[First Moscow "snapshot" register of acute coronary syndromes: characteristics of patients, management and outcomes during hospitalization].

AIM: To characterize inhospital management of patients (pts) with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized pts with ACS. METHODS: The registry included data on consecutive pts with ACS hospitalized with label ACS in coronary care units (CCU) or equivalents within 24 hours (h) after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 percutaneous coronary intervention [PCI] capable or "invasive") city hospitals officially treating ACS patients. RESULTS: Total number of pts--584 (mean age 66.4 +/- 13.1 years; > or = 65 years 54.6%; women 44.2%; registered in invasive hospital--42%). Portions of pts labeled ST-elevation (STE) and non ST-elevation (NSTE) ACS--27.9 and 72.1%, respectively. Portion of pts hospitalized within 1-st 12 h after symptoms onset--65.2% (68% among STEACS pts). Reperfusion therapy--44.8% of pts with STEACS (54.3% in invasive and 21.3% in noninvasive hospitals, p < 0.0001). Thrombolysis (TI) was performed in 19% of STEACS pts (41.9% prehospital). In hospital median admission to initiation of TI time--0.30 h (quartiles I-III 0.15-0.30 h). Rate of primary (p) PCI in STEACS pts--overall 25.8%, in invasive hospitals--36.2%, in pts admitted within 12 h--31.4 and 40.5%, respectively. Median admission--pPCI initiation time--1.35 h (quartiles I-III 1.00- 2.15 h). PCI rate among NSTEACS pts--6.2 overall and 20.5% in invasive hospitals (14.7% during 1st 72 h). Medication in hospital: aspirin--95.2, clopidogrel--70.7, ticagrelor--4.3%, parenteral anticoagulants--88.9 (1/3 unfractionated heparin [UFH] subcutaneously), ACE inhibitors--83.3, beta-blockers--86.3, statins--58.3%. Mean duration of hospital stay--13.2 +/- 4.4 days. Transferral from noninvasive to invasive hospital for urgent coronary intervention--4.5 and 3.5% of STE and NSTE ACS pts, respectively. Hospital mortality--12.4 and 1.9% among pts registered as STE and NSTEACS, respectively. Cardiac troponins measured--42% (39% among STEACS) pts. CONCLUSION: The following features of inhospital management of pts diagnosed as ACS at CCU (or its equivalent) admission could be object of improvement: low rate of reperfusion therapy and use of PCI, long interval between admission and initiation of PCI, insufficient use of some standard medications, frequent use of subcutaneous UFH, rare transferal of PCI eligible pts from noninvasive to invasive hospitals. However existing management was associated with reported low hospital mortality in patients labeled as NSTEACS.

[Prehospital management of patients with acute coronary syndrome in Moscow. Data of the first Moscow "snapshot" register].

AIM: To characterize the state of prehospital management of patients with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized patients with ACS. METHODS: The registry included data on consecutive patients with ACS admitted to coronary care units or their equivalents of participating hospitals within 24 hours after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 PCI capable or "invasive") city hospitals officially treating ACS patients. Data concerning prehospital stage was collected by hospital physicians. RESULTS: Among 584 patients included in the registry 88.8% were brought by ambulances. Time (median) from onset of symptoms to call for medical aid was 2.4 h, to hospitalization - 4.3 h, from call for medical aid to hospitalization--1.6 h. Calculated approximate time of contact of ambulance staff with patient at site of attack (the latter time minus official time to arrival and transportation time) was more than 50 min. Referral diagnoses were myocardial infarction (MI) in 29.3, unstable angina in 48.4, other acute conditions in 22.3% of patients. Among patients referred as unstable angina about 49% were diagnosed as MI during hospitalization. Referral diagnosis of ambulance physicians did not appear among independent predictors of inhospital death or new MI (ST depressions, Killip class > or = ll, high GRACE score). Rate of prehospital thrombolysis was 8.0% among all patients diagnosed in hospital as ST elevation (STE) ACS (10.8% among STEACS patients admitted within 12 h of symptoms). There were significantly less patients older than 65 years among those subjected compared with not subjected to prehospital thrombolysis (23.1% vs. 59.6%, respectively; p = 0.024). Clopidogrel (mostly 300 mg) and recommended loading dose of aspirin were given to 70.9 and 51% of patients, respectively. Unfractionated heparin and enoxaparin were given to 49.4 and 7.5% of all patients, respectively. Inhospital bleeding rate was significantly higher in patients phehospitally treated with anticoagulants. CONCLUSION: The following characteristics of prehospital management of patients diagnosed as ACS at hospital (CCU) admission could be object of improvement: long time of contact of ambulance staff with patients; attempts to diagnose (exclude) MI associated with unjustified referral to noninvasive hospitals; preferential use of thrombolysis in younger patients; relatively rare use of guideline recommended doses of aspirin and clopidogrel. Of note is association of inhospital bleedings with prehospital administration of anticoagulants.

[Comparison of data from registries of acute coronary syndromes RECORD and RECORD-2: management of patients and its results in noninvasive hospitals].

