[Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction - REGION-IM].

AIM: Based on data from the Russian REGION-IM registry, to study the features of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) in real-life clinical practice. MATERIAL AND METHODS: REGION-IM is a multicenter prospective observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 6 and 12 months after inclusion in the registry. The patient's records contain demographic and history data; information about the present case of MI, including the time of the first symptom onset, first contact with medical personnel, and admission to the hospital; coronary angiography (CAG) data, percutaneous coronary intervention (PCI) data, and information about the thrombolytic therapy (TLT). RESULTS: Reperfusion therapy was performed in 88.9 % of patients with STEMI. Primary PCI (pPCI) was performed in 60.6 % of patients. The median time from the onset of symptoms to pPCI was 315 minutes [195; 720]. The median time from ECG to pPCI was 110 minutes [84;150]. Isolated TLT was performed in 7.4 %, pharmaco-invasive treatment tactics were used only in 20.9 % of cases. The median time from ECG to TLT (prehospital and in-hospital) was 30 minutes [10; 59], whereas the median time from ECG to prehospital TLT was 18 minutes [10; 39], and in 63 % of patients, TLT was performed more than 10 minutes after diagnosis. PCI followed TLT in 73 % of patients. CONCLUSION: The frequency of reperfusion therapy for STEMI in the Russian Federation has increased considerably in recent years. The high frequency of pPCI is noteworthy, but the timing of pPCI does not always comply with clinical guidelines. The results of this registry confirm the high demand for pharmaco-invasive strategies in real-life clinical practice. Taking into account geographical and logistical features, implementing timely myocardial reperfusion requires prehospital TLT. However, the TLT frequency in the Russian Federation is still insufficient despite its proven maximum effectiveness in the shortest possible time from the detection of acute MI.

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.

[Evaluation of vascular modification in hypertensive patients].

Assessment of arterial stiffness for revealing vascular modification in hypertensive patients seems to be an actual problem in clinical practice. 377 patients with arterial hypertension and 232 nonhypertensive subjects were included in the research. The noninvasive technique of investigation of pulse wave velocity (PWV) was used. The reference values of carotid-femoral and carotid-radial PWV in relation of age and gender in nonhypertensive subjects and hypertensive population are described. Dependence of PWV on different clinical markers are shown. Correlations between PWV and left ventricular hypertrophy, PWV and carotid artery intima-media thickness are introduced. Therefore noninvasive technique of assessment of large and medium arterial stiffness can be used for separating patients with vascular modification from general population.

[Effect of atorvastatin on hemorheological parameters in patients with arterial hypertension with dyslipidemia].

We assessed effect of 6-weeks therapy with atorvastatin on parameters of lipid metabolism and some hemorheological characteristics in 27 patients with arterial hypertension (AH) and dyslipoproteinemia (DLP). In addition to general clinical examination we studied hemorheological profile including hematocrit, blood plasma and whole blood viscosity with the method of rotational viscosimetry at various shear rates, deformability of erythrocytes by filtration method, and cytoarchitectonics of erythrocytes. At the background of pronounced lipid lowering effect of atorvastatin we noted obvious improvement of microrheological properties of erythrocytes appearing as significant decrease of rigidity index of erythrocytes and of their aggregation. Basing on these findings we concluded that improvement of fluidity of erythrocytes promoting facilitation of blood flow efficacy in microcirculatory vascular bed can be a supplementary reason for administration of atorvastatin to patients with AH and DLP.

[Effects of hypotensive treatment on structural-functional properties of the vascular wall in hypertensive patients].

AIM: To study structural-functional properties of the walls of large and middle-size arteries and changes of these properties in the course of hypotensive therapy in hypertensive patients. MATERIAL AND METHODS: Of 609 participants of the trial (233 males and 376 females), 377 patients with essential hypertension stage I-II (mean age 46.9 +/- 7.2 years) entered the study group, 232 healthy subjects (mean age 45.7 +/- 6.9 years)--the control group. Pulse wave velocity (PWV) for vessels of elastic and muscular type was measured in all the examinees. Circadian blood pressure monitoring, echocardiography, duplex scanning of the common carotid artery were performed in hypertensive patients. 76 hypertensive patients were reexamined 6 months after treatment with amlodipin (n = 32) or fixed combination perindopril+indapamide (n = 44). RESULTS: Mean PWV appeared to be higher in hypertensive patients in whom PWV correlated with left ventricular (LV) remodeling and thickness of intima-media complex (IMC). After 6 months of hypotensive therapy PWV significantly lowered for both types of vessels studied. IMC thickness reduced by 10.1%, on the average, LV myocardial mass index--by 6.3%. CONCLUSION: The link between PWV, LV hypertrophy and IMC allows PWV use as a method of detection of cardiovascular remodeling in hypertension and for follow-up of antihypertensive treatment effect on this remodeling in outpatient treatment of hypertension.

