Aim. To study the relationship between comorbidity and acute heart failure (AHF) complicating myocardial infarction (MI).Material and methods. The analysis included 993 patients with MI from the registry of acute coronary syndrome RECORD-3. Killip class II-IV was recorded in every fifth patient (n=205). Hospital mortality was 6,3%. The mean age was 64,3 (63,5-65,0) years (men — 66,1%). All patients were divided into three groups depending on the number of comorbidities (type 2 diabetes, chronic kidney disease, atrial fibrillation, anemia, stroke, hypertension, obesity, peripheral atherosclerosis, thrombocytopenia). The first group included patients with no more than one disease (n=251), the second one — with 2 or 3 diseases (n=480), and the third one — with 4 or more diseases (n=262).Results. AHF detection rate increased in groups with increasing comorbidity: 12,3%, 17,9% and 33,6%, respectively (p<0,0001). Regardless of the initial therapy, in patients of the first group without AHF the hospital mortality rate did not exceed 1%. In patients of the third group with Killip class II-IV AHF the hospital mortality was the highest and also did not depend on the choice of treatment strategy (24,6% with conservative management, 31,6% with percutaneous coronary intervention (PCI)). PCI made it possible to reliably (p<0,05) reduce the risk of hospital mortality in patients of the second and third groups without AHF relative risk 4,3 (1,0-19,9) and 4,2 (1,1-18,3), respectively. Analysis of a 1-year follow-up revealed that AHF is a death predictor after hospital discharge independent of the comorbidity severity: 11,1%, 13,3%, and 14,3%, respectively. In patients without AHF a 1-year mortality increased from the first to the third group: 1,1%, 5,8% and 7,0%, respectively (p=0,043).Conclusion. Сomorbidity is an independent predictor of heart failure in MI, and their combination is associated with the most unfavorable in-hospital prognosis, regardless of the treatment strategy. The greatest advantage of PCI for reducing the hospital mortality rate was obtained in patients with comorbidity and without manifestations of AHF.

Aim. To study the relationship between comorbidity and acute heart failure (AHF) complicating myocardial infarction (MI). Material and methods . The analysis included 993 patients with MI from the registry of acute coronary syndrome RECORD-3. Killip class II-IV was recorded in every fifth patient (n=205). Hospital mortality was 6,3%. The mean age was 64,3 (63,5-65,0) years (men — 66,1%). All patients were divided into three groups depending on the number of comorbidities (type 2 diabetes, chronic kidney disease, atrial fibrillation, anemia, stroke, hypertension, obesity, peripheral atherosclerosis, thrombocytopenia). The first group included patients with no more than one disease (n=251), the second one — with 2 or 3 diseases (n=480), and the third one — with 4 or more diseases (n=262). Results. AHF detection rate increased in groups with increasing comorbidity: 12,3%, 17,9% and 33,6%, respectively (p<0,0001). Regardless of the initial therapy, in patients of the first group without AHF the hospital mortality rate did not exceed 1%. In patients of the third group with Killip class II-IV AHF the hospital mortality was the highest and also did not depend on the choice of treatment strategy (24,6% with conservative management, 31,6% with percutaneous coronary intervention (PCI)). PCI made it possible to reliably (p<0,05) reduce the risk of hospital mortality in patients of the second and third groups without AHF relative risk 4,3 (1,0-19,9) and 4,2 (1,1-18,3), respectively. Analysis of a 1-year follow-up revealed that AHF is a death predictor after hospital discharge independent of the comorbidity severity: 11,1%, 13,3%, and 14,3%, respectively. In patients without AHF a 1-year mortality increased from the first to the third group: 1,1%, 5,8% and 7,0%, respectively (p=0,043). Conclusion . Сomorbidity is an independent predictor of heart failure in MI, and their combination is associated with the most unfavorable in-hospital prognosis, regardless of the treatment strategy. The greatest advantage of PCI for reducing the hospital mortality rate was obtained in patients with comorbidity and without manifestations of AHF.

