Independent Predictors of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention During Hospitalization.

PURPOSE: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period. MATERIALS AND METHODS: We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12-48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end-points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy. RESULTS: Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F-induced RPR (р<0.001), levels of creatinine (р<0.001), hemoglobin (р<0.001), and glucose (р=0.026), age (р=0.01), iron-deficiency anemia (р=0.01), left ventricular ejection fraction (р=0.004), number of stents (р=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP-induced RPR >76 % (р=0.003), levels of creatinine >189 µmol / L (р=0.003), and hemoglobin <114 g / L (р=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (А / А) on development of stent thrombosis was also detected (р=0.028). CONCLUSION: ADP-induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.

[Reference values of platelet aggregometry in healthy subjects.]

In this article, we set forth the average values and reference intervals of platelet aggregation in practically healthy individuals on the AggRAM optical aggregometer. The reference intervals of platelet aggregation activity with 5 µg/ml adenosine-5`-diphosphate and the area under the aggregation curve were 67,4-92,5% and 54,5-85,3; the reference intervals of platelet activity with 10 µg/ml adenosine-5`-diphosphate and the area under the aggregation curve were 76,8-97,2%% and 68,8-90,4. The obtained values of indicators can be used as reference in the clinical diagnostic laboratory of the University Hospital of Semey State Medical University.

[CYTOKINE PROFILE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH AND WITHOUT COMPLICATIONS].

The aim of this study was to evaluate the prognostic role of the cytokine profile in patients with ST segment elevation myocardial infarction (STEMI). Materials and methods: In the present paper we studied cytokines IL-6, IL-1ß, IL-10, TNFα and CRP in 81 patients with different course of STEMI. Results: In patients with complicated course of STEMI a significant increase in the concentration of IL-6, IL-10, FNOα, CRP was recorded on the 1st, 7th and 14th days compared with control group of healthy subjects and a group of patients with uncomplicated STEMI. Concentrations of TNFα>35.49 pg/ml, IL-6>33.37 pg/ml, IL-10>34 pg/ml, CRP>10.84 mg/l on day 1 may suggest cardiovascular complications in STEMI patients within 1 year after the onset of the disease. We have not found reliable prognostic levels of IL-1ß, as the concentration of this cytokine remained within the accepted normal range.. Discussion: It is concluded that initially elevated levels of CRP l, TNFα, IL-6, IL-10 in the blood make it possible to identify groups of patients with myocardial infarction with ST-segment elevation at high risk of cardiovascular events throughout the year.

Diagnostic and therapeutic strategies for resistant arterial hypertension--focus on countries with emerging economies.

Arterial hypertensionis an important worldwide health problem. Its relevance relates both to the high incidence and prevalence in all adult communities and to the high risk of serious and potentially fatal cardiovascular events due to hypertension. Resistant hypertension is defined as a blood pressure (BP) remaining above goal (>140/90 mm Hg) despite the use of at least 3 optimally dosed antihypertensive drugs from different classes, with one of the drugs being a diuretic. The exact prevalence of RH is unknown, but it is generally estimated at 10-20% of hypertensive patients. The aim of this review article is to address several important issues: (1) How to diagnose true RH ? (2) What is the optimal state-of-art management of RH in the light of the most recent scientific evidence and what is the role of various medical specialties in this process ? (3) Are there any country specific issues related to diagnosing and treating of RH in Kazakhstan and if so, how to tackle them ?Long-lasting resistant hypertension increases by 50-80% the risk of major cardiovascular events (myocardial infarction, stroke) and end-organ damage. (heart failure, vascular dementia, chronic kidney disease). Adherence to well chosen therapy is the key factor in achieving blood pressure control and this must be based on adequate patient education and universal access to drug therapy. Thus, early recognition and appropriate management of RH must be among the top priorities of all public health initiatives to reduce the burden of cardiovascular diseases (Tab. 2, Fig. 1, Ref. 31).

The Impact of Patient Adherence to Dual Antiplatelet Medication Following Percutaneous Coronary Intervention on the Occurrence of Adverse Cardiovascular Events.