Positive changes are declared to occur during recent years in management of hospitalized patients with acute coronary syndromes (ACS) in Russia. Most of these changes are related to availability of invasive treatment. But considerable portion of patients (pts) are still treated in hospitals without facilities for invasive myocardial revascularization (noninvasive hospitals - NIHs). Aim of this study was to compare some characteristics of management of ACS in NIHs which participated in ACS registries RECORD (2007-2008, 8 NIHs from 6 cities; n=381) and RECORD-2 (2009-2011, 3 NIHs from 3 cities, n=680). Results. Groups of pts recruited in these NIHs had similar mean age and portion of women (67.6 and 66.5 years, 51.1 and 53.1 % in RECORD-2 and RECORD, respectively, p=0.64). Time from symptoms onset to hospitalization was shorter in RECORD-2 (3.2 vs 4.1 hours for ST-elevation [STE], =0.03; 4.0 vs 6.5 hours for non ST elevation [NSTE] ACS, <0.0001). Among RECORD-2 NSTEACS pts more had ST depressions (50.6 vs 28.7%, <0.0001), high risk of death according to GRACE score (39.1 vs 20.9 %, <0.0001), but less Killip class >II (15.0 vs 21.6%, p=0.025). No such differences existed among STEACS pts. Thrombolysis was more often used in RECORD-2 (62.6 vs 34.1%, <0.0001). Both STEACS and NSTEACS RECORD-2 pts more often received clopidogrel (63.5 vs 18.8%, p<0.0001, and 41.6 vs 11.1%, <0.0001, respectively). More NSTEACS RECORD-2 pts were given parenteral anticoagulants (93.4 vs 80.4%, <0.0001), low molecular weight heparins (23.4 vs. 3.4%, <0.0001) and fondaparinux (10.4 vs 0.7%, <0.0001), but still in 20% of NSTEACS RECORD-2 pts unfractionated heparin was given subcutaneously. Twenty RECORD-2 pts (2.9%) were transferred to invasive hospital but none during first 24 hours. There were no significant differences between registers in hospital mortality (20.0 vs 21.2%, =0.84; 4.2 vs 2.7%, =0.24 in STE and NSTE ACS pts of RECORD-2 and RECORD, respectively). Conclusions. Despite some improvement in management of pts occurring in 2-3 years NIHs mortality in STEACS remained very high. Numerically higher mortality in NSTEACS could be partially attributed to higher risk of RECORD-2 pts.

[Adherence to guidelines on management of acute coronary syndrome in Russian hospitals and outcomes of hospitalization (data from the RECORD-2 Registry)].

BACKGROUND: Complete following existing guidelines for management of acute coronary syndrome (ACS) is known to be associated with better outcomes. Partly this is explained by lesser adherence to recommendations in high risk patients. Aim of our study was to assess relationship between degree of following current guidelines and in hospital outcomes independently from initial assessment of risk. METHODS: Each key recommendation from guidelines issued between 2008 and 2011 (13 for STE ACS, 12 for NSTE ACS) was given weight of 1. Sum of these units constituted index of guideline adherence (IGA). IGA was retrospectively calculated for 1656 patients included in Russian independent ACS registry RECORD-2 (7 hospitals, duration 04.2009 to 04.2011). The patients were divided into 2 groups according to quartiles of IGA distribution: 1) low adherence group (quartiles I-II); 2) high adherence group (quartiles III-IV). RESULTS: In low adherence compared with high adherence group there were significantly more patients more or equal 65 years (=0.0007), with chronic heart failure [CHF] (<0.0001), previous stroke (<0.0001), atrial fibrillation [AF] (=0.0002), Killip class more or equal II (=0.0065), high risk of death by GRACE score (=0.035). Inhospital mortality was 9.3 and 2.4% in low and high adherence group, respectively (p<0.0001). The following independent predictors of inhospital death were identified: IGA quartiles I-II (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.3-7.1; <0.0001), high GRACE score (OR 3.3; 95% CI 1.8-6.0; <0.0001), admission systolic BP less or equal 100 mm Hg (OR 3.1; 95% CI 1.8-5.4; <0.0001), admission serum glucose more or equal 8 mmol/l (OR 2.9; 95% CI 1.8-4.7; <0.0001), age more or equal 65 years (OR 2.3; 95% CI 1.3-4.0; =0.005), ST elevation more or equal 1 mm on first ECG (OR 1.7; 95% CI 1.1-2.5; =0.013). From groups with low and high adherence to guidelines we selected pairs of patients (n=588) with similar (or close) age, type of ACS, GRACE score, Killip class, presence of other important risk factors (CHF, AF, previous stroke), and formed 2 equal subgroups without significant differences in important demographic, anamnestic, clinical and laboratory data. Hospital mortality was 7.8 and 2.7% in low and high adherence subgroup, respectively (p<0.0001). CONCLUSIONS: In RECORD-2 ACS registry low adherence to guidelines was more frequent among high risk patients and was independent predictor of inhospital death. Association between degree of guidelines adherence and outcomes persisted after equalizing groups by some factors of risk of mortality.

[Acute non ST-elevation coronary syndrome in real practice of hospitals in Russia. Comparative data from RECORD 2 and RECORD registries].

