[Duration and Timing of Initiation of Therapy With Platelet P2Y12 Inhibitors in the Treatment of Patients With Acute Coronary Syndrome].

In recent years, the issues of choice of an agent for dual antiplatelet therapy (DAPT) as well as timing of initiation and duration of DAPT in patients with acute coronary syndrome (ACS) have been actively discussed. In this article we present data of major randomized trials of clopidogrel and novel P2Y12 inhibitors - prasugrel, ticagrelor, cangrelor - assessing strategy of administration of antiaggregants in patients with ACS before coronary angiography / percutaneous coronary intervention. The article also contains analysis of differences between recommendations of the European Society of Cardiology and American College of Cardiology/American Heart Association on therapy with oral P2Y12 inhibitors in the management of patients with ACS.

[Prognostic power of various models in determination of level of coronary risk in patients with non ST-elevation acute coronary syndrome].

The GRACE prognostic scale appeared ineffective for prognostication of deaths and sum of deaths and myocardial infarctions (MI) during hospitalization and demonstrated moderate level of prognostic value during 6 months of observation. TIMI model gave similar result relative to prediction of death/MI/refractory ischemia during 14 days and 12 months of observation. PURSUIT risk model showed very good level of prognostic significance during 30 days and 12 months of observation. Comparison of GRACE and PURSUIT models relative to all cause death and composite of death and MI showed that PURSUITd scale had better accuracy of predictions.

[Prognostic value of creatine kinase MB-fraction and TroponinT increase in patients after coronary bypass grafting (data of 3-year prospective observation)].

The aim of this work was to investigate prognostic value of creatine kinase MB-fraction and troponin T increase in patients after coronary bypass grafting (during 3-year prospective observation). Parameters were studied in 6, 12, 48 and 72 hours after surgical myocardial revascularization. It was revealed that increase of myocardial necrosis markers is associated with significant more frequent development of cardiovascular complications during 3-year prospective observation.

[Efficacy of multifactorial preventive interventions in achievement of target levels of low density lipoprotein cholesterol in survivors of myocardial infarction]. / Effektivnost' mnogofaktornykh profilakticheskikh vmeshatel'stv v dostizhenii tselevogo urovnia kholesterina lipoproteidov nizkoi plotnosti u bol'nykh, perenesshikh infarkt miokarda.

AIM: To assess Efficacy of multifactorial preventive Interventions in achievement of target levels of low density lipoprotein cholesterol in survivors of myocardial infarction. METHODS: Design of the study was open randomized comparative prospective. Two groups of patients with history of myocardial infarction were formed ("active intervention", n=88, "observation", n=48) and followed for 12 months. All interventions consisted in recommendatory and expository measures. Achievement of target low density lipoprotein cholesterol (LDLCH) levels, modifiable risk factors, blood lipids spectrum were assessed in 2-3, 5-6 and 12 months of observation. RESULTS: Overall effect of undertaken multifactorial intervention on modifiable risk factors was positive. By the end of the period of observation number of risk factors per patient decreased from 3.8+/-0.99 to 2.8+/-1.29 (p<0.05). However target levels parameters in many cases were not reached. About half of patients could not decrease consumption of saturated fats and cholesterol, nearly 25% continued to smoke. More than 55% maintained excessive weight and 64% had abdominal obesity. Among patients of "observation" group only 5 (4.2%) began to take lipid lowering drugs. In active intervention group average LDLCH lowering was 23%, 38% of patients received lipid lowering drugs and 44% (of those who completed the study) achieved target LDLCH levels.

[The efficacy of physical exercises in correcting the lipid metabolic disorders in patients who have had a myocardial infarct]. / Effektivnost' fizicheskikh trenirovok v korrektsii narushenii lipidnogo obmena u bol'nykh, perenesshikh infarkt miokarda.

The influence of 4-month exercise training (ET) on the dynamics of lipids and lipoproteins of blood plasma regarding their initial level was studied in 64 postmyocardial infarction (PMI) patients. The initial 2 months bicycle exercise was performed in the moderate regimen (50-60% of individual ET), the next 2 months--in intensive regimen (70-90% of new threshold training). 46 control patients did no exercise. Two and four months of ET resulted in reduction of plasma cholesterol and its atherogenic fractions, an increase in high-density lipoprotein cholesterol level and exercise tolerance compared to the controls. Thus, ET in two-step regimen corrects lipid blood spectrum in PMI patients.

[Effects of lovastatin (mevacor) on platelet function in hypercholesterolemia in patients with ischemic heart disease]. / Izuchenie vliianiia lovastatina (mevakora) na funktsiiu trombotsitov pri giperkholesterinemii u bol'nykh ishemicheskoi bolezniu serdtsa.

The impact of a 4-week course of lovastatin (mevacor) therapy on platelet function was examined in 26 patients with coronary heart disease concurrent with hypercholesterolemia (the baseline plasma cholesterol level was 250 mg% or more). The agent was given in a daily dose of 20-40 mg. The agent in this dose was found to have no action on the thromboxane-prostacyclin balance in plasma, on the degree of ADP-induced aggregation and lipid peroxidation in platelets, phospholipid composition and levels of ester-bound cholesterol in platelet membranes. Free cholesterol tended to increase at the end of the 4th week of treatment. Despite the effective reduction of plasma levels of total and LDL cholesterols whose action on platelets is well known, there was no estimated decrease in the activity of platelets during lovastatin therapy.

[Significance of platelet membrane destruction in vasospastic angina pectoris during its exacerbation]. / Znachenie membrannykh narushenii v trombotsitakh pri vazospasticheskoi stenokardii v period obostreniia zabolevaniia.

The parameters of the structure and function of platelet membranes were examined in 30 patients with unstable vasospastic angina in relation to the outcome of the disease (myocardial infarction stabilization or development). The fractions of phospholipids (lysophosphatidylcholine, phosphatidylserine, sphingomyelin, phosphatidylcholine, phosphatidylethanolamine), the levels of platelet membranous free and esterified cholesterol, plasma malonic dealdehyde and thromboxane B2, the activity of platelet superoxide dismutase and catalase were determined. The exacerbation of vasospastic angina was found to appear as accumulation of cholesterol (mainly of its fraction), an increase in platelet membranous levels of phosphatidylcholine, phosphatidylethanolamine and sphingomyelin, accumulation of malonic dealdehyde. These changes were more profound in cases with subsequent myocardial infarctions. There were differences in the dynamics of the examined parameters in relation to the outcome of the disease.