68 patients with a frontal QRS-T angle <100 degrees were in Group A, and 27 patients with a frontal QRS-T angle >100 degrees were in Group B. There was a significant difference between the two groups with respect to MACE, including heart failure (Group A=8.8%, Group B=77.8%, p=0.00), pulmonary oedema (Group A=10.3%, Group B=77.8%, p=0.00), and cardiogenic shock (Group A=7.4%, Group B=40.7%, p=0.00). Conclusion: A frontal QRS-T angle of >100 degrees was a reliable factor for assessing in-hospital major adverse cardiac outcomes such as heart failure, pulmonary oedema, and cardiogenic shock. Hence, a frontal QRS-T angle of >100 degrees on a 12-lead ECG is a cost-effective, reliable, and noninvasive parameter of MACE in patients with acute MI.

СОСТОЯНИЕ ФУНКЦИИ ПОЧЕК ПРИ ИНФАРКТЕ МИОКАРДА С РЕЦИДИВИРУЮЩИМИ ЭПИЗОДАМИ ИШЕМИИ У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА

Relevance. Changes in renal function and their significance in reinfarction and early postinfarction angina have not been insufficiently established. Aim. To evaluate renal function changes in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction and/or early postinfarction angina - 110 patients; II - control, without it - 555 patients. A comparative assessment of renal function changes in first 48 hours (1) and the end of third week disease (2), also risk analysis of recurrent ischemia and poor outcome in selected groups were performed. Results. The study group was distinguished by high levels of creatinine1 (0.11±0.03 (mmol/l)), lower - glomerular filtration rate (74.2±20.6 (ml/min/1.73 m2)) from the control (0.10±0.02 (mmol/l) and 78.3±17.9 (ml/min/1.73 m2), respectively; p=0.04). In both groups, there was a deterioration in indicators (creatinine, I: 2.3%; II: 5.9%; glomerular filtration rate - I: -5.8 and -6.3%, respectively; p<0.0001) during the observation period. The risk of recurrent ischemia increases with creatinine1 levels≥0.11 mmol/l and a glomerular filtration rate1˂70 ml/min/1.73 m2. In the study group, the risk of poor outcome is high with normal renal function. In the control group, it increased at creatinine1 levels≥0.10 mmol/l, glomerular filtration rate1˂65 ml/min/1.73 m2. Conclusions. Patients with recurrent ischemia have higher creatinine levels than controls. In both groups, during the study, there was a slight increase in creatinine and a decrease in glomerular filtration rate. The above values of renal function indices should be used in the formation of groups at high risk of early recurrence of ischemia and poor outcomes, as well as for predictive modeling of these complications.

СОСТОЯНИЕ ЛИПИДНОГО ОБМЕНА У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА С ИНФАРКТОМ МИОКАРДА И РЕЦИДИВИРУЮЩИМИ ЭПИЗОДАМИ ИШЕМИИ

Relevance. Dyslipidemia is considered one of the main risk factors for the development of recurrent myocardial infarction and early postinfarction angina. Aim. To evaluate the features of lipid metabolism in acute and subacute myocardial infarction in men under 60 years old with recurrent episodes of ischemia (recurrent myocardial infarction and/or early postinfarction angina) to search for new approaches to improve prevention measures. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 68 patients; II - control, without it - 427 patients. A comparative assessment of lipid metabolism parameters and their dynamics in selected groups were performed. Results. The study group differed in higher levels of total serum cholesterol (6.17±1.78 mmol/l) from the control group (5.56±1.28 mmol/l; p=0.02) at the end of the third week of disease, its dynamics during the observation period (I: 9.1%; p<0.0001; II: -1.8%; p<0.0001) and the dynamics of the atherogenic coefficient (I: -4.7.1; p=0.02; II: 6.3%; p<0.0001). In both groups, the group showed an increase in lipoproteins of low (I: 33.1; p=0.02; II: 45.5%; p<0.0001) and very low density (I: 275.8; p=0,0004; II: 233.4%; p<0.0001), atherogenic indices, decrease: triglycerides (I: -31.8%; p=0.02; II: -1.7%; p<0.0001) and high-density lipoproteins (I: -0.6%; p=0.02; II: -6.1%; p<0.0001). Conclusions. The group with recurrent ischemia is characterized by more pronounced hypercholesterolemia at the end of the subacute period of myocardial infarction in comparison with the control group due to an increase in the concentrations of atherogenic lipid metabolism fractions. The dynamics of indices and the coefficient of atherogenicity during this period is multidirectional, which requires additional study.