AIM: to compare data on pre- and in hospital treatment of non ST-elevation (NSTE) acute coronary syndromes (ACS) in Russian ACS registers RECORD (recruitment from 11.2007 to 02.2008) and RECORD-2 (from 04/2009 to 04.2011). MATERIAL: Four of 7 hospitals participating in RECORD-2 were invasive (57.1% vs. 55.6% in RECORD). In RECORD-2 10-30 consecutive patients with NSTEACS were included monthly in each center; recruitment in RECORD was described elsewhere. RESULTS: Mean age of patients was similar in two registries. Portion of women was significantly higher in RECORD-2 (42.9% vs. 26.0% in RECORD; <0.0001). Although markers of necrosis were measured in higher proportion of patients in RECORD-2, frequency of troponin determination was not significantly different (47.0 vs. 43.5% in RECORD; =0.64). Patients in RECORD-2 more frequently received prehospital aspirin (51.6 vs 33.5%; <0.0001), aspirin in recommended initial dose 160-325 mg (64.3 vs. 47.1%; =0.03), and clopidogrel during hospitalization (47.0 vs. 27.6%; <0.0001). Rates of in hospital use of parenteral anticoagulants in both registries were similar, but among anticoagulants in RECORD 2 proportion of fondaparinucs became noticeable (9.5%) and that of low molecular weight heparin (LMWH) became significantly higher (21.2 vs. 11.6% in RECORD). Almost one third of patients in RECORD-2 who were treated with unfractionated heparin (UFH) received it subcutaneously. About half of patients treated with intravenous infusion of UFH received it for less than 48 hours. Although higher proportion of patients hospitalized in invasive hospitals were subjected to diagnostic coronary angiography in RECORD-2 (80.8 vs. 54.3% in RECORD; <0.0001) differences between registries in rates of percutaneous coronary interventions (PCI) (all - 37.3 vs. 29.9%; =0.051; first 72 hours - 22.7 vs. 24.8%; =0.55), and coronary artery bypass graftings (5.6 vs. 5.8%; =0.12) were not significant. There were no significant differences in rates of any in hospital unfavorable events. Analysis of treatment and outcomes in groups of high risk patients (GRACE score >140) gave results close to those in all patients except mortality which was statistically similar but numerically higher in RECORD-2 (9.3 vs. 7.9% in RECORD; p=0.68). CONCLUSION: Comparison of data of 2 limited NSTEACS registers conducted with interval of about 2 years showed only modest shift towards fulfillment of contemporary recommendations which was not associated with increase in rates of PCI and improvement of outcomes especially in high risk patients.

[Assessment of the prognostic value of the CRUSADE score in patients with acute coronary syndromes hospitalized in a noninvasive hospital].

Background. The CRUSADE score was created for assessment of bleeding risk in patients with acute coronary syndrome (ACS). However its accuracy was not confirmed in populations of patients treated in Russian hospitals, in noninvasively managed patients, in patients without myocardial infarction (MI). Aim. To assess prognostic value of the CRUSADE score in all pts with ACS, hospitalized in a noninvasive hospital in Russia. Material and methods. Study group comprised 602 patients with ACS admitted to a Moscow community noninvasive hospital (mean age 69.6+/-12.4 years, non-ST elevation ACS - 84.2%). The group was formed by inclusion of 25 consecutively hospitalized patients per month. During hospitalization we registered deaths and all bleeding events classified by TIMI and/or GUSTO criteria. The cut-off of high bleeding risk for CRUSADE score was 40. Results. Any bleedings occurred in 91 patients (15.1%), combination of major and moderate bleedings was registered in 36 patients (6.0%). In high bleeding risk group by CRUSADE score in comparison with non-high risk group bleedings were significantly more frequent (total 20.8 vs. 9.9%, respectively, p=0.0002; major 6.9 vs 1.9%, respectively, p=0.0024; moderate 5.2% vs 1.6%, respectively, p=0.013; combination of major and moderate 9.4 vs 2.9%, respectively, p=0.0007). Sensitivity and specificity of the CRUSADE score for sum of major and moderate bleedings during hospitalization were 77% and 52%, respectively, with area under ROC-curve 0.68. We selected 149 patients (24.8%) who had similar characteristic with patients of the CRUSADE derivation cohort (non-ST elevation MI, no use of vitamin K antagonists, survival and no discharge 48 hours after admission). In this CRUSADE-specific group rate of major/moderate bleedings was significantly higher among high risk compared with other patients (15.6% vs 3.5%, respectively, p=0.016), but for all bleedings difference between these groups was not significant (28.1 vs. 17.6%, p=0.16). In the CRUSADE-specific group sensitivity and specificity of the CRUSADE score for major/moderate bleedings during hospitalization were 81 and 59%, respectively, with area under ROC-curve 0.76. Conclusions. In noninvasively treated ACS patients high risk of bleeding by CRUSADE score was closely associated with occurrence of total as well as major and moderate bleedings. Prognostic accuracy of the CRUSADE score for prediction of major or moderate bleeding during hospitalization was higher in CRUSADE-specific group (patients satisfying criteria of the CRUSADE derivation cohort).

[Factors associated with inhospital severe bleeding in noninvasively treated patients with non ST elevation acute coronary syndrome].

UNLABELLED: Risk factors of bleeding in acute coronary syndrome (ACS) were derived from data of clinical trials and registers with high proportion of invasively treated patients. Aim of this study was to elucidate factors associated with severe bleeding in patients with non ST-elevation (NSTE) ACS treated in a noninvasive hospital. MATERIAL AND METHODS: From November 2009 to April 2011 24 NSTEACS patients had severe GUSTO or TIMI bleeding. For each of these patients we selected 3 age matched controls without severe bleeding from hospital registry of ACS in which we included 25 consecutive patients each month during about the same period of time. RESULTS: The group of patients with severe bleeding compared with control group (n = 72) had greater portions of patients with Killip class > or = 2 (50.0% vs 16.7%; p = 0.002), with history of chronic renal failure (20.8% vs 4.2%; p = 0.02) or bleeding (16.7 vs 2.8%, p = 0.03), with admission creatinine clearance < 30 (20.8% vs 5.6%; p = 0.04), with GRACE score > 140 (75.0 vs 45.8%, p = 0.01). Patients with bleeding prehospitally less frequently received aspirin (25.0 vs 58.3%, p = 0.005) and parenteral anticoagulants (16.7 vs 38.9%, p = 0.04), while in hospital they were more frequently given diuretics (62.5 and 26.4%, p = 0.005) and less frequently--low molecular weight heparin (8.3 vs 20.8%, p = 0.045) while use of parental anticoagulants was similar in both groups (87.5 vs 91.7%, respectively). Mortality and rate of inhospital myocardial infarctions in groups with and without bleeding were 62.5 and 1.4%, 21.7 and 1.4%, respectively. CONCLUSIONS: Inhospital severe bleeding in noninvasively treated patients with NSTEACS was associated with: well known predictors (heart and renal failure, history of bleeding); high risk of ischemic events and therefore very high mortality; lesser use of some antithrombotic drugs at various stages of treatment.

