Vol 23, No 2 (2017)

The purpose of study. To evaluate efficiency of different coagulants used under transcutaneous coronary interventions in patients with acute coronary syndrome without elevation of ST segment.The methods. The sampling of 346 patients was randomized in two groups. In the group I (n=155) transcutaneous coronary intervention was implemented using bivalirudin and in group II (n = 191) - using unfractionated heparin. The additional randomization of patients of group I: in subgroup A (n = 77) infusion of bivalirudin continued during four hours after intervention and in subgroup B (n = 78) infusion was discontinued in X-ray operating room. The criteria of inclusion: patients with acute coronary syndrome without elevation of ST segment with multi-vascular affection of coronary channel (risk on SYNTAX score = 23-32); high and medium degree of risk according GRACE scale; absence of re-vascularization of myocardium in anamnesis. The criteria of exclusion: patients with very high risk according GRACE scale; affection of left coronary artery trunk. The results. During period of hospitalization, total rate of intra- and post-operative cardiovascular complications had no reliable differences in two groups and amounted to 7.1% and 8.4% correspondingly (p = 0.6423). The serious bleedings (BARC 3 and 5) occurred reliably more frequently in patients of group II. Also, the groups had no differences in rate of development of acute thrombosis of stents. In subgroup A reliably less frequently occurred serious cardiovascular complications as compared with patients of subgroup B (1,3% и 13% correspondingly; р = 0,001). At that, rate of bleeding reliably had no differences. At trans-radial access, in patients of group I rate of bleeding and cardiovascular complications amounted to 0% and 2.9% and at trans-femoral access these indices were reliably higher - 3,3% и 10% correspondingly (р < 0,001). In group II a similar tendency is noted: at trans-radial access these indices amounted to 6% and 4.6% and at trans-femoral - 33.7% and 11.9% correspondingly (р<0,001). When compared with these indices is was established that independently of selected arterial access, cordial occurrences reliably had no differences in group of bivalirudin and heparin. At that, bleeding were reliably more often detected in group of heparin ((р < 0,001). The remote results of treatment (average term was 12±0,14 months) were observed in 192 patients and out of them 91 patients were of group I and 101 patients of group II. The total rate of cardiovascular complications was reliably lower in group I in comparison with group II and amounted to 2.2% and 6% correspondingly (р = 0,0312).The conclusion. The application of such direct inhibitor of thrombin as bivalirudin during transcutaneous coronary intervention in patients with acute coronary syndrome without elevation of ST segment contributes to decreasing of risk of hemorrhagic complications during the nearest post-operative period and differs by its positive effect on remote prognosis in such patients. The application of transcutaneous coronary intervention by radial access and also prolongation of infusion of bivalirudin during 4 hours after transcutaneous coronary intervention are additional factors of benevolent prognosis under endovascular treatment of acute coronary syndrome without elevation of ST segment.

Purpose of study. To investigate age gender and clinical anamnestic characteristics of patients with atypical clinical forms of acute myocardium infarction.Materials and methods. The study was based on data of the WHO programs “The register of acute myocardium infarction”. The analysis comprised 836 cases of acute myocardium infarction. The atypical clinical forms of acute myocardium infarction were detected in 184 patients (18.7%). In the structure of atypical clinical forms of acute myocardium infarction the following alternatives were appropriated: asthmatic (32,6%), collaptoid (31,5%), abdominal (13.6%), arrhythmic (7.6%), peripheral (5.4%)б painless (4.9%) and cerebral (4.3%).Results of study. The most of the males (62.5%) found themselves in the group of patients with abdominal form of acute myocardium infarction and most of the females in the group with cerebral form of acute myocardium infarction. In all analyzed groups the individuals older than 60 years prevailed. In the group of patients with cerebral form were most of the individuals underwent earlier acute myocardium infarction (50.0%). The diabetes mellitus most frequently was registered in individuals with painless acute myocardium infarction (55.5%). In all cases, course of acute myocardium infarction was complicated. Under atypical clinical forms of acute myocardium infarction higher lethality was registered and in groups with arrhythmic and cerebral forms it reached 100%.The conclusion. The whole group of patients with atypical clinical forms of acute myocardium infarction was presented by over-age contingent, severe in clinical, anamnestic and prognostic layouts. The unsatisfactory diagnostic of atypical clinical forms of acute myocardium infarction resulted in higher lethality of the given group of patients. With regard to that a general tendency of alteration of age structure of population of Russia is a steady increasing of percentage of individuals of older age groups t5he rate of occurrence of atypical clinical forms of acute myocardium infarction will regularly increase.

The magnesium is one of the most important microelements, a universal regulator of biochemical and physiological processes. This microelement is a co-factor of enzymes and participates in energetic, plastic and electrolyte metabolism, in regulation of cell growth, synthesis of protein, etc. In many countries the magnesium deficiency is a burning problem. The medications of non-organic and organic salts of magnesium are used for supplying it. The efficient medications are such asparaginic salts of magnesium as magnesium DL-asparaginate, potassium and magnesium L-asparaginate and magnesium L-asparaginate hydrochloride. The other obligate factor is vitamin B6 (pyridoxine) that as magnesium plays important role in main processes of metabolism and benevolently effects the central nervous system. The vitamin B6 supports increasing absorption of magnesium in intestine ameliorates its transportation into cells and processes of intra-cellular accumulation and potentates pharmacological effects of magnesium. By-turn, magnesium supports activation of vitamin B6 in liver. Therefore, it is appropriate to apply jointly magnesium and vitamin B6.

In spite of significant increasing of number of patients with disorders of diastolic function of heart and fibrillation of atria, understanding of mechanisms of their development and modes of treatment is still to be reached. The present review presents Actual view of the role of diastolic dysfunction of heart in development and progression of fibrillation of atria, including possibilities of its adjustment after interventional treatment.