Background. In order to provide personalized medicine and improve cardiovascular outcomes, a method for predicting adverse left ventricular remodeling (ALVR) after ST-segment elevation myocardial infarction (STEMI) is needed. Methods. A total of 125 STEMI patients, mean age 51.2 (95% CI 49.6; 52.7) years were prospectively enrolled. The clinical, laboratory, and instrumental examinations were performed between the 7th and 9th day, and after 24 and 48 weeks, including plasma analysis of brain natriuretic peptide (BNP), transthoracic echocardiography, analysis of left ventricular-arterial coupling, applanation tonometry, ultrasound examination of the common carotid arteries with RF signal amplification. Results. Patients were divided into 2 groups according to echocardiography: “ALVR” (n = 63)—end-diastolic volume index (EDVI) >20% and/or end-systolic volume index (ESVI) >15% after 24 weeks compared with initial values; “non-ALVR” (n = 62)—EDVI <20% and ESVI <15%. In the ALVR group, hard endpoints (recurrent myocardial infarction, unstable angina, hospitalization for decompensated heart failure, ventricular arrhythmias, cardiac surgery, cardiovascular death) were detected in 19 people (30%). In the non-ALVR group, hard endpoints were noted in 3 patients (5%). The odds ratio of developing an adverse outcome in ALVR vs. non-ALVR group was 8.5 (95% CI 2.4–30.5) (p = 0.0004). According to the multivariate analysis, the contribution of each of the indicators to the relative risk (RR) of adverse cardiac remodeling: waist circumference, RR = 1.02 (95% CI 1.001–1.05) (p = 0.042), plasma BNP—RR = 1.81 (95% CI 1.05–3.13) (p = 0.033), arterial elastance to left ventricular end-systolic elastance (Ea/Ees)—RR = 1.96 (95% CI 1.11–3.46) (p = 0.020). Conclusion. Determining ALVR status in early stages of the disease can accurately predict and stratify the risk of adverse outcomes in STEMI patients.

The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (TLT). The study included 117 patients with STEMI following effective TLT. The elective coronary angiography followed by percutaneous coronary interventions was performed in the interval from 3 to 24 hours after a successful systemic TLT. Before and after cardiac catheterization, the telemetric ECG monitoring was performed using AstroCard Telemetry system (Meditec, Russia). During the study, two groups of patients were formed. Group 1 included 85 patients (72.6%) without new ST-segment deviations on telemetry. 77 patients (90.6%) had no recurrent coronary artery thrombosis at angiography. Eight patients (9.4%) from group 1 were diagnosed with thrombosis of the infarct-related coronary artery. Group 2 included 32 patients (27.4%) who underwent TLT and then had ST-segment re-elevation episodes of 1 mV or more in the infarct-related leads, lasting for at least 1 minute. In group 2, in 27 of 32 patients (84.4%), thrombosis of the infarct-related coronary artery was confirmed (p<0.01 compared with group 1). In 71.9% cases, the recurrent ischemic episodes were asymptomatic (‘painless myocardial ischemia’) (p<0.01). Thus, in patients with STEMI and successful TLT, re-elevation of ST-segment during remote ECG monitoring is strongly related to angiographically documented coronary artery thrombotic reocclusion. The absence of chest pain during recurrent myocardial ischemia requires continuous ECG telemetry to select patients for the rescue percutaneous coronary interventions at an earlier stage.

Objective: To study the correlations between the parameters of the left ventricular-arterial coupling (LVAC) and the parameters of local arterial stiffness in patients after STEMI 6 months after revascularization. Design and method: 125 patients (mean age 51.2 ± 8.8 years) after STEMI were included in the study. The diagnosis was confirmed by biomarkers of myocardial necrosis, ECG, coronary angiography. Echocardiography was performed at the 7–9th day and 6 months after STEMI (MyLab, Esaote, Italy), followed by calculation of LVAC indices: arterial elastance (Ea), left ventricular elastance (Ees), LVAC index (Ea/Ees). The study of the right and left common carotid arteries (CCA) was carried out on a MyLab ultrasound scanner (Esaote, Italy) using high-frequency RF signal technology. The following parameters were recorded: QIMT - intima-media thickness, DC - lateral distensibility coefficient, stiffness index β, loc Psys - local SBP, locPdia - local DBP, locPWV - local pulse wave velocity, AP - amplification pressure. Results: In the study of the correlation of LVAC indices with the CCA rigidity parameters recorded on 7–9th day from the STEMI, a relationship was revealed only between Ees and LocPsys (r = 0.40; p = 0.01), Ees and LocPdia (r = 0, 26; p = 0.004). After 6 months of follow-up, a closer relationship between the LVAC and the parameters of the local CCA stiffness was diagnosed. The Ea indicator correlated with DC (r = -0.23; p = 0.009), PWV (r = 0.21; p = 0.02), LocPsys (r = 0.33; p = 0.0002), LocPdia (r = 0.26; p = 0.004) and AP (r = 0.19; p = 0.03). The Ees indicator was found to be associated with LocPsys (r = 0.38; p = 0.00001), LocPdia (r = 0.27; p = 0.002), AP (r = 0.22; p = 0.01). Conclusions: After 6 months, there was a closer correlation between the LVAC indices and the parameters of local pressure and rigidity. This is probably partly due to the remodeling of the cardiovascular system in the postinfarction period and the inclusion of compensatory-adaptive mechanisms that ensure the contractile function of the heart.

Objective: To study adherence to treatment with atorvastatin at various doses for 48 weeks in patients with STEMI. Design and method: The study included 117 STEMI patients mean age 52.1 ± 8.4 years in the first 24–96 hours from the disease onset. In accordance with the lipid-lowering therapy, the patients were divided into two groups. The first group included 39 people taking atorvastatin 40 mg/day. The second group consisted of 78 patients who received atorvastatin 80 mg/day. On 7–9th day from the STEMIt, after 24 and 48 weeks of follow-up, treatment adherence was assessed using the Morisky-Green questionnaire. In addition, compliance was determined based on the number of dispensed and returned drugs. Results: After 48 weeks of follow-up, pharmacotherapy was continued in the 1st group of 30 people (76.9%), in the 2nd group - 73 (93.6%) patients (p = 0.008); 9 patients (23.1%) from group 1 and 5 people (6.4%) from group 2 (p = 0.008) independently discontinued treatment. After 48 weeks of follow-up, 17 patients (43.6%) in the 1st group were assigned to the number of compliant patients, and 39 people (50%) in the 2nd subgroup (p = 0.54). Ten patients (25.6%) in group 1 and 15 patients (19.2%) in group 2 (p = 0.39) turned out to be insufficiently adherent. There were 3 people not adhering to treatment in the 1st group (7.7%), in the 2nd group - 19 people (24.4%) (p = 0.03). In group 1, the mean score was initially 4 (4;4) points, after 24 weeks - 4 (3;4) points (p = 0.96), after 48 weeks - 4 (3;4) points (p = 0.87). In the group 2 - 4 (4;4) points, after 24 weeks - 4 (3;4) points (p = 0.99), after 48 weeks - 4 (2;4) points (p = 0.34). According to the number of issued and returned drugs, the average amount of drugs taken in group 1 was 91.8 (79;99)%, in the 2nd group - 96.9 (82.8; 100)% (p = 0.23). The correct drug intake (>80% compliance) in group 1 was observed in 21 patients (76.7%); in group 2 - 57 (78.1%). Conclusions: in STEMI patients, 48-week atorvastatin treatment was characterized by good adherence and did not depend on the dose of the drug taken

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