[Cystatin C and bleedings during hospitalization of noninvasively treated patients with acute coronary syndromes].

PURPOSE: To assess relationship between blood level of a marker of renal function cystatin C (CC) and bleeding events in patients with acute coronary syndromes (ACS). MATERIAL AND METHODS: CC level was measured in 160 patients from the ACS registry conducted in a noninvasive hospital in Moscow. Each month we included in this registry 25 consecutively hospitalized patients and recorded deaths and bleeding events (major and moderate by TIMI and/or GUSTO criteria) during hospitalization. CC measurement was made by ELISA in stored blood samples taken within first 24 hours after admission. The cut-off level for CC (> 1.53 mg/l) was established by ROC analysis. RESULTS: There were 10 deaths (6.3%) and 11 bleeding events (6.9%) during hospitalization (median 20 days). Inhospital mortality was 45.5 and 3.4% % among patients with and without bleeding, respectively (=0.0001). Bleeding events occurred significantly more often among patients with CC level >1.53 mg/l compared to those with CC level less or equal 1.53 mg/l (13.8 and 2.1%; respectively, p=0.008). Multifactorial regression analysis identified the following independents predictors of bleeding: thrombolysis at admission (odds ratio [OR] 9.32; 95% confidence interval [95%CI] 1.96-44.29; =0.005), CC level >1.53 mg/l (OR 7.96; 95% CI 1.34-47.26; p=0.023), initial white blood cells count (OR 1.31; 95%CI 1.10-1.57; =0.003). When CC was excluded from regression analysis creatinine clearance entered the list of independent predictors of bleeding (OR 0.95; 95% CI 0.90-0.99; =0.023). CONCLUSION: In this group of noninvasively treated patients with ACS high CC level (>1.53 mg/l) was independently related to major and moderate bleedings during hospitalization. If CC was excluded from analysis, another marker of renal function (creatinine clearance) became an independent predictor of inhospital bleeding.

[Acute coronary syndromes in hospitalized patients with diabetes. Data from the RECORD registry].

BACKGROUND: Diabetes is an acknowledged risk factor of unfavorable outcome in patients with acute coronary syndromes (ACS). According to modern guidelines patients with ACS and diabetes should be treated more aggressively than patients of lower risk. However systematic data on treatment of ACS patients with diabetes in real life hospitals in Russia are lacking. AIM; To analyze main clinical characteristics, inhospital treatment, and outcomes of patients with diabetes included in Russian independent ACS register RECORD. MATERIAL: RECORD embraced 18 hospitals of various types from 13 cities. Number of included patients both with ST elevation and non-ST elevation ACS (STEACS and NSTEACS) was 796; 124 patients (15.6%) reported diagnosis of diabetes mellitus at admission. RESULTS: Patients with diabetes compared with those without were significantly older and more often had other cardiovascular risk factors, signs of heart failure and high GRACE score at admission. Nevertheless their treatment in RECORD was characterized by relatively low rate of invasive interventions and use of certain medications (clopidogrel, statins) and was similar to treatment of patients without diabetes. Hospital mortality of patients with diabetes compared with mortality of those without was substantially and significantly higher (16.9 and 5.2%, respectively, <0.0001). Inhospital outcomes in patients with diabetes depended on activity of treatment and were better in patients subjected to primary PCI (STEACS) and receiving clopidogrel (NSTEACS). But small dimensions of respective subgroups precluded distinguishing between true effect of these treatments or selection for them of patients with relatively lower risk.

[Six months results of the Russian independent registry of acute coronary syndromes RECORD].

In 6 months after inclusion into the Russian independent registry of patients with acute coronary syndromes (ACS) RECORD fate of 43% of participants (n=340) was elucidated by telephone contacts. After discharge after index hospitalization there were 15 deaths (4.8%) and 15 novel myocardial infarctions (MI) (4.8%). As expected patients who died or had MI compared with survivors were older, more often had signs of heart failure (Killip class more or equal II), and were less often prescribed aspirin and statins. Among patients with ST elevation ACS death rate between discharge and 6 months was lower among those subjected to primary PCI (7,7 vs 28,0%; =0,035). Important findings of the study were relatively low use of recommended by current guidelines treatments and high rate of cessation of prescribed at discharge medications. It was not possible basing on material of the study to exclude preferred use of active treatments in lower risk patients as a cause of better 6 months outcomes in more actively treated.

[High lipoprotein(a) in children of patients with premature coronary artery disease: relation to own and parental factors].