ОСОБЕННОСТИ НАРУШЕНИЙ СЕРДЕЧНОГО РИТМА И ПРОВОДИМОСТИ ПРИ ИНФАРКТЕ МИОКАРДА С РЕЦИДИВИРУЮЩИМИ ЭПИЗОДАМИ ИШЕМИИ У МУЖЧИН МОЛОЖЕ 60 ЛЕТ

Relevance. Heart arrhythmia in early postinfarction angina and recurrent myocardial infarction is negatively affected the prognosis of the disease. Aim. To evaluate the peculiarities of heart rhythm and conduction disturbances and electrocardiographic (ECG) changes in men under 60 years old with early postinfarction angina and recurrent myocardial infarction for improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with myocardial infarction type I. Patients were divided into two age-comparable groups: I - study group with recurrent episodes of ischemia (early postinfarction angina pectoris and / or recurrent MI) - 110 patients; II - control, without them - 555 patients. A comparative assessment of heart arrhythmias and electrocardiographic changes observation frequency in the selected groups was performed. Results. In the patients of the study group more often than among all other patients, ventricular fibrillation was observed (8.5 and 3.9%, respectively; p = 0.04), paroxysmal supraventricular tachycardia (5.7 and 1.8%; p = 0.02) and electrocardiographic signs of the right atrium enlargement (9.4 and 1.6%; p ˂ 0.0001). In group I, among the deceased, electrocardiographic signs of left ventricular hypertrophy were more often detected (93.3 and 57.9%; p = 0.02). Arrhythmias that started in the subacute period of myocardial infarction were recorded with the same frequency in both groups of patients (1.4 and 1.6%; p = 0.9). Conclusions. Men under 60 years old with recurrent episodes of ischemia in myocardial infarction are characterized by potentially curable ventricular fibrillation and supraventricular tachycardias. Electrocardiographic signs of left ventricular enlargement were an additional marker of a poor prognosis for these patients. The frequency of occurrence of "late" arrhythmias in this pathology is 1.4%, and the methods of their possible correction require clarification depending on the mechanism of their development.

ОСОБЕННОСТИ ПЕРИФЕРИЧЕСКОЙ ГЕМОДИНАМИКИ У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА С РЕЦИДИВИРУЮЩИМ ТЕЧЕНИЕМ ИНФАРКТА МИОКАРДА

Relevance. Hemodynamics changes in recidivating myocardial infarction and early postinfarction angina are not well understood. In recent years, the frequency of these complications has been increasing. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 102 patients; II - control, without it - 541 patients. A comparative assessment of hemodynamics changes in first 48 hours (1) and the end of third week disease (2), also risk analysis of recurrent ischemia and poor outcome in selected groups were performed. Results. The study group was distinguished by a high level of total peripheral resistance1 (2055.5±965.2 (dyn×sec×cm-5)) from the control (2055.5± 965.2 (dyn×sec×cm-5); p=0.02). In both groups, a decrease in the values of all indicators was noted (p<0.05). A more pronounced decrease in total peripheral resistance was found in the study group, and in the parameters of blood pressure and heart rate - in the control group. The values of total peripheral resistance1 ≥1600 dyne×sec×cm-5 were the markers of the risk of ischemia recurrence. Predictors of poor outcome are blood pressure levels1 (systolic <97; diastolic <70; mean <93.3 (mm Hg)); total peripheral resistance1 <1746.2 dyne×sec×cm-5 and heart rate (˃92 per min). Conclusions. Patients with recurrent ischemia are characterized by higher levels of total peripheral resistance in the first hours of myocardial infarction. For both groups, a decrease in all studied indicators is determined. The above values of hemodynamic parameters should be used in the formation of groups with a high risk of early recurrence of ischemia and an unfavorable outcome, as well as for prognostic modeling of these complications.