Aim. To identify specific risk factors and features of the course of myocardial infarction (MI) in young patients. Material and methods. The study design is based on a comparison of observation data for patients of different ages from the Russian RECORD-3 registry (n=2359) and the registry of acute coronary syndrome of the Kemerovo city in 2015 (n=1343). The clinical and anamnestic portrait was determined, the frequency of hospital complications and the “hard” endpoints were evaluated. Results. Young patients with myocardial infarction (MI) according to RECORD-3 are more often male smokers (p=0.001) with a heredity in cardiovascular pathology (p=0.034), who have an uncomplicated STEMI upon admission to the hospital, and are sent for coronary angiography with stenting (p=0.001), without prescribing statins in the primary and secondary prevention (p=0.050 and p=0.016, respectively). There were no differences with other age groups by endpoints a year later; during the current hospitalization, young patients less often died (p=0.001) or had a relapse of MI (p=0.011). Young patients with MI from Kemerovo were also mostly male smokers (p=0.001), who more often had a history of chronic kidney disease, chronic heart failure, and lipid metabolism disorders (p=0.001), who admitted to the hospital with uncomplicated STEMI, actively undergoing thrombolytic therapy and endovascular diagnosis and treatment (p=0.001). However, it should be noted that these patients were less likely to receive aspirin (p=0.015), dual antiplatelet therapy (p=0.003), angiotensin converting enzyme (ACE) inhibitors (p=0.040) and statins (p=0.001). Moreover, in young patients with MI, deficiency of high density lipoproteins (p=0.005) was more often found in the absence of very high values of low density lipoproteins (p=0.001). Among the complications of inpatient treatment, it should be noted a tendency to bleeding (p=0.001). One year after referent MI a high proportion of repeated non-fatal MI (p=0.005) and deaths (p=0.001) were observed. A comparison of the registries showed that young patients from Kemerovo were more likely to have STEMI (p=0.032), they were more likely to have stenting (p=0.004), they were more often diagnosed with chronic renal and heart failure (p=0.001), and more often ACE inhibitors was prescribed (p=0.017), and MI during hospitalization was more often complicated by bleeding (p=0.003). Conclusion. From 1.7 to 2.4% of all MI occurs in young patients. The most frequent version of the debut is STEMI. The leading factors of cardiovascular risk in such patients are the male gender, active smoking, a hereditary history of cardiovascular diseases, low cholesterol of high density lipoproteins with insufficient statins prevention. In young patients of the Kemerovo registry, chronic heart failure and chronic kidney disease were more often observed, and ACE inhibitors were prescribed, hospitalization was often accompanied by bleeding. In a young age differences in the frequency and structure of outcomes in one year after referent MI were not found when comparing registries.

Aim. To identify specific risk factors and features of the course of myocardial infarction (MI) in young patients. Material and methods. The study design is based on a comparison of observation data for patients of different ages from the Russian RECORD-3 registry (n=2359) and the registry of acute coronary syndrome of the Kemerovo city in 2015 (n=1343). The clinical and anamnestic portrait was de- termined, the frequency of hospital complications and the “hard” endpoints were evaluated. Results. Young patients with myocardial infarction (MI) according to RECORD-3 are more often male smokers (p=0.001) with a heredity in cardiovascular pathology (p=0.034), who have an uncomplicated STEMI upon admission to the hospital, and are sent for coronary angiography with stenting (p=0.001), without prescribing statins in the primary and secondary prevention (p=0.050 and p=0.016, respectively). There were no diffe- rences with other age groups by endpoints a later; the current hospitalization, young patients less often died (p=0.001) or had a relapse of MI (p=0.011). Young patients with MI from Kemerovo also mostly male smokers (p=0.001), who more often a of chronic kidney disease, chronic heart failure, and lipid metabolism disorders (p=0.001), to the with uncomplicated STEMI, thrombolytic therapy and endovascular and in young patients with MI, deficiency of high density lipoproteins (p=0.005) was more often found in the absence of very high values of low density lipoproteins (p=0.001). Among the complications of inpatient treatment, it should be noted a tendency to bleeding (p=0.001). One year after referent MI a high proportion of repeated non-fatal MI (p=0.005) and deaths (p=0.001) were observed. A comparison of the registries showed that young patients from Kemerovo were more likely to have STEMI (p=0.032), they were more likely to have stenting (p=0.004), they were more often diagnosed with chronic renal and heart failure (p=0.001), and more often ACE inhibitors was prescribed (p=0.017), and MI during hospitalization was more often complicated by bleeding (p=0.003). Conclusion. From 1.7 to 2.4% of all MI occurs in young patients. The most frequent version of the debut is STEMI. The leading factors of cardiovascular risk in such patients are the male gender, active smoking, a hereditary history of cardiovascular diseases, low cholesterol of high density lipoproteins with insufficient statins prevention. In young patients of the Kemerovo registry, chronic heart failure and chronic kidney disease were more often observed, and ACE inhibitors were prescribed, hospitalization was often accompanied by bleeding. In a young age differences in the frequency and structure of outcomes in one year after referent MI were not found when comparing registries.

