Risk of complications in patients with acute coronary syndrome determination has received much attention and offered a variety of options for scales in the last years. GRACE scale is the most informative method to assess the risk of death during hospitalization period and during the next 6 months at present. Some studies recommend to complement GRACE scale with detection of the N-terminal prohormone brain natriuretic peptide (NT-proBNP) blood levels.The purpose of the study was to assess risk factors by GRACE scale and activity in serum levels of NT-proBNP in myocardial infarction depending on the types of coronary arteries revascularization.Materials and Methods. The study involved 80 patients with acute myocardial infarction with heart failure; the average age of patients was (61.16±5.79) years, 52 (65 %) men. The patients were divided into 4 groups. Group I included patients who were prescribed thrombolytic therapy (n=10); group II patients underwent percutaneous coronary intervention (PCI) with stenting of the infarction-depending vessels (n=35); group III involved patients (n=23) who were administered both methods of treatment. Group IV included 12 individuals who were administered conservative treatment.Results. The research showed that the lowest levels of NT-proBNP were observed on the 7th day in patients who have been administered percutaneous coronary intervention (PCI) with stenting of the infarction-depending vessels (254.1±11.3 fmol/ml, p<0.05). The risk of adverse events evaluated by the GRACE scale in patients with MI after performed PCI with stenting of the infarction-depending vessels and thrombolytic therapy is lower (12.2±1.35 %) than in patients who were administered thrombolytic therapy (14.23±0.58 %) and those with conservative treatment (15.63±0.89 %).Conclusion. The risk of death by GRACE scale in patients with myocardial infarction after performed PCI with stenting of the infarctiondepending vessels and thrombolytic therapy is lower than in patients without coronary intervention. Zaporozhye medical journal 2016; №6 (99): 17-20Прогнозування ризику при гострому коронарному синдромі залежно від типів реваскуляризації міокарда Р. В. ДенінаПротягом останніх років стратифікації ризику несприятливих подій у хворих на гострий коронарний синдром приділялося багато уваги та пропонувалися різноманітні варіанти шкал. Найбільш інформативною натепер методикою, що дає можливість оцінити ризик смерті як у період госпіталізації, так і протягом найближчих 6 місяців, є шкала GRACE. В окремих дослідженнях рекомендовано до-повнити шкалу GRACE визначенням у крові рівня N-кінцевого фрагмента мозкового натрійуретичного пептиду (NT-proBNP).Мета роботи -оцінити ступінь ризику несприятливих подій за шкалою GRACE та активність сироваткових рівнів NT-proBNP при інфаркті міокарда залежно від способу реваскуляризації коронарних артерій.Матеріали та методи. Обстежили 80 осіб на гострий інфаркт міокарда з супутньою серцевою недостатністю, середній вік становив 61,16±5,79 року. Серед пацієнтів переважали чоловіки 52 (65 ...

Early restoration of coronary blood flow in acute myocardial infarction with elevation helps reduce the area of myocardial necrosis, prevent dilatation of the ventricular cavity, and reduce the development of arrhythmias and mortality. However, despite modern technologies in STEMI treatment, the development of reperfusion syndrome, in particular, arrhythmias, is possible after the restoration of blood flow in the infarct-related artery, which is a consequence of acute cellular, metabolic and local electrophysiological changes in the myocardium. The aim: is to investigate the long-term effects of reperfusion syndrome on the catabolic/anabolic activity of connective tissue and the processes of connective tissue framework formation in the post-infarction period in patients with myocardial infarction. Materials and methods. The study involved 156 patients with acute myocardial infarction with ST segment elevation (STEMI), and 15 apparently healthy individuals (control of laboratory parameters). The average age of the patients was (57.8±1.2) years. The percent of male patients prevailed (76 %). All MI patients were divided into two groups: Group I (98 people) – MI patients without clinical signs of reperfusion syndrome during revascularization, Group II (58 people) – MI patients with the signs of reperfusion syndrome in the form of rhythm and conductivity disturbances during revascularization of coronary arteries by percutaneous coronarography intervention (PCI) with prolonged stenting of the infarct-dependent coronary artery. Peculiarities of connective tissue metabolism were studied by the content of free and bound oxyproline, glycosaminoglycans, and antibodies to atypical collagens (Ig M and Ig G) in blood serum. Results. The recovery period after myocardial infarction showed an increase in collagen catabolism over collagen synthesizing processes in patients with MI who had reperfusion syndrome. The described patterns were also established by changes in glycosaminoglycans. The study showed an increase in the level of antibodies to atypical collagens. Particularly, the level of Ig M, which was within the norm (0.43±0.18) ng/ml, in patients with MI without reperfusion manifestations was three times higher (p<0.001), and in cases of  combination of MI and reperfusion syndrome – the highest (p<0.001). Conclusions: Changes in collagen-synthesizing processes are observed in patients with MI, with a tendency to increase the processes of catabolism of the connective tissue matrix. The presence of reperfusion syndrome manifestations in MI patients after revascularization aggravates the processes of catabolism, even in the recovery period after MI. Increase in the activity of catabolic processes stimulates fibrosis and formation of rigid matrix and atypical collagen, to which antibodies are synthesized, thus blocking the pathological circuit of restructuring of the heart connective tissue framework, and accordingly its pathological remodeling. The obtained study results contribute to the identification of more sophisticated approaches to revascularization techniques to avoid negative effects of reperfusion syndrome, as well as new effective medications for collagen synthesis correction, which can increase the effectiveness of rehabilitative management of such

