The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.

Aim. To study the comparative efficacy and safety of clopidogrel and ticagrelor in the “double” antiplatelet therapy (DATT) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) in the early and late periods in real clinical practice, and to assess adherence to treatment.Materials and methods. The study included 109 patients with ACS, who underwent PCI. Patients were divided into two groups: the 1st group (n=57) – received ticagrelor and the 2nd group (n = 52) – received clopidogrel in the DATT for 12 months. The frequency of ischemic events (death from cardiovascular causes, repeated myocardial infarction (MI) and stent thrombosis (ST)) and hemorrhagic events was analyzed during hospitalization, in 3 months, 6 months and in 12 months. Also, the reasons of repeated hospitalizations during the year were analyzed. The adherence of patients was assessed using the Moriski–Green scale.Results. There were no significant differences in the ticagrelor and clopidogrel groups (8.8% vs. 11.5%, p=0.87) for the incidence of stent thrombosis (ST). In the correlation analysis, in half of all cases of subacute ST in the total sample (n=109) (in 4 (3.65%) cases from 8 (7.3%)), the main reason for its development was the lack of adherence of patients to DATT (τ=0,6; p<0,001). The frequency of minor bleeding significantly prevailed in the ticagrelor group versus the clopidogrel group (38.6% vs. 21.2%, p=0.047). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (1.8% and 1.9%, p=0.52). However, the difference in the rates of fatal bleeding, including more instances of fatal intracranial bleeding (1.8% vs. 0%; p=0,34), allows us to talk about the best hemorrhagic safety of clopidogrel.Conclusion. In this study, ticagrelor and clopidogrel were comparable in their effectiveness. Ischemic events and repeated hospitalizations in both groups are associated with the progression of atherosclerosis, confirmed by angiography; the development of stent restenosis, as well as low adherence, which is the main predictor of subacute TS. In addition, clopidogrel versus ticagrelor showed better hemorrhagic safety in the frequency of development of minor bleeding.

1 Нижегородская государственная медицинская академия Россия, 603950, Нижний Новгород, пл. Минина и Пожарского, 10/1 2 Городская клиническая больница № 5. Россия, 603950, Нижний Новгород, ул. Нестерова, 34БЦель. Изучить влияние терапии ривароксабаном на частоту развития кардиоэмболических инсультов и системных тромбоэмболических ослож-нений (ТЭО), кровотечений у пациентов с неклапанной фибрилляцией предсердий (ФП) в сравнении с варфарином Материал и методы. В открытое нерандомизированное исследование включено 126 пациентов старше 18 лет, обратившихся в кардиоло-гический диспансер с неклапанной ФП. Учитывая социально-экономические возможности пациентов, обратившиеся были разделены на 2 группы: ривароксабан получали 77 больных и 49 лечились варфарином. Оценивалась частота развития острого коронарного синдрома, ише-мического инсульта и иных ТЭО, кровотечений, а также международное нормализованное отношение (МНО) и процент времени нахожде-ния в терапевтическом диапазоне МНО для принимавших варфарин. Результаты. Частота ишемического инсульта значимо не отличалась между группами, но встречаемость иных ТЭО была значимо выше в слу-чае использования варфарина (0 против 8%; р=0,011). Частота осложнений в виде развития малых кровотечений значимо преобладала в группе варфарина (0 против 20%; p=0,0004). В группе варфарина процент времени нахождения МНО в терапевтическом диапазоне со-ставил только 43%. Через 9 мес 93,5% больных продолжали принимать препарат ривароксабан, а для варфарина этот показатель снизил-ся до 67,4%. Заключение. Данные собственного клинического наблюдения применения ривароксабана у пациентов с неклапанной ФП продемонстри-ровали эффективность, сравнимую с таковой у варфарина. По безопасности ривароксабан превосходил варфарин. Aim. To study the effect of rivaroxaban compared with warfarin on the incidence of cardioembolic stroke and systemic thromboembolic complications (TEC), bleeding in patients with non-valvular atrial fibrillation (AF). Material and methods. Patients (n=126) older than 18 years, appealed to the Cardiology Clinic with non-valvular AF were included into an open non-randomized study. The patients were divided into 2 groups based on their socio-economic status: 77 patients received rivaroxaban and 49 -warfarin. The incidence of acute coronary syndrome, ischemic stroke and other TEC, bleeding as well as (only for patients taking warfarin) international normalized ratio (INR) and time in the therapeutic INR range were evaluated. Results. The incidence of ischemic stroke was not significantly different between groups, at the same time the incidence of other TEC was significantly higher in the warfarin group (0 vs 8%, p=0.011). The incidence of minor bleedings was significantly prevailed in warfarin group (0 vs 20%; p=0.0004). The time in the target INR range in the warfarin group was only 43%. 93.5% of patients continued to receive rivaroxaban after 9 months, and warfarin -67.4% of patients. Conclusion. The results of our own clinical studies of rivaroxaban in patients with non-valvular AF hav...