Purpose: to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical course of ischemic heart disease (IHD) during 3–5 years of follow-up in men after coronary artery bypass grafting (CABG).Materials and methods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwent color duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT) of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels was assessed by the Agatston method. After 3–5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followup was 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcification scores.Results. Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinical and anamnestic factors only one risk factor – smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval [CI] 1.2–78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenic syndrome and BCA involvement. In the group of patients with baseline coronary calcification index >400 there were more smokers (р=0.026) and patients with lesions in >3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage we revealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= –0.24, р=0.06), Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3–5 years after CABG a medium positive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029). Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoral bone as the only significant predictor of calcium score increase during 3–5 years of follow-up.Conclusion. Dynamics of calcification of CAs in men with IHD during 3–5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive. There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone prior to CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary calcification was found. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral density of femoral bone.

The registries of acute coronary syndrome (ACS) are the main tool for quality assessment of medical care and provision of medicines in this disease. Purpose: based on the results of the Russian RECORD-3 registry we aimed at estimating the main clinical characteristics, approaches to diagnosis, treatment and outcomes of in-hospital treatment in patients with non-STsegment elevation ACS (NSTE-ACS) in Russian hospitals participating in the registry. Materials and methods. RECORD-3 registry of ACS was performed in 47 hospitals of 37 Russian cities in March to April, 2015. The analysis comprised 1495 patients with NSTE-ACS. Results. When dividing the patients with NSTE-ACS into the groups of subjects, admitted to PCI centers (n=1012) and noninvasive hospitals (n=483), we found that the patients in PCI centers were more often males, were younger, and had more often history of revascularization procedures. At the same time, the patients in noninvasive hospitals had a greater severity: high incidence rates of arterial hypertension, hypercholesterinemia, and atrial fibrillation. ACS forms, complicated with acute heart failure, were more frequent in noninvasive hospitals: 16% (n=76) vs. 11% (n=111) in PCI centers, р=0.006. The patients from noninvasive hospitals less often received statins, beta-blockers, and fondaparinux, but they received more frequently clopidogrel, angiotensin-converting enzyme inhibitors, diuretics, nitroglycerin, pressor amines, and anticoagulants including subcutaneous administrations of unfractionated heparin. The frequency of fatal outcomes in NSTE-ACS was higher in noninvasive hospitals (3.7% vs. 1.7%, p=0.022). Conclusions. The situation with medication underuse in the treatment of patients with NSTE-ACS persists in noninvasive hospitals accompanied by an increase in the hospital mortality rate as compared with PCI centers.

Purpose . To assess factors associated with pre-hospital delay in seeking medical care in patients with myocardial infarction. Materials and Methods : 51 patients with myocardial infarction, included in the original single-center research trial, were surveyed to assess the differences in the time intervals from the onset of symptoms to the decision to seek medical care, as well as the factors, associated with delay in calling emergency medical service. Results . We found that the majority of patients (> 70%) with myocardial infarction, admitted to the Kemerovo Regional Clinical Cardiology Dispensary, applied for medical care within 6 hours from the onset of symptoms. However, there was a group of patients with increased pre-hospital delay time. Patient delay may affect the effectiveness of treatment for acute coronary syndrome. These patients were commonly of younger age and males, with higher education working in the urban areas. Information campaigns targeted at this group of patients should be launched to raise their awareness and highlight the crucial role of prompt and timely calling EMS after the onset of myocardial infarction. Conclusion . It seems to be a rationale to launch informational campaigns targeting this group of patients (young working men living in large industrial cities) to highlight the importance of early and prompt seeking of medical care after the onset of MI symptoms.