AIM: To elucidate associations between high level of lipoprotein(a) [Lp(a)] in children of persons with premature (onset <55 years, men; <60 years, women) coronary heart disease (PCHD) with own and parental characteristics. MATERIAL AND METHODS: We surveyed 133 families: probands (n=122, 80.7% men) with PCHD, spouses (n=95, 12.1% men) and native probands children (n=177, 55.8% men) aged 5-34 years. Factors associated with high ( more or equal 30 mg/dl) LP(a) were selected by logistical regression with adjustment for sex and age separately in younger (5-17 years, n=83) and adult (18-34 years, n=94) children. RESULTS: High LP(a) was high in 21 (25.3%) younger children. Factors independently associated with high LP(a) in this group were apoprotein B (apo B) (odds ratio [OR] 1.03, confidence interval (CI) 1.00-1.05, =0.025) and plasminogen 1.03 (CI 1.01-1.06, =0.027) of these children; high Lp(a) 8.92 (CI 1.98-40.2, =0.0044) and apo B 1.03 (CI 1.00-1.05, =0.047) of consort-parent; high Lp(a) 12.3 (CI 2.88-52.8, =0.0007), high education 5.59 (CI 1.36-23.1, =0.017) and atherogenic dyslipidemia (a-DLP) 0.16 (CI 0.04-0.74, =0.019) of proband-parent. LP(a) was high in 25 (26.6%) adult children. It was independently associated with own low density lipoprotein cholesterol (LDL-C) 1.71 (CI 1.09-2.69, =0.019); high Lp(a) 13.6 (CI 2.39-77.7, =0.0033) and LDL-C 3.38 (CI 1.28-8.92, =0.014) of consort-parent; high Lp(a) 26.9 (CI 5.48-132.3, =0.0001) and a-DLP 0.13 (CI 0.02-0.82, =0.030) of proband-parent. CONCLUSIONS: High Lp(a) levels in these groups of children of patients with premature CHD were associated with characteristics of both parents especially with their elevated Lp(a). Other predictors of high LP(a) were also plausible except high education of proband-parent which possibly reflected some unaccounted factors. Association of high Lp() of children of both age groups with atherogenic dyslipidemia of proband-parent requires confirmation.

[Metabolic syndrome in families of patients with premature coronary heart disease: impact of 2009 Joint Interim Statement criteria].

AIM: To assess effect of transition from metabolic syndrome (MS) definition of International Diabetic Federation (IDF, 2005) to definition of Joint Interim Statement (JIS, 2009) on proportion of persons with MS among patients with premature coronary heart disease (CHD) and members of their families. MATERIAL: We examined 817 members of 375 families: 353-probands with premature CHD (65.7% men, 77.6% after MI, age 23-67 years); their 212 consorts (18.9% men, 5.7% with CHD, age 28-67 years), and 252 their children (52.4% men, without overt CHD, age 16-46 years). Parameters analyzed included body mass index (BMI), waist circumference, systolic/diastolic BP, serum high density lipoprotein (HDL) cholesterol (CH), triglycerides (TG). Impaired fasting glucose (IFG) and diabetes mellitus (DM) we defined according to ADA criteria. High BP was defined as prehypertension or hypertension (NHBPEP 4 report on high BP in children/adolescents or JNC 7 criteria, depending on age). RESULTS: Portions of individuals with MS according to JIS and IDF definitions were in the whole population 335/817 (41.0%) and 305/817 (37.3%), among probands 62.9% and 56.1%, consorts 37.3% and 36.8%, adult children 13.5% and 11.5%, respectively. All 305 persons with IDF MS satisfied JIS definition but JIS criteria identified MS in 30 more persons (25 with CHD). They were predominantly men (22/30), not obese (BMI range 19.1-29.1; median 25.5 kg/m2), with 3-4 AHA/NHLBI (2005) MS components, most had low HDL-CH (27); high TG (26), high BP (24), 14 persons had IFG, 5 - DM. CONCLUSION: In this heterogeneous population the use of JIS definition resulted in diagnosis of MS in small additional portion (9%) of persons with obvious high risk already requiring interventions because of CHD and/or level of CHD risk factors.

[Own and parental predictors of high level of low density lipoprotein cholesterol at children of persons with "premature" coronary heart disease].

AIM: To elucidate associations between high low density lipoprotein cholesterol (LDL-C) in children of persons with premature coronary heart disease (PCHD) and their own and parental characteristics. METHODS: We examined members of 282 families: probands (n = 262, 70.1% men) with PCHD (onset before 55 [men] or 60 [women] years), their spouses (n = 192, 19.2% men), and children of probands (n = 372, 55.8% men) aged 5-38 years. We defined high LDL-C in children aged 5-17 years as a90 percentile (Lipid Research Clinics Program Prevalence Study), in children aged 18-38 years - > or = 3.36 mmol/l. Factors related to children's high LDL were selected by logistic regression with sex and age adjustment. RESULTS: High LDL-C was found in 40/155 (25.8%) children aged 5-17 years. It was independently related to non-smoking of proband's spouse, higher own body mass index (BMI), LDL-C of proband and his spouse, lower heart rate of proband. High LDL-C was revealed in 85/217 (39.2%) children aged 18-38 years. It was independently related to metabolic syndrome of parent-nonproband, higher level of LDL-C of both parents, lower height of proband. INTERPRETATION: Most associations of high LDLAC of offsprings of patients with PCHD including negative relation to height and heart rate of proband are plausible. Association with parental nonsmoking can be result of analysis of unreliable data from small group but also reflect better economical conditions and more atherogenic nutrition of nonsmokers in Russia.