ДВНЗ «Івано-Франківський національний медичний університет» Резюме. У статті проаналізовано один із видів науково-дослідної роботи студентів, а саме: студентський науковий гурток із внутрішньої медицини. Робота в науковому гуртку забезпечує формування та поглиблення клінічного і аналітичного мислення, підвищує ефективність навчального процесу та сприяє виявленню здібних студентів.Ключові слова: студентський науковий гурток, формування знань, студенти. СТУДЕНЧЕСКИЙ НАУЧНЫЙ КРУЖОК: СОВЕРШЕНСТВОВАНИЕ ПРОФЕССИОНАЛЬНЫХ НАВЫКОВ Р.В. ДенинаРезюме. В статье проанализирован один из видов научно-исследовательской работы студентов, а именно: студенческий научный кружок с внутренней медицины. Работа в научном кружке обеспечивает формирование и углубление клинического и аналитического мышления, повышает эффективность учебного процесса и способствует выявлению способных студентов.Ключевые слова: студенческий научный кружок, формирование знаний, студенты.

У представленому клінічному випадку розглядається тактика ведення пацієнтів з ятрогенними ускладненнями черезшкірного коронарного втручання з приводу обструктивної ішемічної хвороби серця. Акцентовано увагу на особливостях невідкладної допомоги та медикаментозного лікування пацієнтів з ятрогенною перфорацією коронарної артерії. Випадок цікавий не лише для спеціалістів інтервенційної кардіології, але й для кардіологів-терапевтів та сімейних лікарів, оскільки менеджмент пацієнтів з ускладненнями після черезшкірних коронарних втручань, зокрема після перфорації коронарної артерії, заслуговує особливої уваги. Висновки з клінічного розбору даного випадку можуть бути корисними для реальної медичної практики.

Dyslipidemia is an important problem for family doctors, as it is a risk factor for the development of atherosclerotic cardiovascular diseases (ACVD). ACVD is the cause of more than 4 million deaths in Europe today. Women in this sad statistic are 2.2 million, and men - 1.8 million. It is expected, that mortality due to cardiovascular diseases in men aged up to 65 years is significantly higher than in women (430 thousand and 193 thousand, respectively). The ESC/EAS-2019 (European Society of Cardiology / European Society of Atherosclerosis) updated guidelines on the management of people with dyslipidemia (DLP) provide specific recommendations that can be used by family doctors in Ukraine in their daily preventive and curative work. The ESC/EAS-2019 (European Society of Cardiology / European Society of Atherosclerosis) and the Ukrainian Society of Atherosclerosis (USA) guidelines emphasize that the cornerstone of the prevention and treatment of ACVD is primarily the detection and correction of DLP. The prevalence of DLP in Ukraine is about 20%. At the same time, for effective correction of DLP it is important to verify the type of dyslipidemia, isolate genetically determined forms of dyslipidemia (familial hypercholesterolemia), establish cardiovascular risk, select the most effective measures of lifestyle modification and formulate therapeutic goals of prevention / treatment. In the treatment of DLP apart from lifestyle modification, the drugs of choice are statins in high-intensity doses. Ezetimibe and PCSK-9 inhibitors can be used in addition to statin therapy in case of its ineffectiveness or side effects. It was found, that resistance to statins and their intolerance is the basis for the use of non-statin hypolipidemic drugs (nutraceuticals), among which the most studied are ω-3 PUFA and phytosterols. The ESC / EAS (2019) guidelines state that consumption of ω-3 PUFAs is associated with a lower risk of death from CVD and stroke. It was noted, that the mechanism of reducing TG levels under the influence of ω-3 PUFA may be related to their ability to interact with PPAR (receptors that activate the proliferation of peroxisomes) and reduce the secretion of apoprotein B. Recent clinical studies confirm the need for high doses of highly purified form of ω-3 PUFA for patients with elevated TG levels, despite treatment with statins. Another non-statin drug that reduces LDL levels is bempedoic acid. Studies have shown a significant reduction in LDL levels in patients receiving additional bempedoic acid. The effectiveness of bempedoic acid as a monotherapy of DLP is now being studied. This review presents new data on the effectiveness of the combination of sugar cane extract policosanol with ω-3 PUFA (docosahexaenoic acid 10%). The drug of this composition "Cardioneurin" is present on the pharmaceutical market of Ukraine. Clinical studies have shown, that in case of resistance or intolerance to statins, especially in high doses, a hybrid strategy of lipid-lowering therapy can be used - a combination of low-intensity doses of statins with a combined nutraceutic "Cardioneurin". This treatment reduces the level of atherogenicity by 22%, which gives grounds for its use in the practice of family doctors. Other forms of policosanol (other than sugar cane), such as those derived from beeswax or wheat germ, do not have an adequate evidence base. Thus, dyslipidemia is the primary and main factor in the development of ACS, it in most cases occurs long before the emergence of other important risk factors and may even be a prerequisite for their occurrence. Epidemiological evidence suggests, for example, that DLP may in itself be a risk factor for STEMI / NSTEMI and unstable angina.