В настоящее время исследователями всего мира все ча-ще обсуждается проблема коморбидности. При этом, ана-лизируя литературу, можно встретить различные, близкие по смыслу понятия: коморбидность, мультиморбидность, полиморбидность. Если коморбидность -одновременное наличие у пациента нескольких заболеваний, связанных единым патогенезом, то полиморбидность, или мульти-морбидность, -это наличие множественных заболеваний, как связанных, так и не связанных между собой [1].Мультиморбидность связана со значительным увели-чением риска смерти, инвалидизации, неблагоприятного течения заболеваний, c большими экономическими за- Цель исследования. Оценить особенности ассоциации мультиморбидности с риском развития сердечно-сосудистых осложнений (ССО) у пациентов с острым коронарным синдромом (ОКС). Материал и методы. Проведено ретроспективное, регистровое исследование с участием 1097 пациентов с ОКС. Средний возраст больных всей выборки составил 62 (61-63) года. Летальность в изучаемой группе составила 4,6%. Годовая летальность от всех причин составила 10,9%, трехлетняя -16,9%. Мультиморбидность, доля которой составила 70,5%, констатировали при наличии у пациента не менее 2 фоновых патологий: артериальной гипертонии, анемии, мультифокального атеросклероза, сахарного диабета, инсульта, ожирения, дисфункции почек. Результаты. Установлено, что с мультиморбидностью ассоциируются пожилой возраст, женский пол, высокий риск смерти по шкале GRACE, перенесенный ранее инфаркт миокарда, высокий класс острой сердечной недостаточности по классификации Killip, снижение частоты проведения чрескожного коронарного вмешательства (ЧКВ) на госпитальном этапе и коронарного шунтирования (КШ) после выписки из стационара. Госпитальная и отдаленная летальность также существенно возрастали с увеличением количества фоновых заболеваний. Многофакторный анализ позволил установить, что мультиморбидность отягощает среднесрочный (годовой) прогноз в большей степени, чем госпитальный или трехлетний. Заключение. Мультиморбидность оказывает неблагоприятное влияние на прогноз. Несмотря на ассоциацию мультиморбидности со снижением частоты проведения как ЧКВ, так и КШ, реваскуляризация значительно улучшает прогноз у этой категории пациентов. Приведенные данные позволяют сделать вывод о необходимости не только повысить возможность проведения хирургической реваскуляризации, но и более эффективной диспансеризации мультиморбидных пациентов. We aimed to evaluate the peculiarities of association of multimorbidity with cardiovascular risk in patients with acute coronary syndrome (ACS). Material and methods. The retrospective registry study included 1097 patients with ACS. The mean age of the patients of the entire sample was 62 (61-63) years. The in-hospital mortality within the studied group was 4.6%. The annual mortality from all the causes was 10.9% and the three-year mortality was 16.9%. The presence of at least 2 background pathologies: arterial hypertension, anemia, multivessel coronary artery disease or polyvascular disease, diabetes mellitus, stroke obesity or rena...

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Aim. To assess the relationship of abdominal obesity with left ventricular systolic function and to predict outcomes in patients with MI within 10 years.Methods. 581 medical records of patients enrolled in the Acute coronary Syndrome Registry between 2008 and 2010 were retrospectively reviewed for the period of 10 years. The following clinical endpoints were collected: all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, stroke, hospitalization due to unstable angina and decompensated heart failure. Baseline left ventricular ejection fraction (LVEF) and the presence of abdominal obesity measured as waist-to-hip ratio were collected in all patients.Results. Abdominal obesity was found in 392 (67.4%) patients admitted with MI. The presence of abdominal obesity did not affect main outcomes within 10 years after the indexed event. Cardiovascular mortality was the lowest among patients with abdominal obesity., an association between abdominal obesity and low cardiovascular mortality was found in patients with intermediate LVEF using the risk stratification data based on the severity of systolic dysfunction at discharge. The highest rate of recurrent hospitalization due to unstable angina was found in patients with abdominal obesity and intermediate LVEF.Conclusion. The prevalence of abdominal obesity in MI patients was high (67%). Abdominal obesity appeared to confer protective effects on the 10-year clinical outcomes in patients with low and intermediate LVEF based on all-cause and cardiovascular mortality. The waist-to-hip ratio were significant in the generation of 10-year allcause and cardiovascular disease mortality prediction models in patients with MI.

Aim. To study the effect of body mass index (BMI) on the 3-year prognosis of patients after myocardial infarction (MI).Material and methods. The study is based on data from a 3-year observation of patients with MI from the Kemerovo registry of acute coronary syndrome (n=1366). The characteristics of patients with MI, distributed by the BMI, were determined, the outcomes were analyzed, the risk factors and predictors for the vascular events and mortality were identified.Results. Obesity was detected in 32.2% people with MI (I degree – 22.3%; II – 7.7%; III – 2.3%), lack of BMI at 0.5%, normal BMI at 20.5%, overweight at 46.9%. Patients with different BMI showed a comparable incidence of recurring MI. In patients with normal BMI, when compared with patients with obesity, unstable angina pectoris (UA), heart failure (HF) and strokes developed often. In patients with normal BMI compared with obese patients, fewer deaths from all causes were recorded within 3 years after MI. A similar pattern with respect to the group with normal BMI in terms of high overall mortality was obtained among patients with overweight who had a lower UA. Patients with obesity was favorable in relation to the development of HF, strokes and overall mortality than patients with overweight. Differences in the 3-year outcomes in the group of patients with MI and underweight were not found when compared with patients with normal and overweight, however, they had a higher of strokes compared with patients with obesity. At patients with I degree obesity within 3 years after MI UA, HF, strokes were less. Patients with III degree obesity, the maximum frequency of total mortality was recorded. The development of death from all causes during the observation period in patients with MI and obesity was associated with: male, smoking, multivessel arterial diseases, non-endovascular reperfusion, acute HF with MI, history of vascular events and angina pectoris; whereas with overweight: multifocal atherosclerosis and arterial hypertension; with a deficit of BMI: non-reperfusion; with normal BMI: heredity for cardiovascular diseases, dyslipidemia and atrial fibrillation.Conclusion. 3 years after MI patients with obesity of the I degree are less likely than patients with obesity of II-III deaths from all causes are recorded; these patients are less likely than patients with normal weight to develop strokes, HF, UA. Thus, patients with MI and the presence of I degree obesity are characterized by better survival during 3 years of observation.

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