[Antiplatelet therapy in coronary heart disease. Some problems and achivements].

Standard double antiplatelet therapy (aspirin plus clopidogrel) used in patients with coronary artery disease during acute coronary syndromes (ACS) and/or in conjunction with percutaneous coronary interventions (PCI) has some limitations. Relatively large proportion of patients has "laboratory" resistance to clopidogrel - an essential component of standard therapy. Basic weakness of this agent is necessity to be converted into active metabolite by CYP 450 enzymes. Other drugs potentially interfere with this conversion. The puzzle of clinical value of obvious laboratory interaction of clopidogrel with its conjecturally almost obligatory companions proton pump inhibitors is still unresolved. It has been shown recently that loss of function alleles of some CYP450 genes especially CYP2C19*2 are responsible for reduced reaction of platelets to clopidogrel. Detection of this allele is possible. However practical application of such genetic testing is subject of disagreement among experts. Another way for therapy guidance is use of platelet function testing. But at present there is no agreement concerning preferable test. Studies aimed at clarification of practical role of some laboratory test are close to completion. Recognition of resistance by any method calls forth administration of higher doses of clopidogrel or use of novel agents. CURRENT trial has recently demonstrated advantages of clopidogrel double dose in ACS patients subjected to PCI. Novel P2Y12 receptor inhibitors prasugrel and ticagrelor have been shown to be superior to clopidogrel in large randomized trials. Direct P2Y12 antagonist ticagrelor seems to be especially attractive because of effect on total mortality and acceptable rate of bleeding. Among agents under study thrombin receptor blockers appear most promising.

[The RECORD registry. Treatment of patients with acute coronary syndromes in hospitals with and without possibilities to perform invasive coronary procedures].

The participants initiated RECORD registry in Russia recruited 796 patients (pts) with ST elevation (STE, n=256) and non ST elevation (NSTE, n=550) acute coronary syndrome (ACS) between 11.2007 and 02.2008. Ten of 18 participating hospitals (H) had facilities for coronary angiography and revascularization (invasive H-IH). STEACS. Percentages of pts with history of heart failure (HF) and with high GRACE score were significantly higher among pts in noninvasive (N) H. Pts in NH also had numerically although insignificantly higher mean age, portions of pts aged 75 years, with history of myocardial infarction (MI), and with Killip class II. In IH 60.9% of pts were subjected to reperfusion therapy (but only 30.4% - to primary PCI). In NH thrombolytic therapy was used in 34.1% of pts. Inhospital mortality was 14.3% in IH and 21.2% in NH. Within IH among pts subjected to PCI (n=49) proportion of persons aged 75 years and mean age were significantly lower compared with nonPCI pts, portion of subjects with high admission GRACE score ( 150) was numerically although insignificantly (p=0.07) smaller. There were no differences in clinical characteristics between nonPCI pts in IH and pts in NH. Therapy of nonPCI pts in IH was closer to guidelines with higher rate of thrombolytic therapy (42 vs 34.1%) and especially of clopidogrel use (42 vs 18.8%). However inhospital mortality of nonPCI pts in IH was closer to that in NH (18.9 vs 21.2%). NSTEACS. Pts in NH had significantly higher age. Portions of pts aged 75 years, with history of MI and of HF, with Killip class II, and high GRACE score in NH were significantly larger than in IH. Treatment of pts in IH was closer to guidelines with significantly higher use of clopidogrel and low molecular weight heparin, 54.3% of pts were subjected to angiography, 24.8% - to PCI, 9.4% - to coronary bypass surgery. Mortality was equal and relatively low in IH and NH (2.8 and 2.7%, respectively) despite differences in clinical characteristics of pts. Within IH invasively compared with noninvasively treated pts had significantly lower mean age and lower portion of pts 75 years, lower portions of pts with history of MI and HF, with Killip class II. Mortality was equal but rate of MI was significantly higher in invasively treated pts. Comparison of results of invasive treatment in IH and treatment in NH: mortality was equally relatively low (2.5 and 2.7%, respectively) despite higher proportions of pts with old age, history of HF, high GRACE score in NH; development of inhospital MI was significantly more frequent among invasively treated pts (7.9 vs 1.7%). Conclusion. Lower risk pts were admitted to IH and within IH lower risk pts were actually subjected to invasive treatment. Results of invasive reperfusion in STEACS were better than results of noninvasive treatment but effect of selection of lower risk pts can not be excluded. No positive effect of either invasive treatment or treatment in advanced H was revealed in NSTEACS.

[Waist circumference below metabolic syndrome harmonizing criteria is associated with increased cardiovascular risk].