THE CLINICAL COURSE OF MYOCARDIAL INFARCTION PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH RECURRENT EPISODES OF ISCHEMIA

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively affects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction clinical features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 79 patients; II - control, without it - 432 patients. A comparative assessment of the myocardial infarction clinical features frequency in selected groups were performed. Results. The studied groups did not differ in the frequency of the main variants of the myocardial infarction course. In patients of the study group more often than in the control group, a complicated course of the disease was observed (88.2 and 50.2%, respectively; p < 0.0001), deaths (13.6 and 3.4%; p < 0.0001). Complications in the study group were dominated by arrhythmias (47.3 and 33.7%; p = 0.007), cardiogenic shock (13.6 and 6.1%; p = 0.006), myocardial ruptures (3.6 and 0.5% ; p = 0.004), thromboembolism (15.5 and 2.2%; p <0.0001), urinary dysfunction (7.3 and 2.5%; p = 0.01), Dressler's syndrome (4.5 and 1.1%; p = 0.009) and mental disorders (16.4 and 5.6%; p < 0.0001). Conclusions. Nonanginal forms of the disease in the study group were observed in 17% of cases. The complications of the disease for group I are characterized by cardiac arrhythmias and conduction disorders, thromboembolism, myocardial ruptures, cardiogenic shock, extracardiac complications of myocardial infarction. The study group has a worse prognosis, which requires early diagnosis, revascularization, the use of auxiliary mechanical devices, and careful implementation of standardized treatment algorithms.

ELECTROLYTIC EXCHANGE FEATURES DURING MYOCARDIAL INFARCTION WITH RECURRENT EPISODES OF ISCHEMIA IN MEN UNDER 60 YEARS OLD

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively effects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction sodium, potassium, chlorides, calcium metabolism, features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 110 patients; II - control, without it - 555 patients. A comparative analysis of blood serum electrolyte levels, their dynamics from the first hours to the end of the third week of myocardial infarction in the selected groups were performed. Their impact on the risk of recurrent ischemia and unfavorable outcome was assessed. Results. In the study group, in the first hours of the disease, the levels of chloride were higher (103.7±5.5 and 101.7±4.7 (mmol/l); p=0.002), and total calcium at the end of the third week of myocardial infarction (2.3±0.2 mmol/l) - lower than in the control (2.46±0.16; p=0.001). With an unfavorable outcome in the study group, the sodium level was lower in the first hours of the disease (138.7±4.9 and 142.7±6.6 (mmol/l); p=0.049). Moreover, the risk of its development was associated with sodium levels ≥148.0 mmol/l (absolute risk: 100.0%; relative - 13.8; p<0.0001) and potassium levels ≥5.3 mmol/l (absolute: 71,4%; relative - 12.4; p<0.0001). The risk of developing recurrent episodes of ischemia in the examined increased at chloride levels ≥104.7 mmol/l (absolute: 28.4%; relative: 3.1; p=0.0001) and sodium ≥139.0 mmol/l (absolute: 19.5%; relative: 1.7; p=0.03) in the first hours of myocardial infarction and calcium (<2.4 mmol/l) at the end of the third week of the disease (absolute: 31.0%; relative: 4.9; p=0.003). Conclusions. The listed combinations of levels of basic electrolytes in blood serum are markers of recurrence of ischemia in myocardial infarction and poor outcome. They should be used to identify risk groups with the necessary preventive measures and for predictive modeling.

CORONARY ARTERIES DAMAGE FEATURES IN IN YOUNG AND MIDDLE-AGED MEN WITH MYOCARDIAL INFARCTION AND RECURRENT EPISODES OF ISCHEMIA

Relevance. Recurrent ischemic events (RIS) adversely affect the duration of treatment and the prognosis of myocardial infarction (MI). Aim. To evaluate the coronary arteries condition in men under 60 years old (y.o.) with RIS and MI to improve understanding of the mechanisms of development and prevention. Material and methods. The study included men 19-60 years old with type I of MI. Patients were divided into two age-comparable groups: I - study group, with RIS (early postinfarction angina pectoris and / or recurrent MI) - 26 patients; II - control, without them - 114 patients. A comparative assessment of angiographic data in the selected groups was performed. Results. Patients in the study group had a greater (15.5%) than in the control (7.9%; p = 0.01) history of coronary artery bypass surgery, the degree of infarction-related artery stenosis (96.9 ± 7.7 and 92.3 ± 10.8%, respectively; p = 0.02). The magnitude of the narrowing of the coronary artery was associated with the coefficient of atherogenicity (r = 0.87; p <0.05), end-systolic (r = 0.53; p <0.05) and diastolic (r = 0.6; p <0, 05) left ventricle (LV) sizes, glomerular filtration rate (r = -0.5; p <0.05) in the first hours of MI, creatinine in the first hours (r = 0.47; p <0, 05) and at the end of the third MI week (r = 0.65; p <0.05). Conclusions. In men under 60 y.о. with RIS during MI, the most pronounced association with a history of coronary artery bypass surgery and a greater lumen narrowing of the infarct-associated artery, which, in turn, increased with impaired renal function and lipid metabolism, and was also associated with LV dilatation.

Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

Relevance. The presence of oncological diseases, high polymorbidity in elderly and senile patients can lead to a complicated course of acute coronary syndrome, including the development of acute kidney injury and/or chronic kidney disease, which contributes to a deterioration of the immediate and long-term prognosis and an increase in mortality.The research purposes. To study the course of acute coronary syndrome depending on the presence or absence of oncological diseases in elderly and senile people and to identify clinical and laboratory-instrumental features.Materials and methods. The study included 200 patients (men — n=122 (61 %), women — n=78 (39 %), Me age — 69 (65;77) years). The patients were divided into two groups: 1) the main group — acute coronary syndrome in combination with oncological diseases (n=100) (men — n=61 (61 %), women — n=39 (39 %), Me age — 69 (65;77) years); 2) the comparison group — acute coronary syndrome without oncological diseases (n=100). The groups were formed by the copy-pair method in a ratio of 1:1 by gender and age. All patients were evaluated for anamnesis parameters, the total number of diseases, the Charlson comorbidity index, the main clinical and laboratory-instrumental parameters and the development of complications. We collected an average portion of morning urine on the first day of hospitalization to determine the content of KIM-1 (pg/ml) in 40 patients of the main group and 47 from the comparison group. We collected daily urine on the 2nd day of hospital treatment to determine the level of K+, Na+, Cl-, uric acid and albumin.The results. Patients of the main group, according to the anamnesis, were more often diagnosed with stable angina (p = 0.042), diabetic kidney disease (p = 0.017), chronic kidney disease (p = 0.013) and anemia (p = 0.008). In addition, these patients had a higher Charleson comorbidity index [8 (6; 9) and 5 (4; 6) points; p <0.001] and a total number of diseases [6 (5; 7) and 4 (3; 5); p <0.001]. Patients with oncological diseases with the development of acute coronary syndrome more often complained of shortness of breath (p=0.008) and heart rhythm disturbance (p=0.004). In patients of the main group a lower left ventricular ejection fraction was diagnosed [51.0 (44; 55) and 54 (48; 57), p=0.013]. Acute kidney injury was more frequently diagnosed in the study group than in the comparison group (p <0.001), including acute kidney injury by “basal” creatinine (p=0.005), acute kidney injury by creatinine dynamics (p=0.047), and acute kidney injury by chronic kidney disease (p=0.003). The KIM-1 leel in patients of the main group was higher [921.0 (425.1; 1314.8) and 658.0 (345.6; 921.4) pg/ml; p=0.011]. In patients with acute kidney injury, in contrast to patients without acute kidney injury, a higher level of KIM-1 was detected [999.2 (480.8;1314.1) and 663.1 (360.5;905.2) pg/ml; p=0.008]. Patients with acute coronary syndrome and oncological diseases in the hospital were more likely to develop urgent complications (p=0.005), including death (p=0.024) and acute heart failure (p <0.001). They also had a higher incidence of early post-infarction angina (p=0.018) and anemia (p=0.005).Conclusions. Our study found that patients in the main group had a higher Charlson comorbidity index, a greater number of diseases, including stable angina, diabetic kidney disease, chronic kidney disease, and anemia. These patients with the development of acute coronary syndrome more often complained of shortness of breath and heart rhythm disturbance. Patients with oncological diseases were more often diagnosed with acute kidney damage, including “basal” creatinine, creatinine dynamics, and chronic kidney disease. The level of KIM-1 in the urine was higher in this group of patients. Patients of the main group in the hospital were more likely to develop urgent complications, including acute heart failure and death. There was also a high incidence of early post-infarction angina and anemia.

Myocardial Infarction in Women of Reproductive age: Risk Factors, Clinical Picture, Prognosis

