The aim of the present study was to assess the effectiveness of standard medical therapy in lowering the risk of cardiovascular death in the remote period after myocardial revascularization (MR), taking into account the presence of renal dysfunction. Material and Methods: The study included 90 patients with coronary heart disease (CHD) and indications for revascularization. We evaluated a drug therapy obtained at different stages of revascularization, as well as the severity of patients' condition and the prevalence of renal dysfunction. Results: In the remote period after MR (5.8±0.05 years), 71/78.9% patients participated in the study; death occurred in 10/12.3% patients. The duration of therapy for chronic myocardial ischemia before MR (P=0.005), as well as compliance with prescribed therapy during 6 months (P=0.008) after this procedure, affected cardiovascular death in the remote period after MR. Using statins before MR reduced the risk of cardiovascular death by 17.2% (P=0.01), beta-blockers-14.95% (P=0.04), and ACE inhibitors (ACEIs)-15.75% (P=0.03). The lack of regular use of acetylsalicylic acid (ASA) for 6 months after RM was associated with an increase in the risk of cardiovascular death up to 36.2% (P=0.005). Statins and ACEIs are drugs that reduce the risk of cardiovascular death in the presence of renal dysfunction (P<0.05). Conclusion: An efficient drug regimen for patients after MR is important in reducing a long-term prognosis of cardiovascular death and for an efficient correction of coronary artery patency.

Aim. To assess the effect of electrolyte changes on the prognosis of long-term cardiovascular events after acute coronary syndrome (ACS).Material and methods. The study included 105 patients with ACS who underwent coronary angiography (CA) with coronary stenting. At the study inclusion (before CA with coronary stenting), we collected data on traditional risk factors, analyzed levels of urinary sodium and potassium, kaliuresis and natriuresis. Free water clearance (FWC) and electrolyte free water clearance (EFWC), as well as fluid balance using bioelectrical impedance analysis were determined. Study endpoints (fatal and nonfatal cardiovascular events) were determined 6,2±0,2 months after CA with coronary stenting.Results. It was found that a decrease in urinary sodium (χ2=5,64, p=0,02, Constanta B0 =-0,62, Estimate =-16,5) and natriuresis (χ2=4,1, р=0,044, Constanta B0 =-1,38, Estimate =-5,2) increase the death risk. Urinary sodium of 0,2 mol/L and natriuresis of 0,5 mol are threshold levels of increased risk of death. Urinary potassium decrease was associated with an increase in death risk (threshold level — 0,5 mol/L, χ2=4,99, р=0,025, Constanta B0 =-0,63, Estimate =-70,4) and acute myocardial infarction (threshold level — 0,06 mol/L, χ2=3,93, р=0,04, Constanta B0 =-0,99, Estimate =-58,0) in the long-term period. Increase in EFWC increased the likelihood of long-term transient ischemic attack after ACS (χ2=4,61, р=0,03, Constanta B0 =-2,95, Estimate =-1,0). There were no significant relationships in the matter of FWC (p>0,05). However, with a decrease in intracellular fluid volume compared to normal values and a decrease in FWC or an increase in EFWC, the likelihood of longterm composite endpoints after ACS increases.Conclusion. As a result of the study, risk markers for long-term fatal and non-fatal cardiovascular events after ACS were established: decrease in urinary sodium <0,2 mol/l and potassium <0,5 mol/l; decrease in FWC and increase in EFWC with or without cellular dehydration. The established markers can complement the current cardiovascular risk score methods in patients with ACS.