AIM: To test the hypothesis that waist circumference (WC) just below Joint Interim Statement ([JIS], 2009) abdominal obesity thresholds can be associated with worse risk factors profile than smaller WC. METHODS: In a study of risk factors in families of patients with "premature" coronary heart disease (CHD) we examined 229 persons without CHD with body mass index (BMI) 18.5 kg/m and WC <94 cm (men) or <80 cm (women) (67 spouses [28-62 years] and 162 children [16-37 years]) of probands. Risk factors studied included smoking, BMI, WC, BP, total and high density lipoprotein cholesterol (HDL C), triglycerides (TG), basal serum glucose, diabetes and metabolic syndrome (MS JIS criteria, 2009). High BP was defined as prehypertension (PreHT) or hypertension (HT) and named PreHT/HT. In persons aged 16-17 years we used criteria 4 th report of National High BP Education Program Working Group on High BP in Children and Adolescents, in persons 18 years - 7 th Joint National Committee Report (USA). TG 1.7 mmol/l, serum basal glucose 5.6 mmol/l were defined high, HDL C <1.0 mmol/l (men), <1.3 mmol/l (women) - low. Framingham risk score of cardiovascular disease (CVD) was calculated for persons aged 30 years. Factors associated with various ranges of WC were selected by logistical regression univariate analysis. Odds ratios were compared in 2 groups of WC distribution: top ( 83 cm men, 73 cm women - intermediate [I] WC) vs 2 lower (<83 cm men; <73 cm women) tertiles. Analysis was carried out in 2 age groups according to median age: 16-26 years (n=115, 23.5% with IWC) and 27-62 years (n=114, 50.0 % with IWC). RESULTS: Persons aged 16-26 years with IWC had significantly higher risk to have high TG, low HDL C and PreHT/HT than those with smaller WC: odds ratios 7.53 (95% confidence interval [CI] 1.69-33.6; p=0.008), 3.56 (95% CI 1.35-9.36; p=0.010) and 2.22 (95% CI 1.13-4.36; p=0.020), respectively. No significant relationship was found between IWC and registered risk factors in age group 27-62 years. In persons aged 30-62 years (n=90, 51.1% with IWC) IWC was related to presence of 5% Framingham risk score: OR vs smaller WC 2.59 (95% CI 1.01-6.67; p=0.048). CONCLUSION: Among younger consorts and adult children of patients with "premature" CHD persons with WC 83 - <94 cm (men), 73 - <80 cm (women) had worse risk factors profile compared with persons with smaller WC.

[Spousal concordance for factors related to metabolic syndrome in families of patients with premature coronary heart disease].

PURPOSE: To elucidate risk factors concordance between spouses in families of patients with "premature" coronary heart disease (CHD). METHODS: We examined 174 spouse pairs. There were 174 probands with "premature" (onset before 55 years) CHD aged 32-63 years and 174 their spouses aged 28-63 years. Among probands 18.4% had angina pectoris only and 81.6% had history of myocardial infarction. There were 10 patients with CHD among spouses (5.75%). Characteristics studied included alcohol consumption, tobacco smoking, education, body mass index (BMI), waist circumference (WC), heart rate, systolic and diastolic blood pressure (DBP), total, low and high density lipoprotein cholesterol, triglycerides (TG), apoproteins -I and B, lipoprotein (a), blood glucose and insulin, homeostasis model assessment-insulin resistance (HOMA IR), fibrinogen, activity of plasminogen activator inhibitor type 1. Concordance of variables of continuous and ordinal type was estimated by Spearmanis rank correlation coefficients adjusted for sex and age. Pairs were divided according to proband age (32-47 and 35-63 years) and spousal concordance for characteristics studied was evaluated separately in 2 groups distinguished by age of proband (probands 32-47, spouses 28-53 years, and probands 48-63, spouses 35-63 years) with presumably different duration of marriage/cohabitation. RESULTS: Registered characteristics of spouses except apo -I correlated positively. Correlations between 9 characteristics were significant: education, insulin, HOMA IR, WC (R=0.608, 0.424, 0.421, 0.294; all p=0.0001), glucose (R=0.261; p=0.0007), TG and fibrinogen (both R=0.222; p=0.0036 and 0.0063, respectively), BMI and DBP (R=0.195 and 0.185, respectively; both p<0.016). All correlations were similar in groups of "younger" and "older" pairs with exception of PAI 1 activity (R = -0.035 and 0.320, respectively; p=0.042). CONCLUSION: In families of patients with premature CHD we found various degree of spousal concordance for risk factors mostly those considered to be related to metabolic syndrome. Correlations between risk factors levels in groups with presumably different duration of marriage were similar suggesting that concordance was due to assortative mating.

[Non-ST-elevation acute coronary syndrome. Comparison of effects of atorvastatin and rosuvastatin on blood levels of lipids and markers of inflammation].

UNLABELLED: Data on rapid effects of statins in patients (pts) with acute coronary syndrome (ACS) are mostly from trials of atorvastatin (ATO). We hypothesized that due to high potency 10 mg of rosuvastatin (ROS) would produce same changes of lipids and inflammation markers as 40 mg ATO. METHODS: We openly randomized 53 pts (69.7+/-10.1 years, 58.5% - man) within 36 h of non ST elevation (NSTE) ACS (56.6% NSTE myocardial infarction) to ROS 10 (n=19), ATO 40 (n=19) mg/day or no statin (n=15). Pts with low density lipoprotein cholesterol (LDL-C) >6, triglycerides (TG) >4.5 mmol/l, C-reactive protein (CRP) >10 mg/l (non-fasting sample) were not included. LDL-C, high density lipoprotein (HDL)-C, TG, apolipoproteins A-1 (apoA), and B (apoB), high sensitivity CRP, tumor necrosis factor-alpha (TNFalpha), interleukin-6 (IL-6) were measured in fasting blood sampled at randomization and 2 weeks later. RESULTS: Both statins caused similar decreases of LDL-C (-44.0% ROS, -50% ATO; both p<0.00001 vs control [-4%]). TG significantly rose in ROS (p=0.042) and control (p=0.008) groups but not in ATO group (p=0.615). HDL-C decreased similarly in 3 groups. ApoA-1 did not differ between 3 groups at all time points. ApoB decreased more in ATO (-32.6%), than in ROS (-24%) group (p=0.049). CRP and IL-6 changes from baseline were insignificant. In ROS group CRP had tendency to decrease but same tendency took place in control. TNFalpha significantly increased in all groups. There were no significant differences between 3 groups in inflammation markers. CONCLUSION: In pts with NSTEACS effect on lipids of ROS 10 mg was somewhat inferior to ATO 40 mg/day. Unexpectedly ATO and ROS during first 14 days of NSTEACS produced no significant effect on inflammation markers possibly because of insufficient dose of both.