The aim of this study was to assess significance of serum neutrophil gelatinase-associated lipocalin (sNGAL) and cystatin C (sCC) in prediction of adverse cardiovascular outcome after ST-segment elevation myocardial infarction (STEMI).

Aim. To investigate on the most significant predictors of cardiovascular risk in acute coronary (ACS) and kidney dysfunction (KD) patients, underwent percutaneous coronary intervention (PCI).Material and methods. Totally, 206 patients included into the study. As the criteria of KD glomerular filtration rate below 60 mL/min/1,73 m2 was taken, by CKD-EPI (2011) based on the blood creatinine concentration at hospitalization. In-hospital mortality was 13,1% (n=27). All-cause annual mortality was 15,5% (n=32), 3-year mortality — 21,8% (n=45).Results. Monofactorial analysis showed that the most significant factors of inhospital and long-term mortality in ACS and KD patients after PCI were congestive heart failure, stroke, myocardial infarction anamnesis, acute heart failure (AHF), hyperglycemia, prominent systolic dysfunction of myocardium, tachicardia and hypotension at admittance, multivessel disease, as acute kidney injury (AKI) developed during hospitalization (criteria RIFLE and AKIN). Step-by-step selection in Cox regression showed that the factors of in-hospital mortality were anamnesis of stroke, AHF at admittance, AKI development during hospitalization. C-statistics of the developed model was 0,82, that is seriously more significant than that of GRACE 2,0-0,74 score. In the analysis of long-term survival by Cox, it was revealed that stroke and myocardial infarction anamnesis, as AHF at admittance and AKI regardless of other factors, are related to the increase of fatal outcomes rate during one and three years of observation. Also, the area under ROC of the invented risk models was 0,84 and 0,76, respectively, for 1 and 3 years. In GRACE 2,0 such parameter was more significantly lower — 0,78 and 0,69, respectively.Conclusion. The results witness on the significance of additional risk factors introduction into risk assessment in patients with ACS and baseline KD, and the developed novel models were better than GRACE.

Aim. To evaluate gender differences in the disease course and in treatment at inpatient stage of management of ST elevation acute coronary syndrome (STEACS) patients by the data from the Russian Registry of Acute Coronary Syndromes “RECORD-3”.Material and methods. The study was conducted based on the data from Russian registry “RECORD-3”, in 47 institutions of 37 cities of Russia. The Registry included all consequtive patients with ACS, hospitalized in the participated institutions during march-april 2015, totally 2370 ACS patients. From the general group, patients were selected with the admission diagnosis STEACS (n=864). Mean age of STEACS patients was 62,6±12,4 y. Among them, 712 (82,4%) were primarily hospitalized into centers with invasive methods available, others (n=152, 17,6%) to non-invasive. The analysis was conducted, of the in-patient stage of patients, including reperfusion methods, and analysis of medication therapy.Results. More than a half of patients (68%) with STEACS were males, and hospitalized women were 10 years older. Females with ACS were at baseline clinically more complicated with arterial hypertension (AH), angina, chronic heart failure (CHF), diabetes 2 type, and atrial fibrillation in anamnesis. Higher number of acute heart failure was found (HF) (Killip II-IV) in females with ACS. There were no gender differences by the time of onset of pain to admittance and of doorballoon time. However coronary and ventriculography (CVG), percutaneous interventions (PCI), thrombolysis were done significantly (p=0,0001) rarer in females than in males. Higher mortality was found in females with STEACS comparing to males. There was higher rate of mortality in STEACS of females comparing to males (17,5% vs. 6,3%, p=0,0001). Monofactorial analysis revealed factors related to non-direction of patients to coronary arteriography: older age (more than 60 y. o.), female gender, cardiovascular comorbidity, acute heart failure at admittance. Conclusion. By the results of data analysis of “RECORD-3”, there were special characteristics of STEACS patients revealed for females: mean age is 10 years older than males; higher rate of cardiovascular comorbidity; reperfusion performed more rare, including outpatient stage of management. All these lead to significantly worse outcomes.