[Complex approach to treatment of patients with bone and joint pathology in a geriatric department].

The influence of therapeutic training of 240 patients with postmenopausal osteoporosis in combination with degenerate-dystrophic diseases of spine and joints on the awareness of the disease, dynamics of physical activity, and quality of life was studied. The training was conducted on the structured program for patients with osteoporosis and osteoarthrosis. It was worked out by the Family medicine department of Ural State Medical Academy. The program was revised by us and adapted to patients of gerontological hospital and given as "School for patients with chronic pain syndrome". The training was followed by the true increase of awareness of the disease and physical activity. In studying the quality of life, there were noticed improvements on the scale of pain, activity of work about the house, social activity and general status.

[Structural and functional characteristics of cardiovascular system in elderly patients with borderline hypertension].

Structural and functional state of the heart and vessels was studied in elderly patients with borderline hypertension. Remodeling in these patients was compared with that in patients of the same age with normal or higher blood pressure levels. Analysis revealed substantial contribution in remodeling of both age and hypertensive factors. Compared with subjects with normal blood pressure patients with hypertension had greater myocardial mass, higher frequency of left ventricular hypertrophy with cases of concentric hypertrophy and isolated hypertrophy of interventricular septum. Elderly patients with borderline hypertension had more pronounced disturbances of diastolic function. Overall characteristics of patients with borderline hypertension were similar to those found in the elderly with higher level of hypertension. Presence of borderline hypertension was associated with higher than age specific stiffness of vessels. Character and degree of remodeling of the heart and vessels in the elderly patients with borderline hypertension evidence for elevated risk of cardiovascular complications.

[Arterial hypertension in aged patients in practice of therapists of the Ivanovo region]. / Arterial'naia gipertoniia u bol'nykh pozhilogo vozrasta v praktike vrachei-terapevtov Ivanovskoi oblasti.

The authors analyse current practice of management of elderly patients with arterial hypertension in medical institutions of the Ivanovo region to find out factors impeding introduction of modern approaches to treatment of the hypertensive elderly. Medical documents were analysed for aged 291 outpatients and 178 inpatients with arterial hypertension (AH). 100 physicians filled in questionnaires. The following data were obtained: 91% physicians are sure about age-specific standards of arterial pressure; 85% physicians make their decision on elderly hypertensive patients' treatment basing on diastolic pressure; the necessity of AH treatment in the elderly is supported by only 6% physicians; nonpharmacological treatment of AH in practiced in 9% elderly patients; 40, 39, 28 and 16% patients receive ACE inhibitors, calcium antagonists, beta-blockers, diuretics, respectively; the percentage of unjustified hospitalizations is high; target arterial pressure was reached only in 0.9% hypertensive aged patients. It is concluded that the impeding factors for updating AH treatment in the region studied are the following: lack of information, stereotypes in medical practice, uneffective organization of medical aid for aged patients with hypertension.

[Features of microcirculatory disorders in acute and recurrent hemorrhagic vasculitis (Schönlein-Henoch disease)]. / Osobennosti mikrotsirkuliatornykh narushenii pri ostrom i retsidiviruiushchem gemorragicheskom vaskulite (bolezni Shenleina-Genokha).

AIM: To study microcirculatory disturbances in acute and chronic hemorrhagic vasculitis (HV). MATERIAL AND METHODS: The examination of 44 HV patients included clinical and immunological examinations, conjunctival biomicroscopy, tests for blood viscosity, aggregation of erythrocytes, coagulation parameters. In 8 patients morphological examination of skin microvessels was made (light microscopy and electron microscopy). RESULTS: Changes in microcirculation of patients with acute HV were characterized by increased IgA and red cell aggregation, tendency to hypercoagulation. Morphologically, there was high permeability of the microvessels wall. In patients with chronic HV laboratory parameters normalized except elevated level of circulating immune complexes and red cell aggregation. Morphological picture of microcirculatory disturbances in patients with chronic HV was characterized by productive vasculitis. CONCLUSION: In HV patients microcirculatory disorders caused by immunologic mechanisms are realized through increased permeability of microvessel wall, high aggregation of erythrocytes in microvessels and hypercoagulation in acute HV. In patients with chronic HV productive vasculitis and high aggregation of erythrocytes are registered.