PURPOSE To elaborate a risk score for prognostication of long-term survival of patients with chronic ischemic heart disease (CIHD) using data of the PROGNOSIS-IHD Registry. MATERIAL AND METHODS Participants of the PROGNOSIS-IHD Registry (n=641, 500 men, 141 women) were inhabitants of Moscow region consecutively admitted for planned hospitalization with diagnosis of IHD to the clinic of the Center of Preventive Medicine from 01.01.2004 to 31.12.2007. During hospitalization all patients underwent coronary angiography. Diagnosis of IHD was not confirmed in 100 of 641 patients. In 2010 vital status was determined in 551 patients (86%). Mean duration of observation was 3.9 years. Uni- and multi-factorial analysis was used for assessment of prognostic value of clinical-anamnestic and instrumental parameters. RESULTS The following parameters which were included into the risk score were most significant for prediction of occurrence of a primary end point (fatal and nonfatal cardiovascular complications [CVC]): feeling of shortness of breath (relative risk [RR] 1.86 and 1 point in risk score); history of unstable IHD course (acute coronary syndrome, myocardial infarction, unstable angina) (RR 1.76 and 1 point); need in diuretics before hospitalization (RR 1.92 and 1 point); stenosis of a cardiac valve (RR 2.95 and 2 points); zones of abnormal contractility of left ventricular myocardium at echocardiography (RR 2 and 1 point). Risk of death and nonfatal CVC in patients with suspected IHD was considered very low, low, medium, and high at score values 0, 1 (RR 1.6), 2 (RR 2.4), and more or equal 3 (RR 6.1), respectively. CONCLUSION Novel scale has high prognostic significance relative to stratification of risk of death and nonfatal CVC in patients with suspected CIHD and can be used in wide clinical practice because of its informativeness, simplicity, and accessibility.

Aim. To study the role of instrumental findings in the evaluation of long-term outcomes and life for stable coronary heart disease patients (CHD) in the “PROGNOS CHD” registry. Material and methods. In the frame of registry the retro-, prospective, observational, cohort study is performed, that included all patients inhabitants of Moscow region, consequently admitted to the hospital of SSRCPM from 01.01.2004 to 31.12.2007 planned with the admittance dignosis “CHD”, and for whom the coronary arteriography was done. Totally 641 pt (500 male, 141 female). Mean follow-up period 3,9 years (0,76–6,52). At the end the life status defined for 551 (86%) patient. Into analysis the data from instrumental methods included: ECG, echocardiography (Echo), exercise testing (ET). Results. The risk for primary endpoint (PEP) was increased by: scar changes in resting ECG — 2,2 times (p=0,0007), tachicardia 2,7 times (p=0,02), rhythm disorders 1,76 times (p=0,04); valve stenoses by Echo — 3 times (p=0,04), ventricle dilation 1,8 times (p=0,02), local contractility defects 1,8 times (p<0,003); ST horizontal depression during ET — 2,2 times (p=0,04, ns by crosstabulation). Risk of PEP decreased by the ET possibility to perform — by 1,6 times (p=0,049), normal EF by 1,5 times (p=0,001). The prevalence of secondary endpoint was increased by: scar changes on ECG — 1,5 times (p=0,01); positive ET — 13,2 times (p=0,01), downsloping ST depression at ET — 2,1 times (p=0,01), low and medium exercise tolerance — 2,8 (p=0,04) and 2,1 times (p=0,04), resp. The worse for PEP were scar changes on ECG, dilation of the heart chambers, disordered local contractility of LV, valve stenoses by Echo, and positively influenced outcomes — normal EF and the fact of ET performing. Conclusion. High predictive significance of various broad known instrumental methods of diagnostics, like resting ECG, Echo or ET, make possible to use them for risk stratification of cardiovascular complications development in chronic CHD and for defining of indications to invasive diagnostic procedures.

