russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2019-3-7-16russjcardiol-3179Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФакторы риска кровотечений у больных с острым коронарным синдромом: данные наблюдательного исследования ОРАКУЛ IIBleeding risk factors in patients with acute coronary syndrome: data from observational studies ORACUL IIhttps://orcid.org/0000-0003-4144-4719БражникВ. А.BrazhnikV. A.

Москва

vabrahznik@bk.ruhttps://orcid.org/0000-0002-4203-3586МинушкинаЛ. О.MinushkinaL. O.

Минушкина Лариса Олеговна — доктор медицинских наук, профессор кафедры терапии, кардиологии и функциональной диагностики

Москва

minushkinalarisa@gmail.comhttps://orcid.org/0000-0001-8910-4137ГулиевР. Р.GulievR. R.

Москва

glvrst@gmail.comhttps://orcid.org/0000-0002-8867-117XАверковаА. О.AverkovaA. O.

Аверкова Анастасия Олеговна — аспирант кафедры терапии, кардиологии и функциональной диагностики

Москва

avek@mail.ruhttps://orcid.org/0000-0002-9742-359XРогожинаА. А.RogozhinaA. A.

Рогожина Анастасия Александровна — аспирант кафедры терапии, кардиологии и функциональной диагностики

Москва

rogozhina007@list.ruhttps://orcid.org/0000-0001-5292-1336КоролеваО. С.KorolevaO. S.

Королева Ольга Сергеевна — кандидат медицинских наук, ассистент кафедры терапии, кардиологии и функциональной диагностики

Москва

olgakoroleva@hotmail.comhttps://orcid.org/0000-0001-8377-1350ЗубоваЕ. А.ZubovaE. A.

Зубова Екатерина Андреевна — врач

Москва

zubova.katerinka@inbox.ruhttps://orcid.org/0000-0002-3991-2547КарманчиковаЕ. А.KarmanchikovaE. A.

Карманчикова Елена Александровна — врач-терапевт

Ставрополь

dr.lena81@gmail.comhttps://orcid.org/0000-0001-8582-708XХасановН. Р.KhasanovN. R.

Хасанов Нияз Рустемович — доктор медицинских наук, доцент, заведующий кафедрой пропедевтики внутренних болезней

Казань

ybzp@mail.ruhttps://orcid.org/0000-0002-6962-3260ЧичковаМ. А.ChichkovaM. A.

Чичкова Марина Александровна — доктор медицинских наук,  профессор, заместитель главного врача

Москва

m.chichkova@mail.ruhttps://orcid.org/0000-0002-1816-8309БоеваО. И.BoevaO. I.

Боева Ольга Игоревна — доктор медицинских наук, доцент, заведующий кафедрой медицинской радиологии с курсом дополнительного профессионального образования

Ставрополь

Box0270@mail.ruhttps://orcid.org/0000-0002-4510-6197ГалявичА. С.GalyavichA. S.

Галявич Альберт Сарварович — доктор медицинских наук, профессор, заведующий кафедрой факультетской терапии и кардиологии лечебного факультета

Казань

agalyavich@mail.ruhttps://orcid.org/0000-0001-7065-2045ЗатейщиковД. А.ZateyshchikovD. A.

Затейщиков Дмитрий Александрович — доктор медицинских наук, профессор, зав. кафедрой терапии, кардиологии и функциональной диагностики, зав. первичным сосудистым отделением

