[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

Aim      To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods  The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion      Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

COVID-19 in Russia: Evolution of Views on the Pandemic. Report II

Over the two years of the novel coronavirus infection (COVID-19) pandemic, there has been an evolution of views in various fields of medicine, which has led to a powerful development of scientific research in the field of epidemiology, clinic, diagnosis and therapy of COVID-19. This article discusses the evolution of views and approaches to the study of the clinic and therapy of COVID-19. The symptoms and aggravation of the course of cardiovascular diseases with COVID-19 have been established. The main strategy for organizing surgical care for patients with COVID-19 is indicated. The main criteria for the treatment of COVID-19, the need to prescribe SGCS on an individual basis, and the need to search for new methods of anti-inflammatory therapy for COVID-19, one of which may be the use of alkylating drugs in ultra-low doses, are described. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

COVID-19 in Russia: Evolution of Views on the Pandemic. Report I

Over the two years of the novel coronavirus infection (COVID-19) pandemic, there has been an evolution of views in various fields of medicine, which has led to a powerful development of scientific research in the field of epidemiology, clinic, diagnosis and therapy of COVID-19. The article highlights the evolution of views and approaches to the study of the epidemiology and radiology of COVID-19. The data of molecular genetic studies are shown, which are the most important component of epidemiological surveillance. The study of the manifestations of the COVID-19 epidemic process made it possible to distinguish two stages in the development of the epidemiological situation in the Russian Federation. At the first stage of the epidemic, two rises in the incidence rate of the population were recorded, regulated by social and natural factors. The second stage of the epidemic was due to a change in the biological properties of the SARS-CoV-2 virus, followed by a change in the prevailing genovariants (Alpha, Delta and Omicron). At the second stage of the epidemic, three rises in the incidence of the population were recorded. The general principles for the use of radiodiagnosis methods, which are used primarily to detect lung damage in COVID-19, are given. With the accumulation of experience, a natural change in ideas about the algorithms for the use of visualization technologies has occurred. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

Impact of cardiovascular diseases and their therapy on mortality of ICU patients with COVID-19

There are various data on negative impact of comorbidities on treatment outcomes in patients with novel coronavirus infection (COVID-19). However, the impact of cardiovascular diseases and especially their therapy on the course of infectious process and unfavorable outcomes in COVID-19patients has not been sufficiently studied. Objective. To assess the impact of concomitant cardiovascular diseases and chronic drug intake for their treatment on in-hospi-tal mortality in ICU patients with COVID-19. Material and methods. A single-center retrospective cohort study of ICU patients with COVID-19 was carried out between March 6, 2020 and June 3, 2020 at the Demikhov Moscow City Clinical Hospital. We analyzed the following data: age, gender, previous comorbidities, Charlson comorbidity index, therapy of chronic cardiovascular diseases, severity of COVID-19, NEWS and SOFA scores. Univariate analysis included assessment of relative risk (RR). Multivariate analysis was carried out using regression model. Results. We analyzed medical records of 403 patients (231 (57.3%) men). Mean age of patients was 62.4±15.3 years. Over-all 30-day mortality rate was 44.9% (n=181). Multivariate analysis showed that coronary artery disease (adj. OR 2.459, 95% CI 1.589—3.806, p<0.001) and hypertension (adj. OR 2.893, 95% CI 1.667—5.019, p<0.001) were independent predictors of mortality in ICU patients with COVID-19. Conclusion. Coronary artery disease and hypertension are independent predictors of poor outcomes. Long-term use of angioten-sin-converting enzyme inhibitors, β-blockers, acetylsalicylic acid or statins for cardiovascular diseases does not significantly affect clinical outcomes in ICU patients with COVID-19. © 2022, Media Sphera Publishing Group. All rights reserved.

What treatment really make sense for critically ill patients with COVID-19: single-center retrospective cohort study

Introduction. Even now — a year after the pandemic announcement by WHO, there is lack of clinical evidence to confirm the efficacy of the majority of anti-COVID drugs, evenly for general and critically ill patients. Objective. To estimate the efficacy and safety of some anti-COVID-19 drugs as well as the impact of the demographic data and comorbidity on clinical outcomes of critically ill patients. Materials and methods. The single-center retrospective cohort study was performed on critically ill patients admitted to the ICU of Moscow Municipal Hospital No. 68 from March 6 to June 3, 2020. Anthropometric parameters, severity of the condition and comorbidities, as well as CT data, treatment in the ICU, duration of mechanical ventilation and the patients’ length of staying the ICU were taken into account and analyzed. Results. Overall, 403 patients (231 male, average age: 62.4 ± 15.3 years, range from 21 to 97 years) were enrolled into the study. In hospital mortality rate appeared to be 44.9 % (181/403) and was equal for men and for women (p = 1,000). The application of low molecular weight heparin was the single one significant predictor of mortality reduction according to the results of multivariate analysis — HR = 0.742 (0.545–0.991), p = 0.045. The main unmodifiable predictors for mortality elevation in the ICU were: age 65+ (RR 2.116 [1.680–2.664], p < 0.001) and Charlson’s comorbidity index (HR 1.136 [1.087–1.188], p < 0.001). The group of patients with a fatal outcome had a higher comorbidity index, the number of points on the SOFA scale (p < 0.001), as well as a larger median number of days in the ICU (p = 0.012). Conclusions. Current study has convincingly proved that low molecular weight heparin to be used for while treating severe acute respiratory syndrome coronavirus 2 patients in intensive care settings. © 2021, Practical Medicine Publishing House LLC. All rights reserved.