The study is aimed at the comparative assessment of the incidence of adverse cardiovascular events in the inhospital and long-term period in patients with initial renal dysfunction (RD) and without it after coronary artery bypass grafting (CABG). Material and methods : 720 patients with clinical manifestations of coronary atherosclerosis, operated on between 2011 and 2012, were included in the study. All patients underwent preoperative measurement of serum creatinine levels, the estimation of glomerular filtration rate (GFR) using the MDRD formula, and the risk scoring using the additive EuroSCORE model. Results : The cut-off value for GFR was set at 60 mL / min / 1.73 m2 in this study, suggesting significant impact on the patients’ outcomes after CABG. There were differences in the preoperative clinical status among the patients with and without RD. Patients with decreased GFR were more likely to have chronic kidney disease, lower extremity arterial disease, extracranial arterial disease, compared to patients with normal GFR. Patients with RD reported higher rates of adverse cardiovascular and renal complications in the in-hospital period. Patients with decreased GFR < 60 mL / min / 1,73m2 were more likely to have recurrent angina and progression of chronic heart failure one year after CABG. The assessment of the impact of renal dysfunction, defined by the levels of GFR, on the development of adverse outcome reported that patients with RD in the moderate risk group were more likely to have combined adverse outcome, compared to patients without RD one year after CABG. Conclusion : The presence of renal dysfunction has an adverse impact on the in-hospital outcome after CABG. Renal dysfunction had no predictive value on long-term outcome, but it increased the incidence of higher angina class and chronic heart failure.

Purpose . To assess factors associated with pre-hospital delay in seeking medical care in patients with myocardial infarction. Materials and Methods : 51 patients with myocardial infarction, included in the original single-center research trial, were surveyed to assess the differences in the time intervals from the onset of symptoms to the decision to seek medical care, as well as the factors, associated with delay in calling emergency medical service. Results . We found that the majority of patients (> 70%) with myocardial infarction, admitted to the Kemerovo Regional Clinical Cardiology Dispensary, applied for medical care within 6 hours from the onset of symptoms. However, there was a group of patients with increased pre-hospital delay time. Patient delay may affect the effectiveness of treatment for acute coronary syndrome. These patients were commonly of younger age and males, with higher education working in the urban areas. Information campaigns targeted at this group of patients should be launched to raise their awareness and highlight the crucial role of prompt and timely calling EMS after the onset of myocardial infarction. Conclusion . It seems to be a rationale to launch informational campaigns targeting this group of patients (young working men living in large industrial cities) to highlight the importance of early and prompt seeking of medical care after the onset of MI symptoms.

Aim: to study associations of polymorphic genetic variants of inflammatory response, endothelial function, lipid metabolism, and blood coagulation with impaired renal function in patients with ST elevation myocardial infarction (STEMI). Material and methods. We enrolled in the study 171 patients admitted to the Kemerovo Cardiology Dispensary within 24 hours after onset of STEMI. All patients underwent genotype identification of 25 polymorphic variants of 18 major candidate genes for cardiovascular disease. Genotyping was performed with DNA chip SINKAR-1 (Institute of Medical Genetics and LLC "Genomic Diagnosis"). Glomerular filtration rate (GFR) was estimated using serum creatinine level measured at admission. Results: Comparison of allelic and genotype frequencies of the studied polymorphisms revealed that angiotensin-converting enzyme (ACE) gene rs4291 was associated with decreased GFR: odds ratio (OR) for carriers of rare TT genotype was 2.31 [1.01-5.25], p=0.043. Analysis of genotype combinations of ACE rs4343 polymorphism and hepatic lipase gene (LIPC) rs1800588 - showed that AA genotype of rs4343 polymorphism in combination with CC genotype of rs1800588 polymorphism was associated with lowest risk of renal dysfunction, whereas GG and AG genotypes of ACE rs4343 in combination with TT and CT genotypes of LIPC rs1800588 with the highest risk. Analysis of combinations of genotypes for three loci (ACE rs4291 and rs4343, LIPC rs1800588) revealed that combination of risk genotypes of three genetic variants led to increase of odds ratio up to 4.42 [1.37-14.26], p=0.012. Conclusion. In STEMI patients an association was found between reduced GFR and TT genotype of ACE gene rs4291, as well as genotype combinations of ACE gene rs4291, rs4343 and LIPC gene rs1800588. Higher odds ratios obtained with combination of "risk" genotypes of three polymorphisms demonstrated additive effects of genetic loci on the studied trait.