Aim: to identify predictors of stent thrombosis in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) for 12 months by creating a miathematical logistic regression model to optimize rehabilitation, secondary prevention of ischemic events in the first year after ACS, as well as a personalized approach to treatment. Materials and methods. The analysis used data from the hospital register, which contained information on all PCIs, performed in the Semashko hospital between September 2016 and August 2018 (2378 patients). For this study we selected a sample of 183 ACS patients (146 men and 37 women) after PCI: 25 with definite stent thrombosis confirmed by repeated coronary angiography (CAG) (the main study group), and 158 without developing definite stent thrombosis (the comparison group) according to the observation for 12 months. All patients during hospitalization and 1 year after discharge received standard medical therapy ACS, according to international recommendations. Laboratory tests, electrocardiography (ECG), echocardiography, 24-hour ECG monitoring were performed for in patients. For determining predictors of the development of stent thrombosis we performed a logistic regression analysis. Results. A mathematical model of multifactorial prognostication of stent thrombosis in patients with ACS after PCI was created. The model included the following predictors: Killip class >II; life-threatening paroxysmal tachyarrhythmias (atrial fibrillation and/or ventricular fibrillation) as ACS complication of; left ventricular ejection fraction ≤45%; CA dissection; CAG confirmed CA thrombosis before PCI. Conclusion. The proposed model in patients with ACS allows us to estimate the risk of stent thrombosis after PCI, as well as to improve the accuracy of the event prediction. The model is easy to use, can be applied by practicing cardiologists during hospitalization. This model allows us to personalize secondary prevention in the first year after ACS, and thus help to reduce cardiovascular mortality, incidence of recurrent myocardial infarctions, unstable angina, and emergency revascularization.

303 Проблема не в том, чего вы не знаете... А в том, в чем вы уверены на 100%. На самом деле все абсолютно не так! Марк ТвенДо сих пор интересен вопрос: "Медицина -это ре-месло или искусство?". И на него нет однозначного от-вета. Вероятно это ремесло, которое основывается на искусстве использовать свои знания, опыт и интуицию у данного конкретного больного.То, что фибрилляция предсердий (ФП) -это плохо, мы давно и хорошо знаем, и то, что увеличивается риск инсульта и протекают они тяжелее, и больше летальных исходов -тоже факты известные [1][2][3]. Доказано и то, что варфарин снижает частоту развития ишемическо-го инсульта практически на 67% [4], и сейчас мы име-ем четкие и конкретные рекомендации по выбору ан-тикоагулянтной терапии Европейского общества кар-диологов (ESC) и Российского кардиологического об-щества (РКО) (рис. 1) [5,6]. Выбор антикоагулянтной терапииНесмотря на все наши теоретические знания, на прак-тике частота назначения антикоагулянтной терапии при ФП в лучшем случае приближается к 55%, а в боль-шинстве случаев значительно ниже [7] -это значит, что основная часть пациентов остаётся незащищенной от возможных тромбоэмболических осложнений. Какая причина этого диссонанса между теорией и практикой? Действительно, мы боимся использовать варфарин со-вершенно объективно, поскольку препарат имеет узкое терапевтическое окно, что требует подбора дозы и по-стоянного мониторирования международного норма-лизованного отношения (МНО) (что не всегда возможно в наших условиях) с целью поддержания эффективной Одним из основных направлений ведения больных с фибрилляцией предсердий является адекватная первичная и вторичная профилактика тромбоэмболических ослож-нений. Многолетняя практика и накопленный опыт использования варфарина, к сожалению, не привели к более широкому и эффективному использованию антикоагулянтной терапии. В последние несколько лет появились новые пероральные антикоагулянты, лишённые тех недостатков варфарина, которые препятствовали его назначению и длительному применению. Одним из них, наиболее изученным, имеющим самый большой перечень показаний к применению и очень привлекательным, является ривароксабан. Adequate primary and secondary prevention of thromboembolic complications is one of the main goals of management of patients with atrial fibrillation. Many years of practice and experience of warfarin use, unfortunately, did not lead to wider and more efficient use of anticoagulation therapy. New oral anticoagulants devoid of drawbacks of warfarin, which prevented its prescription and long-term use, have appeared in the past few years. One of them, the most studied, with the largest list of indications for use, and very attractive, is rivaroxaban.