Background: The objective of this study is to examine the impact of medication adherence on the timing of non-cardiovascular serious events (NCDS) onset in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: This prospective study was conducted at a single center and involved 220 ACS patients who underwent sequential PCI with stenting. The Morisky Green Levine Medication Adherence Scale was employed to assess adherence to dual antiplatelet therapy (DAPT) and its impact on NCDS occurrence. Early in their hospitalization, all patients received education at the Coronary Heart Disease School. The survival rates of patients in both the main group and a control group (n=355) were subsequently evaluated. Results: The study findings indicated an inverse relationship between stent thrombosis development (Rho=-0.334; p=0.001) and the timing of recurrent myocardial ischemia. There was also an inverse correlation between patient adherence and stent thrombosis development (Rho=-0.275; p=0.009). Non-adherent individuals had a 16.8 times higher likelihood of experiencing stent thrombosis compared to compliant patients (p<0.001). Following participation in the CHD School program, treatment adherence increased from 56.5% to 88.2%. Education for ACS patients post-stenting was significantly associated with all-cause mortality within the first 6 months (p=0.040). Conclusion: Secondary preventive measures, including education, impact the success of endovascular interventions in both the early hospital phase and the long term. Patient education can serve as a supplementary intervention to enhance DAPT adherence, thus diminishing the risk of recurrent cardiovascular events and mortality post endovascular intervention.

[The immunogenetic heterogeneity of chronic glomerulonephritis]. / Immunogeneticheskaia geterogennost' khronicheskogo glomerulonefrita.

Clinico-immunogenetic investigations show that there exists highly significant positive and negative associations of HLA-antigen with chronic glomerulonephritis (CGN). The detected HLA markers of CGN predisposition may appear valuable for grouping subjects at high risk to develop CGN, in prognostication of individual features of CGN running, differential diagnosis and perfection of early therapy.

[Optimization of hypotensive therapy in hypertensive patients with new beta-1 selective long-acting adrenoblocker]. / Puti optimizatsii gipotenzivnoi terapii bol'nykh gipertonicheskoi bolezn'iu novym beta1-selektivnym adrenoblokatorom prolongirovannogo deistviia.

20 hypertensive subjects entered the trial of kerlon (Searle, USA). Central hemodynamics was studied by tetrapolar chest rheography according to J. Franz. Therapeutic response to beta-1-adrenoblocker kerlon in hypertension was assessed by hemodynamic indices and acute pharmacological test. The effect was found to depend on the initial hemocirculation type. In hyperkinetic hemodynamics lowering of blood pressure was due to diminution of the cardiac index, in eukinetic and hypokinetic types- to a decrease in the total peripheral vascular resistance.

[Autonomous nervous system in patients with early postmyocardial infarction angina pectoris]. / Sostoianie vegetativnoi nervnoi sistemy u bol'nykh s rannei postinfarktnoi stenokardiei.

Ninety-three patients with acute myocardial infarction were examined. They were divided into 2 groups: 1) those with early postmyocardial infarction angina pectoris and 2) those without it. The autonomic nervous system was studied by exploring its segmental and suprasegmental regions. The autonomic tone was evaluated by variance intervalometry. The test of human lymphocytic rosette formation and bovine red blood cells sensitized with glutaric aldehyde and loaded epinephrine was applied to estimate the adrenoception. The sympathetic tone and tissue adrenoceptor density were found to be higher in patients with early postinfarction angina than in those without it. The finding may be useful in predicting early postinfarction angina in patients with acute myocardial infarction.

[Familial predisposition to stroke].

Fifty-five patients with ischemic stroke, 22 women, 33 men, mean age 61.14 +/- 11.8 years, have been interviewed. A control group included siblings of patients' spouses. In the group of relatives, the frequency of arterial hypertension was higher by 30.8%, diabetes mellitus--by 76%, ischemic heart disease--by 59.4% and stroke--by 41% compared to the controls. In the combined group, the relative risk (RR) of factors studied was substantially higher for relatives by blood. When effect of sex on RR has been determined, the higher RR values for all risk factors in male relatives of patients have been found. In conclusion, the study of familial predisposition to stroke revealed that family members of patients with stroke are a target group for stroke prevention programs.