Purpose: to study clinical and prognostic significance of serum neutrophil gelatinase-associated lipocalin (s-NGAL) in patients with ST-segment elevation myocardial infarction (STEMI). Material and methods. Patients with STEMI (n=85) of less than 24 hours' duration admitted to the Kemerovo Cardiology Dispensary were included in the study. s-NGAL levels (ng/ml) were measured on day 1 and 12 of hospital stay by ELISA using commercial kit. Reinfarction rate and mortality were assessed over 3-year follow-up. Results. Median s-NGAL levels on day1 and 12 were 1.33 (0.36-1.90) and 1.63 (1.25-2.61) ng/ml, that corresponded to a 3.32-and 4.07-fold increase, respectively, compared to reference values. Between days 1 and 12 s-NGAL levels increased by 22.55 % (p=0.0009). Higher values of serum NGAL on day 12 of MI were associated with presence of renal structural lesions, three-vessel coronary artery disease and anterior MI. Patients who underwent percutaneous coronary intervention (PCI) demonstrated only a negligible increase of s-NGAL level by day 12 while in those not subjected to PCI 3-fold increase was observed. Patients with s-NGAL levels >2.6 ng/ml compared with other patients had higher mortality (9.52 vs 31.83%; odds ratio 4.42 [1.30-15.16], p=0.012). Conclusion. High values of serum NGAL in STEMI patients were associated with severe clinical status. s-NGAL level above 2.6 ng/ml on day 12 of hospital stay was associated with 4-fold increase of all-cause mortality during 3-year follow-up.

Aim. To assess the occurence of hemodynamically non-significant multifocal atherosclerosis (from 30% and more), renal dysfunction and their influence on the outcomes of in-hospital period of patients underwent coronary bypass surgery (CABG).Material and methods. The perioperational period of 720 patients analyzed, who were operated in 2011-2012 y. Before CABG all patients were assessed by colored duplex scanning of extracranial arteries and arteries of lower extremities to reveal the signs of multifocal atherosclerosis (MFA), also the creatinine concentration was measured in 1 day before and 7 days after CABG, and GFR was calculated by MDRD equation. The prevalence of worse outcomes was assessed after the operation (myocardial infarction, stroke, acute renal failure, remediastinotomy, death) during in-hospital period.Results. The prevalence of hemodynamically non-significant MFA (30% and more) in patients with CHD after CABG was 48%. Renal dysfunction (RD), by a decrease of GFR <60 ml/min/1,73 m2, developed in 16% of patients underwent CABG. Concomitance of MFA and RD was 21,3%. It was found that in a quarter of patients after CABG there was an adverse outcome that was more prevalent among only those with RD: in 37,9% vs. 22,3% (p=0,03). There were no significant differents found by the prevalence of an adverse outcome in patients only with MFA. Concomitance of MFA and RD was associated with higher chance of adverse outcome in CABG with CHD: in 39,7% cases vs. 23,8% (p=0,006).Conclusion. The high prevalence of MFA and RD (21,3%) was reveled in CHD patients, underwent CABG. Concomitance of MFA and RD is associated with the development of adverse outcome in CABG. It is stated that this exact group of patients is characterized by the highest amount of earlier CABG complications. The main influence on this is of RD, however it is not possible to definitely distinguish the grade of prognostic value of MFA and RD due to common pathophysiological factors of the development of both and quite complicated mechanisms of their influence and worsening.

