Aim. To study the comparative efficacy and safety of clopidogrel and ticagrelor in the “double” antiplatelet therapy (DATT) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) in the early and late periods in real clinical practice, and to assess adherence to treatment.Materials and methods. The study included 109 patients with ACS, who underwent PCI. Patients were divided into two groups: the 1st group (n=57) – received ticagrelor and the 2nd group (n = 52) – received clopidogrel in the DATT for 12 months. The frequency of ischemic events (death from cardiovascular causes, repeated myocardial infarction (MI) and stent thrombosis (ST)) and hemorrhagic events was analyzed during hospitalization, in 3 months, 6 months and in 12 months. Also, the reasons of repeated hospitalizations during the year were analyzed. The adherence of patients was assessed using the Moriski–Green scale.Results. There were no significant differences in the ticagrelor and clopidogrel groups (8.8% vs. 11.5%, p=0.87) for the incidence of stent thrombosis (ST). In the correlation analysis, in half of all cases of subacute ST in the total sample (n=109) (in 4 (3.65%) cases from 8 (7.3%)), the main reason for its development was the lack of adherence of patients to DATT (τ=0,6; p<0,001). The frequency of minor bleeding significantly prevailed in the ticagrelor group versus the clopidogrel group (38.6% vs. 21.2%, p=0.047). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (1.8% and 1.9%, p=0.52). However, the difference in the rates of fatal bleeding, including more instances of fatal intracranial bleeding (1.8% vs. 0%; p=0,34), allows us to talk about the best hemorrhagic safety of clopidogrel.Conclusion. In this study, ticagrelor and clopidogrel were comparable in their effectiveness. Ischemic events and repeated hospitalizations in both groups are associated with the progression of atherosclerosis, confirmed by angiography; the development of stent restenosis, as well as low adherence, which is the main predictor of subacute TS. In addition, clopidogrel versus ticagrelor showed better hemorrhagic safety in the frequency of development of minor bleeding.

Aim: to identify predictors of stent thrombosis in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) for 12 months by creating a miathematical logistic regression model to optimize rehabilitation, secondary prevention of ischemic events in the first year after ACS, as well as a personalized approach to treatment. Materials and methods. The analysis used data from the hospital register, which contained information on all PCIs, performed in the Semashko hospital between September 2016 and August 2018 (2378 patients). For this study we selected a sample of 183 ACS patients (146 men and 37 women) after PCI: 25 with definite stent thrombosis confirmed by repeated coronary angiography (CAG) (the main study group), and 158 without developing definite stent thrombosis (the comparison group) according to the observation for 12 months. All patients during hospitalization and 1 year after discharge received standard medical therapy ACS, according to international recommendations. Laboratory tests, electrocardiography (ECG), echocardiography, 24-hour ECG monitoring were performed for in patients. For determining predictors of the development of stent thrombosis we performed a logistic regression analysis. Results. A mathematical model of multifactorial prognostication of stent thrombosis in patients with ACS after PCI was created. The model included the following predictors: Killip class >II; life-threatening paroxysmal tachyarrhythmias (atrial fibrillation and/or ventricular fibrillation) as ACS complication of; left ventricular ejection fraction ≤45%; CA dissection; CAG confirmed CA thrombosis before PCI. Conclusion. The proposed model in patients with ACS allows us to estimate the risk of stent thrombosis after PCI, as well as to improve the accuracy of the event prediction. The model is easy to use, can be applied by practicing cardiologists during hospitalization. This model allows us to personalize secondary prevention in the first year after ACS, and thus help to reduce cardiovascular mortality, incidence of recurrent myocardial infarctions, unstable angina, and emergency revascularization.

Цель исследования-изучить эффективность мексидола (этилметилгидроксипиридина сукцината) при почечном повреждении у больных острым инфарктом миокарда с подъемом сегмента ST (ОИМпST). Материал и методы. Обследовано 55 больных с ОИМпST. Определяли острое почечное повреждение (ОПП) по критериям базального (расчетного) креатинина, сывороточному креатинину, скорости клубочковой фильтрации, цистатину С и NGAL. Лицам с ОПП к стандартной схеме лечения ОИМпST добавляли антиоксидант (цитопротектор) мексидол с 1-го по 10-й день в дозе 750 мг/сут парентерально (внутривенно). Оценивали показатели ОПП в результате лечения мексидолом. Результаты. Среди 55 больных с ОИМпST зарегистрировано 36 пациентов с признаками ОПП. Проводимая терапия с добавлением мексидола в схему лечения показала положительный результат в виде достоверного снижения маркеров почечного повреждения (креатинина, цистатина С и NGAL мочи) уже через 48 ч. Заключение. Мексидол может использоваться в добавлении к стандартной терапии больных с ОИМпST с признаками ОПП для уменьшения проявления этого грозного осложнения. Ключевые слова: цитопротекторы, инфаркт миокарда, острое повреждение почек (или острое почечное повреждение).

No abstract