В ведение. В настоящее время установлено, что нарушение функции почек ассоциируется с высоким риском сердечно-сосудистых заболеваний. Так, в ряде крупных исследований почечная дисфункция наблюдалась у 14,5-42,9% пациентов с острым инфарктом миокарда (ОИМ) без подъема ST [1, 2]. По данным регистра ACTION, среди пациентов с ОИМ с подъемом сегмента ST на ЭКГ в 30% случаев выявили хроническую болезнь почек (ХБП), а при ОИМ без подъема ST-в 43% случаев [3]. Анализ данных крупных исследований TIMI и InTIME-II выявил повышение 30-дневной летальности у пациентов с ОИМ с подъемом ST при легкой, умеренной и тяжелой ХБП в 1,4; 2,1 и 3,8 раза по сравнению с пациентами без нарушения функции почек [4]. Важным вопросом является эффективность и безопасность процедур реваскуляризации при ОИМ, а также ее недостаточное проведение у пациентов со сниженной функцией почек, что нередко оказывается краеугольным камнем при выборе первичной тактики
Aim. To study the features of treatment of patients with myocardial infarction and different functional state of kidneys at outpatient and inpatient stages of treatment.Methods.A retrospective study included 179 patients admitted to the hospitals of Moscow North-Eastern Administrative District with verified diagnosis of myocardial infarction. Depending on glomerular filtration rate all patients were divided into two groups: patients with acute myocardial infarction and with GFR of ≥60 ml/min/1.73 m2, and those with GFRResults. Prevalence of arterial hypertension among patients with decreased functional state of kidneys was 94.5% vs. 76.8% among patients with preserved kidney function (p=0.004), prevalence of ischemic heart disease was 36.4% vs. 18.8% respectively (p=0.021). Outpatients administration rate of ACE inhibitors to patients with decreased kidney function was 18.2% and that of statins was 1.8%. Among patients with history of myocardial infarction 24.4% received aspirin, and 35.6% received another antithrombotic medication (P2Y12 platelet receptor inhibitor).Conclusions. Arterial hypertension and history of myocardial infarction, prolonged inpatient stay were observed more frequently in patients with decreased kidney function; outpatient administration of ACE inhibitors, statins and antithrombotic medications to patients with history of myocardial infarction and decreased kidney functional ability was rare.
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