[Own and parental predictors of arterial prehypertension and hypertension in children of persons with premature coronary heart disease].

AIM: to elucidate own and parental predictors of arterial prehypertension (PreHT) and hypertension (HT) in children of patients with premature manifested before 55 years in men or before 60 years in women) coronary heart disease (CHD). METHODS: We surveyed 276 families: 258 probands parents with premature CHD, their 214 spouses and 362 native probands children aged 5-37 years. In persons aged 17 years we used criteria of 4 th Report National Education Program Working Group on High BP in Children and Adolescents, in persons 18 years - 7 th Report Joint National Committee (USA). Predictors were selected by logistical regression with adjustment for sex and age. RESULTS: PreHT/HT was revealed in 26/143 (18.2%) children aged 5-17 years. Their own (body mass index [BMI], waist circumference, glucose) and parental (diastolic BP of proband) predictors related to the presence of PreHT/HT with <0.1 in univariate analysis were included in stepwise regression procedure. PreHT/HT was independently associated only with higher own BMI: odds ratio (OR) of top vs bottom tertile 10.2 (95% confidence interval [CI] 1.99-52.8; p=0.005). PreHT and HT were found in 75/219 (34.2%) and 40/219 (18.3%) children aged 18-37 years, respectively. Their own (BMI, waist circumference, glucose, triglycerides and total cholesterol) and parental (waist circumference, BMI, diabetes mellitus, PreHT/HT and triglycerides of proband; education level, alcohol consumption and oral hormonal contraceptive drugs use of spouse) predictors selected in univariate analysis with <0.1, were included in stepwise regression procedure. HT was independently associated with higher BMI (OR top vs bottom tertile 19.9 [95% CI 4.34-90.8]; <0.0001) and glucose (OR top vs bottom tertile 7.85 [95% CI 2.73-22.6]; <0.0001) of children, and PreHT/HT of probands (OR 2.80 [95% CI 1.13-6.94]; =0.026). CONCLUSION: PreHT and HT (age group 5-17 years) and HT (age group 18-37 years) in children of persons with premature CHD were independently related to own "metabolic" risk factors (BMI in both age groups and basal glucose in adult children). Association of preHT/HT of proband with HT in their children became manifested later in childrens life (18-37 years).

[Registry of acute coronary syndromes RECORD. Characteristics of patients and results of inhospital treatment].

PURPOSE: As contemporary information on real life management of hospitalized patients (pts) with acute coronary syndromes (ACS) in Russia is lacking we initiated limited ACS registry using no financial and no or minimal administrative support. METHODS: REgistry of acute CORonary synDromes - RECORD is a participants-initiated internet based project which uses design and adapted documents of the ESC ACS Registry. Overall 18 hospitals from 14 cities of various Russian regions submitted required information. Centers were asked to include < or =50 consecutive pts admitted alive within 24 h after onset of symptoms during 1 month. Ten hospitals had possibilities to perform percutaneous coronary interventions (PCI). RESULTS: From 11.01.2007 to 10.02, 2008 we included 796 pts (men 57.2%, age 31-93, mean 64.7+/-12.1, 25% >75 years) with ST elevation (STE) (n=246) and non-ST elevation (NSTE) (n=550) ACS. Invasive centers registered 65.4 and 46.2% of STEACS and NSTE ACS pts, respectively. STEACS. Median time from symptoms onset to hospitalization was 4.33 h (interquartile range 2.17-9.58 h). Primary reperfusion was used in 127 pts (51.6%) (thrombolysis in 79 [32.1%], primary PCI in 46 [18.7%], both in 2 pts). Median time from admission to start of thrombolysis was 0.33 h (interquartile range 0.17-0.53 h), from hospitalization to "start of PCI" (start of procedure, not to balloon) 1.5 h (interquartile range 0.83 - 4.08 h). Aspirin during hospitalization was given to 93.9, clopidogrel - to 44.9% (1/5 without loading dose) of pts. Average duration of hospitalization was 13.9 days. Hospital mortality was 16.7%. NSTEACS. Median time from symptoms onset to hospitalization was 7.42 h (interquartile range 3-23.75 h). ST depression more or equal 1mm on admission ECG was registered in 29.5%. Cardiac troponin was measured at least ones in 43.5% of pts, in 22.9% no markers of myocardial necrosis were assessed. PCI was used in 11.4%, coronary bypass surgery in 5.8% of pts. Anticoagulants were used in 84.9% of pts (in 73.3% - unfractionated heparin). In hospital aspirin was given to 92.9, clopidogrel - to 27.6% (29.6% without loading dose) of pts. Average hospital stay was 12.4 days. Discharge diagnosis was myocardial infarction in 32, unstable angina - in 51.1, stable angina - in 8.2, "noncardiac disease" - in 8.6% of pts. Hospital mortality was 2.7%. CONCLUSION: Despite limited size RECORD represented wide scope of hospitals. It revealed obvious underuse of conventional treatments. In STEACS this was associated with high hospital mortality. In NSTEACS relatively satisfactory result could be explained by preponderance of unstable angina.