Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction.

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.

[Trastuzumab-induced cardiomyopathy].

The treatment of malignant tumors may cause severe adverse reactions including cardiovascular problems. The case of a young woman with trastuzumab (Herceptin) induced dilatation cardiomyopathy with favorable outcome is presented in the article.

[A case of diagnosis of asymmetric apical hypertrophic cardiomyopathy of the left ventricle with intraventricular obstruction].

The paper describes a case of diagnosis of one of the rare forms of myocardial hypertrophy--asymmetric hypertrophic cardiomyopathy with isolated hypertrophy of the cardiac apex (an apical form) and intraventricular obstruction. It discusses problems in the diagnosis of rare forms of hypertrophic cardiomyopathy.

[Comparative assessment of immediate outcomes of surgical treatment of patients with coronary artery disease and lesion of the brachiocephalic arteries].

From 2000 to 2011, a total of 52 patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries were subjected to a single-stage operation. Depending on the type of operative intervention, all patients were subdivided into two groups: Group One comprising 13 patients who underwent coronary artery bypass grafting (CABG) in a combination with simultaneous stenting of the internal carotid artery, and Group Two consisting of 39 patients subjected to CABG with simultaneous carotid endarterectomy. Assessing the intraoperative parameters revealed that in Group One patients the average duration of operations was significantly lower (179.6±6.4 minutes versus 273.2±5.6 minutes in Group Two, p<0.001) and the time of assisted circulation was less than in Group Two, averaging 75.9±4.5 versus 115.2±3.8 minutes, respectively (p<0.001). The duration of pulmonary artificial ventilation in Group One patients was less than in Group Two patients (9.7±2.6 hours versus 25±4.8 hours, respectively, p< 0.01). Also the duration of staying in the critical care unit was shorter in Group One patients than in Group Two patients (21.5±3.3 versus 82.1±8.0 hours, respectively, p<0.001). The overall hospital mortality rate amounted to 12.8% (5 patients), with all deaths having occurred in Group Two. The lethal outcomes were caused by acute myocardial infarction in three cases, one patient died of progressing multiple-organ failure on the background of acute impairment of cerebral circulation and one death was caused by thrombosis of the mesenteric artery with the development of intestinal gangrene and peritonitis. In the structure of hospital complications cardiac insufficiency was prevalent (23.1% and 59.0% for Groups One and Group Two patients, respectively, p<0.05). Analysing the incidence and structure of other postoperative complications revealed no statistically significant differences between the groups. Our study demonstrated that using surgical methods of treatment of patients with haemodynamically significant stenoses of the coronary and brachiocephalic arteries makes it possible to increase the overall survival rate in patients suffering this disease and to decrease the incidence rate of ischaemic impairments of the coronary and cerebral circulation. The hybrid method of treatment on arteries of various vascular basins may be an alternative to carotid endarterectomy and CABG, especially in patients running high surgical risk.

[Regional experience of conducting registry of acute coronary syndrome].

Since 2008 Cardiological Dispensary of Khanty-Mansi Autonomous Okrug "Center of Diagnostics and Cardiovascular Surgery" has been participating in Rossiysky Registry of Acute Coronary Syndrome. In this paper we present some of the results on the use of percutaneous coronary interventions, time intervals, characterizing urgent medical aid to patients with acute coronary syndrome, rate of complications, and mortality.

[Hybrid operation in combined pathology].

Presented herein are the results of successful surgical treatment for a combined atherosclerotic lesion of arteries of the coronary and carotid basin in a patient with coronary artery disease.

[ST-segment elevation acute coronary syndrome (according to the data of the District Cardiac Dispensary Register of Surgut)].

AIM: To analyze the individual indicators of emergency medical care in ST-segment elevation (STSE) acute coronary syndrome (ACS) according to the data of the ACS Register of the District Cardiology Dispensary, Center for Diagnosis and Cardiovascular Surgery, Khanty-Mansi Autonomic District-Yugra, Surgut, over time from 2008-2010 and 2011 versus the data of health care facilities taking part in the ACS Register. MATERIALS AND METHODS: The quality of medical care for patients with STSE ACS was considered and analyzed in accordance with "The information analytical system user's guide for the integrated rapid assessment of the quality and level of organization of medical care for patients with acute coronary syndrome to "The Federal Register of Patients with ACS". RESULTS: The data of the ACS Register of the Surgut District Cardiology Dispensary indicate that the majority of patients with STSE ACS are males (86.9%); the patients' median age is 56.0 (range 51.0-61.0) years. The scope of performed drug therapy is comparable with the data of the European Registers: aspirin (97.6%), clopidogrel (93.7%), anticoagulants (98.5%), angiotensin-converting enzyme inhibitors (96.6%), beta-blockers (96.1%), and statins (87.4%). In STSE ACS, percutaneous coronary intervention is performed in 93.7% of cases; thrombolytic therapy in 14.6%; emergency coronary bypass surgery in more than 3%. CONCLUSION: The individual indicators characterizing the level of medical care for STSE ACS were analyzed using the ACS Register.