Aim — to investigate the prognostic value of different risk factors associated with stable angina in a contemporary population of patients,to identify the key prognostic features, to evaluate the risk distribution and to construct a reliable tool for the risk prediction.Materials and methods. Prospective observational cohort study, conducted between January, 2004 and December, 2007 in Moscow, Russia. 641 patients were included on the basis of planned hospitalization to National Research Center for Preventive Medicine (Moscow) with a clinical diagnosis of coronary heart disease and performance of coronary angiography. 5 years follow‑up period (median time 3.9 years, min. 0.76 years, max. 6.52 years). 551 patients were followed-up by phone interview, among them: 432 men (78%, (age 57.7 ± 0.4), 119 women (age 60.3 ± 0.7), 354 of them attended follow-up visit and were secondary examined. Univariate and multivariate Cox regression model was used to identify independent predictors of events. Variables were selected in a stepwise forward manner. The probabilityof survival was calculated using the Kaplan—Meier method, and survival were compared using the long-rank test.Results. Annual death rate from all cause was 11.38 per 1000 patient-years at risk. The primary endpoint (combined all-cause mortality, nonatal MI, non-fatal stroke/TIA) was registered in 13.61% of cases, with annual rate of 17.34 per 1000 patient-years at risk. Frequency of the secondary endpoint (cardiovascular adverse events, such as CV death, non-fatal MI, non-fatal stroke/TIA, recurrent angina, endovascular revascularization, CABG) was registered in 36% of all followed‑up cases.Conclusion. This article describes the first results of PROGNOS IBS study — a comprehensive patient registry. Our data demonstrates the risk factors distribution and morbidity/mortality rates in the contemporary population of patients. A score will be developed to estimate risk probability of death and adverse cardiovascular events.

Aim — to investigate the prognostic value of different risk factors associated with stable angina in a contemporary population of patients, to identify the key prognostic features, to evaluate the risk distribution and to construct a reliable tool for the risk prediction. Materials and methods. Prospective observational cohort study, conducted between January, 2004 and December, 2007 in Moscow, Russia. 641 patients were included on the basis of planned hospitalization to National Research Center for Preventive Medicine (Moscow) with a clinical diagnosis of coronary heart disease and performance of coronary angiography. 5 years follow‑up period (median time 3.9 years, min. 0.76 years, max. 6.52 years). 551 patients were followed-up by phone interview, among them: 432 men (78%, (age 57.7 ± 0.4), 119 women (age 60.3 ± 0.7), 354 of them attended follow-up visit and were secondary examined. Univariate and multivariate Cox regression model was used to identify independent predictors of events. Variables were selected in a stepwise forward manner. The probability of survival was calculated using the Kaplan—Meier method, and survival were compared using the long-rank test. Results. Annual death rate from all cause was 11.38 per 1000 patient-years at risk. The primary endpoint (combined all-cause mortality, nonatal MI, non-fatal stroke/TIA) was registered in 13.61% of cases, with annual rate of 17.34 per 1000 patient-years at risk. Frequency of the secondary endpoint (cardiovascular adverse events, such as CV death, non-fatal MI, non-fatal stroke/TIA, recurrent angina, endovascular revascularization, CABG) was registered in 36% of all followed‑up cases. Conclusion. This article describes the first results of PROGNOS IBS study — a comprehensive patient registry. Our data demonstrates the risk factors distribution and morbidity/mortality rates in the contemporary population of patients. A score will be developed to estimate risk probability of death and adverse cardiovascular events.

Aim. To assess the value of specific parameters and integrated indices (II; such as Duke Index (DI), Centre for Preventive Medicine Index (CPMI), and modified CPMI) of the treadmill test in the diagnostics of coronary stenosis severity among patients with stable coronary heart disease (CHD).Material and methods. The study included all patients (260 permanent residents of Moscow City or Moscow Region) who were admitted to the State Research Centre for Preventive Medicine with the CHD diagnosis and who underwent coronary angiography (CAG) and treadmill test in the period between January 1st 2004 and December 31st 2007.Results. There were statistically significant associations between the main treadmill test parameters and the severity of coronary artery (CA) atherosclerosis. The larger number of stenosis-affected CA was associated with a higher prevalence of chest pain and treadmill tests with positive results and ST segment depression >1 mm, as well as with a decreased total duration of treadmill test. Similarly, the increased risk, as assessed by treadmill test indices (DI, CPMI, and modified CPMI), was linked to an increased number of stenosis-affected CA. Modified CPMI demonstrated the highest diagnostic value for the assessment of coronary atherosclerosis severity.Conclusion. The treadmill test parameters which demonstrated their diagnostic value for the assessment of CHD severity included the following: positive test results, retrosternal chest pain as the reason for test discontinuation, ST segment depression >1mm, and short total duration of the test. Overall, all II demonstrated their high value in CHD diagnostics. Modified CPMI was the most effective II in the assessment of CA atherosclerosis severity.