Aim. To assess clinical and predictive value of serum IL-18 in ST elevation myocardial infarction.Material and methods. Totally, 132 patients included, hospitalized to Kemerovo cardiovascular dispensary due to STEMI with <24 hours pain onset. Assessment of IL-18 concentration (pg/ml) was done on 12th day of care.Results. Mean concentration of IL-18 in all patients was 244,02 (172,13-315,91) pg/ml, that was 3,5 times higher than reference range. Correlation analysis showed relation of IL-18 levels with total cholesterol, with low density lipoproteides, left ventricle ejection fraction, glomerular filtration rate (GFR) by CKD-EPI: r=0,18 (р=0,040), r=0,24 (р=0,008), r=-0,19 (р=0,029), r=-0,18 (р=0,039), resp. Median concentration of IL-18 in multifocal atherosclerosis (MFA) patients was 214,75 (129,20-362,35) pg/ml vs. 140,40 (97,80-292,80) pg/ml in non-MFA patients (р=0,010). In those patients without any significant progression of BCA lesion, baseline concentration of IL-18 was 271,0 (128,3-358,4) mg/ml, but in patients with the increase of stenosis grade more than 30% and/or appearance of novel plaques the level of IL-18 was 119,35 (94,61-188,95) pg/ml.Conclusion. In prediction of early (in-hospital) and long-term (3-year) stages of myocardial infarction there was no any clinical and predictive value of IL-18. Concentration of serum IL-18 did not relate to kidney diseases in STEMI patients, but correlates negatively with GFR defined by CKD-EPI. There was significant role of IL-18 in forming of multifocal atherosclerosis. High concentrations of IL-18 at 12th day of hospitalization were related to the increase of total cholesterol and LDL, and with the decrease of contractility of the left ventricle myocardium. In STEMI with MFA there is increase of IL-18 1,5 times. At the same time significant progression of atherosclerotic lesion during one year was found in patients with lower baseline IL-18 level, which requires further studies of the IL-18 role in atherogenesis

Objective: To study the prognostic significance of serum NGAL (sNGAL) and cystatin C in the acute phase of ST-segment elevation myocardial infarction (STEMI) in the late disease period. Material and Methods: 357 patients with STEMI, admitted to hospital within 24 h of symptom onset, were included in the study. Serum creatinine levels with the calculation of glomerular filtration rate (GFR) using the MDRD as well as levels of sNGAL and cystatin C were measured on day 1 and 12–14. Results: All patients were divided into 2 groups according to their estimated GFR: with and without renal dysfunction (RD), defined as a decrease of GFR < 60 ml/min/1.73 m2. Within 3 years of follow-up, the composite endpoint (CEP) were assessed (CEP – death + non-fatal cardiovascular events). The ROC curve analysis was used to determine the thresholds for every biomarker, involved in the CEP development: NGAL (≥ 1.25 ng / ml) and cystatin C (≥ 1.9 mg / l). On day 12–14 of hospitalization elevated NGAL ≥ 1.25 ng / mL was associated with a 3-fold increased risk for adverse cardio vascular events in a 3-year follow up after STEMI; whereas, elevated cystatin C ≥ 1.9 mg/l – with a 2-fold increased risk for the CEP, and signs of RD, found in patients before the discharge from the hospital, – with a 1.5-fold increased cardiovascular risk. The model considering an increase of NGAL over 1.25 ng / l has the highest prognostic value, while the models based on the levels of cystatin C and GFR are of equal prognostic value. Conclusion: The most promising issue in the prognosis of long-term adverse outcomes in patients with STEMI may be considered the assessment of RD using new biomarkers such as sNGAL.

The problem of kidney dysfunction and its impact on outcomes in different groups of cardiac patients continue to being widely used. Kidney dysfunction is associated with a number of traditional cardiovascular risk factors. The use of new biomarkers, cystatin C in particular, to identify kidney injury can contribute to the improvement of early prediction of a risk for renal failure (RF). Cystatin C satisfies many characteristics as an ideal biomarker that can assist in not only detecting the early forms of kidney injury, but also in assessing the risk of RF, the needs for renal replacement therapy, and the risk of death in intensive care unit patients in cardiac clinics. Kidney involvement in many diseases, including those that are not initially regarded as renal, necessitates the elaboration of uniform approaches to managing patients with identified chronic RF, especially to the early prevention and treatment of its complications, such as anemia, phosphorus-calcium metabolic disorders, which substantially worsen the prognosis of other diseases.