[Acute coronary syndrome: regional experience of rendering urgent aid at prehospital stage in Khanty-Mansi Autonomous Okrug--Yugra].

Aim of the study was assessment of efficacy of rendering urgent aid to patients with acute coronary syndrome (ACS) at prehospital stage on the territory of Khanty-Mansi Autonomous Okrug (KhMAO). The analysis showed that yearly about 5000 inhabitants of KhMAO-Yugra received prehospital medical care (30% because of acute myocardial infarction, 70% because of unstable angina). Over 3 years portion of persons requesting medical aid during first 3 hours after onset of pain attack increased 6.1%. Rate of prehospital fibrinolysis did not exceed 6.5%. Alteplase was used most often (79.7%). Late patient's appeal was among causes of rare application of thrombolytic therapy (41.8%). Most physicians responsible for prehospital care considered it necessary to refer patients with ACS directly to centers of interventional cardiology. The data obtained would promote improvement of quality of medical aid to ACS patients at prehospital stage.

[The incidence of postoperative myocardial infarction and the left ventricular function in patients with type 2 diabetes mellitus after recanalization of chronic coronary occlusions].

AIM: To study the effects of intracoronary administration of the ischemic preconditioning (IP) trigger adenosine on the reduced incidence of percutaneous coronary intervention (PCI)-associated myocardial infarction (MI) and left ventricular (LV) systolic and contractile function in patients with type 2 diabetes mellitus (DM) during recanalization of chronic coronary occlusions (CCO). SUBJECTS AND METHODS: The patients were divided into 4 groups: 1) 45 patients without DM who received intracoronary placebo infusion; 2) 51 patients without DM who had 10 mg intracoronary adenosine during PCI; 3) 34 patients with type 2 DM who had intracoronary adenosine during PCI; 4) 37 with type 2 DM who received intracoronary placebo. Troponin I and the MB fraction of creatine phosphokinase were measured an hour before and 18-24 hours and 5 days after PCI. The authors estimated the incidence of PCI-associated MI according to the ESC/ACCF/AHA/WHF (2007) criteria and the time course of changes in LV ejection fraction (EF) and end-systolic volume (ESV) and end-diastolic volume, impaired LV local contractility index (ILVLCI) in 167 patients with CCO 1 day and 1 and 12 months after PCI. RESULTS: There was an improvement in myocardial systolic and contractile function after recanalization and stenting for CCO. The intracoronary adenosine groups showed significantly reduced incidence of PCI-associated MI, increased LV EF, and decreased LV ESV and ILVLCI as compared to the placebo groups. CONCLUSION: The intracoronary injection of the IP trigger adenosine is an effective and safe method to improve LV systolic and contractile function in patients with CCO and type 2 DM.

[Prognostication of results of coronary artery bypass surgery in men living in the North].

We analyzed immediate and remote results of coronary artery bypass surgery and prognostication of outcome of the intervention in dependence on various risk factors in 576 men aged 29 - 71 years living in the North. We formed a model with strong prognostic effect on lethal outcome during in-hospital postoperative period which included the following parameters: perioperative myocardial infarction, complex character of surgery, left ventricular ejection fraction less than 40%, number of distal anastomoses 5 and more, functional class III chronic heart failure. Method of regression analysis revealed factors also related to lethal outcome in period of hospitalization: functional class IV of angina, duration of operation more than 5 hours, mitral insufficiency of 2nd degree and above, myocardial infarction of left ventricular anterior wall, history of 2 or more infarctions. Model with strong prognostic effect on mortality in remote period (3 years after surgery) included the following parameters: left ventricular ejection fraction less than 40%, functional class III chronic heart failure, repeat character of operation, left ventricular aneurysm, lack of use of internal mammary artery. Most significant factors additionally affecting long term mortality were the following: involvement of left coronary artery trunk, duration of surgery more than 5 hours, atherosclerosis of magistral arteries, mitral insufficiency of 2nd degree and above, cardiac rhythm disturbances.