Aim. Using the data from the CHD PROGNOSIS register, to assess the long-term survival of patients with stable coronary heart disease (CHD) confirmed by a diagnostic coronary angiography (CAG). Material and methods. The study design (retro- and prospective observational cohort study) agreed with the register principles. The study included all consecutive patients (Moscow Region residents) who were hospitalised to the State Research Centre for Preventive Medicine with a preliminary diagnosis of CHD, for a diagnostic CAG and therapeutic strategy selection (01.01.2004–31.12.2007). The total number of participants was 641 (500 men and 141 women). Vital status was ascertained in 551 patients (86%). Mean follow-up time was 3,8 years (range 0,76–6,52 years). Results. The register participants had a high prevalence of conventional risk factors and adverse clinical and anamnestic characteristics. CAG???confirmed coronary artery (CA) stenosis ≥50% was registered in 563 patients. In 24 out of 78 individuals with “intact” CA, coronary syndrome X or vasospastic angina was diagnosed; in the other 54, CHD diagnosis could not be confirmed. During the hospitalisation, balloon angioplasty was performed in 38% of the patients with known vital status. Before hospitalisation, the main drug classes with proven prognostic benefits were administered insufficiently often. During the follow-up period (mean follow-up 3,9 years), 50 patients died. All-cause mortality was 11,38±1,61 per 1000 person-years. The leading cause of death was chronic CHD (84%), which confirms high levels of cardiovascular risk in these patients. In total, fatal and non-fatal complications, including revascularisation episodes, were registered in 36%. Conclusion. The established register of stable CHD includes a typical cohort of chronic CHD patients who are referred for invasive diagnostics and treatment. Therefore, the register is expected to provide valid information on the factors determining prognosis and effectiveness of medical intervention, such as pharmacological therapy and percutaneous revascularisation.

Aim. To assess the real rate of dual antiplatelet therapy (DAT, acetylsalicylic acid + clopidogrel) use in patients having appropriate indications according to current clinical guidelines and to study the possibility of prescription rate improvement by education activity directed to doctors. Material and methods. The study consisted of 3 parts. Parts I and II present the results of two questionnaire surveys of patients with acute myocardial infarction, or stenting, who needed in DAT according to current clinical guidelines. The real use of the DAT was assessed in part III on the basis of the multicenter study conducted in different regions of Russia (ROMB study) in a large sample of patients having DAT indications. Results. Part I - PROGNOZ-IBS study. According to the questionnaire survey only 112 out of 239 patients (47%) having an absolute indications, received DOT. Part II - phone survey of patients with acute myocardial infarction in two towns of Lyubertsy and Podolsk. 28 of 71 patients (39%) took the DAT (from some days to 6 months) and 35 patients (49%) — did not take it. Part III - ROMB study. 519 patients did not take DAT, at that 259 (50%) in hospital and 260 (50%) - in out-patient clinic. 521 patients took DAT according to indications, at that 238 (46%) in hospital and 283 (54%) - in out-patient clinic. Conclusion. Less than 50% of patients, having direct indications, received DAT in the real clinical practice. The prescription rate can be improved due to education activity directed to doctors and increase in clopidogrel drugs affordability.

Gofman, E. A.; Kutishenko, N. P.; Martsevich, S. Y.; Deev, A. D.; Shalnova, S. A.; Oganov, R. G. on behalf of the Camelia Workgroup Author Information