Aim To study risk factors (RF) and clinical and anamnestic features of the course and prediction in women with a preserved menstrual cycle and postmenopausal women after ST segment elevation (STEMI) and non-ST elevation myocardial infarction (NSTEMI).Material and methods This study included 121 women aged 32 to 55 years diagnosed with MI. The patients were divided into two groups, group 1 (study group) consisting of 60 women with preserved menstrual function (1А, STEMI; n=38; age, 48.3±5.7 years and 1B, NSTEMI; n=22; age. 49.0±4.8 years), and group 2 (control) consisting of 61 postmenopausal women (2А, STEMI; n=43; age, 49.05±4.9 years; 2B, NSTEMI; n=18; age, 49.9±3.5 years). Beside the analysis of RF and clinical features, a prediction was produced for each subgroup at one year after discharge from the hospital based on the following indexes: hospitalization for unstable angina, non-fatal MI, revascularization, cardiovascular (CV) death, and major adverse cardiac events (MACE), which included all these outcomes.Results In all subgroups, the most frequent RFs were arterial hypertension (AH), overweight and obesity, family history, smoking, and type 2 diabetes mellitus (DM2). Among patients with STEMI, smoking was significantly more frequently observed in the group with preserved menstrual function. Oral contraceptives were used by 3 and 6 women of reproductive age in the STEMI and NSTEMI subgroups, respectively. Incidence of STEMI as the onset of ischemic heart disease (IHD, 46.7%) was higher than in subgroup 2A (27.9 %; р=0.003). Early postinfarction angina was a more frequent complication of MI in subgroup 1A than in 2A (р=0.02).Conclusion The incidence rate of RFs, including AH, overweight and obesity, dyslipidemia, family history, and DM2, was similar in both STEMI and NSTEMI groups. Incidence rate of smoking was statistically significantly higher in subgroup 1A. One-year prediction for women with STEMI and NSTEMI was comparable irrespective of the presence or absence of the menstrual function.

INFLUENCE OF FRAILTY SYNDROME ON THE COURSE OF NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME AND OUTCOMES IN ELDERLY AND SENILE PATIENTS

Background . The incidence of non- ST -segment-elevation acute coronary syndrome (NSTEACS) is especially high in elderly. In such patients, concomitant diseases are more common and there is a higher risk of complications, which emphasizes the relevance of the study of frailty syndrome and outcomes in NSTEACS. Objective . The aim of the study was to analyze the effect of frailty on the course of nonST-segment elevation acute coronary syndrome and outcomes in elderly and senile patients. Design and methods . 126 patients with non- ST -segment elevation acute coronary syndrome at the age of 61 to 90 were involved into the study. Follow-up was carried out during 1 year; clinical endpoints were mortality and recurrent acute coronary syndrome. All patients were divided into 3 groups according to the frailty index by M. Hoover et al.: the first group — 49 patients with frailty syndrome (38,9%), the second — 47 (37,3%) with pre-frailty and 30 patients (23,8%) without frailty. Results . Geriatric syndromes, cognitive impairment, depression, decreased basic and instrumental activity were more often in patients with frailty. They also had more complications, such as bleeding, arrhythmias and early post-infarction angina. During 1-year followup 5 patients with frailty (10.2%), 5 patients (10.6%) with pre-frailty, and 2 patients (6.6%) without frailty had adverse outcomes. When analyzing the influence of age and frailty on the development of adverse outcomes (death, repeated ACS), a higher contribution of age was revealed. Conclusion . Patients with ACS and frailty have a higher risk of adverse outcomes. Some of the reasons are various geriatric syndromes, changes in emotional and cognitive status and more frequent complications. Age and frailty were crucial for the development of adverse outcomes. However, senile age was of higher importance for the outcomes.

MUSIC THERAPY IN PATIENTS WITH HYPERTENSION AND EARLY POST-INFARCTION ANGINA: 17-YEAR EXPERIENCE OF THE MUSIC STUDY

The purpose of this study was to evaluate the effectiveness of music therapy for reduction of anxiety and pain in patients with hypertension (HT) and early post-infarction angina (EPA). Most studies have shown that EPA implies an unfavorable long-term prognosis among patients with acute myocardial

ОСОБЕННОСТИ КЛИНИКО-ИНСТРУМЕНТАЛЬНЫХ ПОКАЗАТЕЛЕЙ У БОЛЬНЫХ С ИНФАРКТОМ МИОКАРДА БЕЗ ЗУБЦА И С ЗУБЦОМ Q

The subject of our study was, first of all, a retrospective analysis of the course of the hospital period of IM without the Qwave. The patients were divided into 2 groups: Group 1 -21 patients with IM without Q wave and Group 2 -23 patients with IM without Q wave. The study results showed that patients with IB without Q wave should be included in the special control group for further personal approach. Patients with IM and wave Q had higher complication rate, so they had such complications as early postinfarction angina -10 (43,7%) cases, rhythm and conduction disorders -12 (52,1%) and 6 (26%). Therefore, along with high risk of repeated IM development and high probability of death, deterioration of basic clinical and laboratory instrumental parameters in the group of patients with IM without a wave Q was observed in 1/2, whereas the initial values of patients with IM without a wave Q did not deteriorate significantly

