The conclusion of the Expert Council reports an agreement on the place of the P2Y 12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y 12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

The conclusion of the Expert Council reports an agreement on the place of the P2Y12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

In a prospective non-randomized comparative open, parallel-group study evaluated the clinical efficacy of succinic acid on the impact on symptoms of anxiety and depression in patients with acute exacerbation of COPD and severe. A total of 134 patients. All subjects men 5168 years. The survey was conducted according to the criteria GOLD 2011. To assess the level of anxiety and depression questionnaire used HADS depression and samooprosnik CES-D. Patients in group 1 (n=61) standard therapy exacerbation. Patients in Group 2 (n=72), the standard therapy was supplemented with acute drug Amber-antitoks within 14 days, 1 tablet (0.5 g) 3 times daily after meals. Between groups were compared indicators characterizing COPD before and after treatment. The positive effect would be achieved in both groups. Patients whose treatment included succinic acid reached higher levels in relation to the comparison group: FEV 1p=0.01; FVCp=0.01; distance traversed in the test with the 6-min walk p=0.003; oxygen saturation after the 6-minute walk test p=0.0001; expiratory pressure at the mouth p=0.01; decreased symptoms of anxiety p=0.003; manifestations of depression decreased p=0.0001. It is concluded that succinic acid is included in the standard treatment of exacerbations of COPD, severe effective for relief of elevated levels of anxiety and depression. This effect is largely associated with improved somatic condition of patients after treatment. This is evidenced by the correlation between the level of anxiety and depression prior to treatment with the clinical manifestations of COPD exacerbations. In particular, the FEV1 (r=-0,72; p=0,01), with the distance traveled by a 6-minute walk test (r=-0,61; p=0,001); with oxygen saturation after 6 minutes walk test (r=-0,77; p=0,001); with expiratory pressure in the oral cavity (r=-0,53; p=0,01), with the oxygen saturation (r=-0,69; p=0,01).

С целью определения сравнительной эффективности фармако-инвазивной стратегии реперфузии миокарда и первичной ангиопластики при остром инфаркте миокарда 326 больных с острым коронарным синдромом с подъемом сегмента ST в первые 6 часов заболевания на догоспитальном этапе были рандормизированы на 2 группы: первичную ангиопластику (1-я группа) и догоспитальный тромболизис с последующей спасительной или отсроченной ангиопластикой в зависимости от эффективности тромболизиса (2-я группа). Анализировались клинико-анамнестические характеристики пациентов, эффективность проводимых реперфузионных мероприятий, размер формирующегося некроза миокарда, клиническое течение заболевания, временные параметры реперфузионных мероприятий. Обнаружено, что фармако-инвазивная реперфузия миокарда при ОКСпST с использованием догоспитального тромболизиса обеспечивает реперфузию в те же сроки, что и первичная коронарная ангиопластика: 236 ± 138,2 мин и 232 ± 71,6 мин соответственно (р > 0,05). Фармако-инвазивная стратегия лечения ОКСпST является альтернативой первичному чрескожному вмешательству в первые 6 часов в случае невозможности проведения ЧКВ в течение 90 минут после первого медицинского контакта.

Nowadays the problem of comorbidity of cardiac artery disease (CAD) and chronic obstructive pulmonary disease (COPD) is a complex, diverse and still poorly studied. Comparative analysis of the clinical features of acute myocardial infarction (AMI) in patients with COPD and without COPD has been performed in the study. It has shown that in patients with AMI diagnosis of COPD is exposed on the basis of the medical history, clinical course that is a complex of syndromes: bronchitic, bronchoobstructive and lung emphysema. It has been found that patients with COPD are more likely to have a history of attacks of angina pectoris, congestive heart failure and ischemic stroke; often the duration of the AMI complicated by cardiac arrhythmias, recurrent myocardial infarction, hospital and high annual mortality in comparison with the patients without COPD. On admission respiratory symptoms have been recorded not only in patients with COPD, but also in long-term smokers with AMI without COPD. In the treatment of acute myocardial infarction in patients with COPD β-blockers have been used in 74%, they have been canceled in 22% in the first 5 days of treatment of the main disease and in 17.4% due to the increase of bronchoobstructive syndrome. Major bronchodilator drugs for the treatment of COPD patients in acute myocardial infarction period were M-cholinolitics and combination (β2-agonist and glucocorticosteroid) drugs, the use of which has shown no adverse effect on the cardio vascular system.

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

На сегодняшний день взаимообусловность ишемической болезни сердца (ИБС) и хронической обструктивной болезни легких (ХОБЛ) неоднократно обсуждалась в отечественной и зарубежной литературе, однако единства мнений по этому вопросу до сих пор не достигнуто. Проведен сравнительный анализ выявленных в результате исследования клинических особенностей течения острого инфаркта миокарда (ОИМ) у пациентов с ХОБЛ, длительно курящих без ХОБЛ и некурящих пациентов с ОИМ. Обнаружено, что пациенты с ХОБЛ в анамнезе чаще страдают приступами стенокардии напряжения, хронической сердечной недостаточностью и нарушением мозгового кровообращения, ишемического характера; чаще течение ОИМ осложняется нарушением ритма сердца, рецидивирующим инфарктом миокарда и ранней постинфарктной стенокардией по сравнению с курящими и некурящими пациентами. Показана высокая госпитальная и годовая летальность у пациентов с коморбидной патологией по сравнению с длительно курящими пациентами без ХОБЛ и некурящими с ОИМ. Выявлено, что в острый период инфаркта миокарда появление (усиление) респираторных симптомов возможно не только у пациентов с ХОБЛ, но и у длительно курящих с ОИМ без ХОБЛ. У пациентов с ХОБЛ в острый период ИМ выявлены различия структурно-функциональных показателей левых и правых отделов сердца по сравнению с длительно курящими и некурящими пациентами. Показано, что при остром инфаркте миокарда у пациентов с ХОБЛ и у длительно курящих пациентов без ХОБЛ респираторные симптомы коррелируют с показателями структурно-функциональных характеристик сердца.

We assessed in a prospective, randomised, placebo-controlled trial the effects of «yantar-antitox» in patients with exacerbations of COPD requiring hospital admission. We recruited patients with exacerbations of severe COPD who were randomly assigned oral «Yantar-antitox» (n=33) or identical placebo (n=45) for 14 days, in addition to standard treatment with nebulised bronchodilators, antibiotics, and oxygen. We did spirometry and recorded symptom scores in inpatients. The 6-min walking distance (6MWD) was also determined. Inflammatory markers were measured in induced sputum and serum. Significant increase in the percentage predicted lung vital capacity, maximal expiratory flow volume, 6MWD were found between the patient in the «Yantar-antitox» — treated group.

Urgent cardiology department of Tomsk research cardiology institute discussed new acute coronary syndrome treatment approaches. Accelerated intravenous 10-15 minutes Streptokinase infusion is favorable modified times delay up to coronary artery reperfusion in myocardial infarction patients. This method had high safety and coronary artery opening rate. Prognosis of serious adverse events in elder patient was depended from myocardial necrosis extend, but not from thrombolythic therapy execution. Pulmonary edema and cardiogenic shock development in MI patients were most high negative prognosis survival index. Early thrombolysis, PCI and their combination increased MI patients survival. Recovery of myocardial function is a new approach for congestive heart failure treatment in post MI patients. Autological mononuclear cell transplantation by its intracoronary infusion is studied in urgent cardiology department.