BACKGROUND. The study of the prognostic significance of markers of tubular dysfunction in patients with the acute coronary syndrome (ACS) and arterial hypertension (AH) is highly relevant, due to the unity of pathogenetic mechanisms and their consequences that develop during an acute coronary event. PURPOSE. Analysis of the influence of tubular dysfunction indi­cators on the risk of cardiovascular complications in patients with hypertension in the late period after ACS. PATIENTS ANDMETHODS. The study included 103 patients with hypertension and ACS. All patients included in the study underwent coronary angiography (CAG) with stenting of the coronary arteries. Before CAG, clinical and anamnestic data were collected, labora­tory (including creatinine and urea, potassium and sodium, plasma osmolarity), and instrumental diagnostic methods were used. The concentration of potassium and sodium in the daily urine, potassium and natriuresis, osmolarity of urine, and the calculated osmolar clearance index (ОС) were determined. Impedance spectrometry was performed to determine the water balance of the body's liquid media. After 17.0±0.51 months, the endpoints of the study were registered: AMI, NS, stable stress angina, repeated myocardial revascularization (RM), and death. RESULTS. It was found that an increase in ОС is associated with the risk of developing repeated RM in the late period after ACS (x2-criterion = 3.89, p = 0.04). Among the indicators of the electrolyte balance of urine, a statistically significant effect on the risk of repeated RM was found with an increase in the con­centration of potassium in the urine (x2-criterion = 4.63, p = 0.03) and daily potassium urea (x2-criterion = 4.85, p = 0.03). The ОС index and an increase in the electrolyte balance of urine were considered and justified as markers of tubular dysfunction. The complex effect of increasing the ОС and reducing the volume of intracellular fluid from the proper values (x2-criterion = 6.16, p = 0.4) on the risk of repeated RM was established. It was found that when the balance of the volume of total fluid and CA is changed, the risk of developing repeated RM is potentiated. It is shown that with the excessive introduction of fluid volume into the body, mainly intravenously and an increase in ОС, the risk of developing repeated RM increases significantly. CONCLU­SION. The study revealed that the presence of tubular dysfunction can be considered as a predictor of adverse cardiovascular prognosis in patients with ACS and hypertension. For a comprehensive analysis of the risk value, it is necessary to control homeostasis and individual selection of the volume of intravenous infusions.

EFFECT IMBALANCE AQUEOUS BODY FLUIDS, AND RENAL DYSFUNCTION, CARDIOVASCULAR SURVIVAL IN PATIENTS AFTER AN ACUTE CORONARY SYNDROME, MYOCARDIAL REVASCULARIZATION РезюмеЦель. Анализ нарушения баланса водных сред организма на прогноз сердечно-сосудистых осложнений в позднем периоде после острого ко-ронарного синдрома (ОКС) и реваскуляризации миокарда с учетом показателей почечной функции. Материалы и методы. В исследование включены 120 пациентов с ОКС, среди которых у 68 пациентов была выявлена нестабильная стенокардия, у 52 больных -острый инфаркт миокарда. Всем больным выполнялась реваскуляризация миокарда. Регистрировалось наличие альбуминурии в диапазоне 30-300 мг/л и скорости клубочковой фильтрации (СКФ). Производился расчет показателей водных сред организма -объемов общей воды (ООВ), общей жидкости, внутриклеточной жидкости (ОВнутриклЖ), внеклеточной жидкости. Конечной точкой исследования являлось наличие сердеч-но-сосудистых осложнений в течение 6 месяцев после ОКС. Результаты. Установлено, что наличие и величина альбуминурии достоверно повышают риск достижения конечной точки исследования. У пациентов, имеющих СКФ менее 60 мл/мин/1,73м 2 изучаемый риск выше на 17,1%, по сравнению с больными с СКФ выше данного предела. Анализ распределения водных сред организма показал достоверное увеличе-ние средних показателей ООВ и ОВнутриклЖ. С помощью статистического анализа выживаемости установлено повышение риска развития сердечно-сосудистых осложнений в позднем периоде после ОКС у пациентов, имеющих повышение ОВнутриклЖ на этапе развития коро-нарной катастрофы. Заключение. В результате проведенного исследования продемонстрирована прогностическая значимость в стратифи-кации риска сердечно-сосудистых осложнений не только наличия альбуминурии, но и ее уровня и величины СКФ менее 60 мл/мин/1,73м 2 .Перераспределение водных сред организма в виде повышения ОВнутриклЖ является маркером неблагоприятных сердечно-сосудистых осложнений в позднем периоде после ОКС. Представленные данные указывают на необходимость всестороннего, комплексного анализа *Контакты/Contacts.