Метаболічна підтримка хворих з інфарктом міокарда з порушеннями функціонального стану печінки

The aim – to improve the existing therapeutic programs for patients with myocardial infarction (MI) by differentiated approach to therapy depending on the presence or absence of liver dysfunction. Materials and methods. 149 patients with acute MI were included to the study – 114 (76.5 %) men and 35 (23.5 %) women of average age 59.9±1.0 years. A comparative clinical-laboratory and instrumental examination was performed in these groups: 107 patients with MI with functional liver disorders (main group) and 42 patients with MI without functional liver disorders (comparison group). For the study of intracardiac hemodynamics, echocardiography was performed in B-mode. 52 patients of main group and 22 patients of comparison group received standard treatment for MI (ACE-inhibitors, β-blockers, clopidogrel and acetylsalicylic acid, anticoagulant therapy, statins). The other 55 patients of main group and 20 patients of comparison group received modified treatment with the addition of the antioxidant bioflavonoid – quercetin to the standard scheme.Results and discussion. In the initial condition of patients of main group there are more pronounced violations of central and peripheral hemodynamics which cause the disorders of protein synthesis, detoxification, energetic dysfunction of liver and lipid metabolism. At the same time there is an excessive activation of lipid peroxidation, suppressed activity of enzymes of the antioxidant protection system, deepening of pathological processes in the heart and in the liver. Inclusion of bioflavonoid quercetin to the complex therapy of patients with myocardial infarction provided the improvement of hemodynamic parameters – increased EF by 22.89 % and elimination of diastolic dysfunction, which were accompanied by normalization of clinical and laboratory parameters of liver function disorders – normalization of levels of bilirubin and ALT, GGT, ALP on 14-th day and reduction of LDL-level by 25.61 % after 3 weeks was marked. Conclusions. Introduction of bioflavonoid quercetin to the complex therapy of patients with MI provided improvement of hemodynamic parameters and restoration of oxidation-reduction equilibrium, reduction of clinical and laboratory manifestations of liver dysfunction and contributed to a significant decrease in the frequency of MI complications development. Restoration of parameters of cardiac hemodynamics, metabolic processes and liver functions provides a significant reduction in the rate of development of acute heart failure by 63.9 %, early post-infarction angina by 22.2 %, rhythm and conduction disorders by 43.6 %.

Impact of type 2 diabetes mellitus in the course of acute myocardial infarction of the left ventricle with involvement to the right ventricle

The aim. To evaluate the effect of diabetes mellitus (DM) on the clinical course of the acute period of myocardial infarction (MI) of the left ventricle (LV) and the biventricular MI.Materials and methods. 309 patients with Q-MI age 65.5±4.42 years were examined. Patients were divided into 3 groups: the 1st group – 155 patients with MI of the right ventricle (RV) on the background of Q-MI of the posterior wall of the LV, the 2nd group – 53 patients with RV MI due the Q-MI of the LV circular localization, and the 3rd group – 101 patients with Q-MI of the LV posterior wall. Patients with DM were 41 (26.5 %) in the 1st group, 22 (41.5 %) - in the 2nd group, and 26 (25.7 %) patients in the third group. The hospital treatment period was 16.8±2.7 days.Results. Patients with DM in all groups had late admission, usually within 12-24 hours (p <0.05) and after the first day of the MI (p <0.05). Among patients with DM there were more women (p <0.05). The presence of DM was associated with a significantly greater number of ventricular arrhythmias and ventricular fibrillation (p <0.05). The clinical course of the acute MI in patients with DM often complicated of early postinfarction angina (p <0.05), recurrent MI and the LV aneurysms in the 2nd group (p <0.05). The acute heart failure (HF) was more severe in patients with DM with prevalence of the number of cases with Killip II-III (p <0.05) and a higher frequency of cardiogenic shock (p <0.05). Patients with DM had more severe manifestations of chronic HF with greater frequency of the HF IIA, IIB and III NYHA in the total group of patients with MI (p <0.05).Conclusion. The DM in patients with Q-ІМ of the LV and the biventricular MI is accompanied by late admission and is more common in women. The presence of the DM in patients with MI is associated with a higher frequency of ventricular extrasystoles, ventricular tachycardias and ventricular fibrillation, cases of early post-MI angina, the development of recurrent MI and the LV aneurysms. Patients with DM have a high frequency of cardiogenic shock and worse manifestations of acute and chronic HF