Москва

dz@bk.ruФГБОУ ДПО Центральная государственная медицинская академия УД Президента РФ; ГБУЗ Городская клиническая больница № 51 Департамента здравоохранения г МосквыРоссияCentral State Medical Academy of the Presidential Administration of the Russian Federation; City Clinical Hospital № 51Russian FederationФГБОУ ДПО Центральная государственная медицинская академия УД Президента РФРоссияCentral State Medical Academy of the Presidential Administration of the Russian FederationRussian FederationФГБУН Институт биохимической физики им. Н.М. Эмануэля Российской академии наукРоссияInstitute for Biochemical PhysicsRussian FederationГБУЗ Городская клиническая больница № 51 Департамента здравоохранения г МосквыRussian FederationCity Clinical Hospital № 51Russian FederationГБУЗ Ставропольского края Ставропольская краевая клиническая специализированная психиатрическая больница № 1Russian FederationStavropol Regional Clinical Psychiatric Hospital № 1Russian FederationФГБОУ ВО Казанский государственный медицинский университет Минздрава РоссииRussian FederationKazan State Medical UniversityRussian FederationГБУЗ Городская клиническая больница № 17 Департамента здравоохранения г. МосквыRussian FederationCity Clinical Hospital № 17Russian FederationФГБОУ ВО Ставропольский государственный медицинский университет Минздрава РоссииRussian FederationStavropol State Medical UniversityRussian Federation20191104201903716Copyright © Бражник В.А., Минушкина Л.О., Гулиев Р.Р., Аверкова А.О., Рогожина А.А., Королева О.С., Зубова Е.А., Карманчикова Е.А., Хасанов Н.Р., Чичкова М.А., Боева О.И., Галявич А.С., Затейщиков Д.А., 20192019Бражник В.А., Минушкина Л.О., Гулиев Р.Р., Аверкова А.О., Рогожина А.А., Королева О.С., Зубова Е.А., Карманчикова Е.А., Хасанов Н.Р., Чичкова М.А., Боева О.И., Галявич А.С., Затейщиков Д.А.Brazhnik V.A., Minushkina L.O., Guliev R.R., Averkova A.O., Rogozhina A.A., Koroleva O.S., Zubova E.A., Karmanchikova E.A., Khasanov N.R., Chichkova M.A., Boeva O.I., Galyavich A.S., Zateyshchikov D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/3179Цель

Цель. Выявление факторов риска кровотечений 2-5 типов по шкале BARC у больных, перенесших острый коронарный синдром (ОКС).

Материал и методы

Материал и методы. Использованы данные 1502 больных из наблюдательного открытого многоцентрового исследования, ОРАКУЛ II (ОбостРение ишемической болезни сердцА: логиКо-вероятностные пУти прогнозирования течения для оптимизации Лечения) — 894 мужчин (59,5%) и 608 женщин (40,5%), возраст — 65,7±12,9 лет. 560 (37,3%) имели ОКС с подъемом сегмента ST и 942 (62,7%) — ОКС без подъема ST. Кровотечения зарегистрированы у 164 больных (10,9%), в том числе во время индексной госпитализации — у 39 (2,6%), из них тяжелых (типы 3-5) 0,5%, значимых — 1,7% (типы 2-5).

Результаты

Результаты. В течение года после выписки кровотечения отмечены у 126 (8,4%) больных, больших — 0,8%, значимых — 2,4%. Развитие кровотечений 2-5 типа ассоциировалось с наличием язвенной болезни желудка и двенадцатиперстной кишки, желудочно-кишечным кровотечением в анамнезе, снижением клиренса креатинина, гемоглобина, возрастом больных, применением антикоагулянтов в составе тройной или двойной антитромботической терапии, проведением чрескожных коронарных вмешательств при индексной госпитализации и наличием сердечной недостаточности 2-4 класса по Killip при поступлении. ROC-анализ показал, что прогностическая ценность шкалы риска кровотечений ОРАКУЛ составляет 0,762, чувствительность — 62%, специфичность — 78%.

Заключение

Заключение. Таким образом, нами на материале рутинной клинической практики создана простая шкала оценки риска кровотечений у больных ОКС.

Aim

Aim. To identify the risk factors for bleeding of BARC scale 2-5 types in patients after acute coronary syndrome (ACS).

Material and methods

Material and methods. The data of 1502 patients from the open multicenter study, ORACUL II, were used — 894 men (59,5%) and 608 women (40,5%), mean age — 65,7±12,9 years. Five hundred sixty (37,3%) patients had ACS with ST-segment elevation and 942 (62,7%) — ACS without ST-segment elevation. Bleeding was recorded in 164 patients (10,9%), including index admission — in 39 (2,6%) patients, of which severe (types 3-5) — 0,5%, significant — 1,7% (types 2-5).

Results

Results. Within a year after discharge, bleeding was observed in 126 (8,4%) patients, large — 0,8%, significant — 2,4%. The development of bleeding type 2-5 was associated with the presence of gastric ulcer and duodenal ulcer, gastrointestinal bleeding in history, decreased creatinine, hemoglobin clearance, age of patients, the use of anticoagulants in the composition of triple or double antithrombotic therapy, conducting of percutaneous interventional procedures, the presence of heart failure 2-4 Killip class at admission. ROC analysis showed that the predictive value of the ORACLE bleeding risk scale is 0,762, sensitivity — 62%, specificity — 78%.

Conclusion

Conclusion. Thus, we based on routine clinical practice have created a simple scale for assessing the risk of bleeding in patients with ACS.

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The authors declare that there are no conflicts of interest present.