The article analyzes a comparative efficacy of pharmacoinvasive reperfusion and
primary percutaneous intervention in patients with ST elevation acute myocardial
infarction in real clinical practice with fulfillment of Guidelines for the “first-medical-
contact — balloon time”. The problem of choice is underlined on the most effective
reperfusion method by emergency teams. The data is provided on a novel
medication — non-immunogenic staphylokinase made in Russia (Fortelyzin®). The
detailed analysis has been done on hospital mortality in myocardial infarction
in Russian and abroad hospitals.

Aim. To conduct the new stage of pharmaco-epidemiologic study of AH — PIFAGOR
IV to study the structure and prevalence of various classes of antihypertensive drugs
usage (ADU) in clinical practice. Material and methods. The study was conducted with physicians questionnaires usage
(GPs, cardiologists), having the practice of AH patients treatment with specially developed questionnaires. Totally 1105 physicians studied (67,5% GPs, 28,1% cardiologists, 8,2% the others) from 73 cities and other places during the period from february to july 2013. Results. The ADU structure by physicians in AH patients includes 5 main recommended drug classes: ACE inhibitors (24,2%), b-adrenoblockers (18,9%), diuretics (18,9%), calcium channel antagonists (17,4%) and angiotensin II receptor blockers (16%), totally 95,4%. Other classes included: central-acting drugs — 3,4%, a-adrenoblockers — 1,2%. In ACE inhibitors class the main are five following: perindopril (20,3%), enalapril (18,3%), lisinopril (18,5%), ramipril (14,2%) and fosinopril (13,6%). In b-blocker class the main are bisoprolol (30,2%), metoprolol in modified and common compounds (25,2%), carvedilol (16%). Diuretic class consists by a half of indapamide (54,8%), torasemide (18,4%), hydrochlorothiazide (19,4%). In calicum antagonists the main are amlodipine (32,6%) including S-amlodipine (1,8%), nifedipine in various forms (21,5%), with modified release — 14,3%, verapamil in various forms (14,6%), diltiazem (13%). In ARBII the main are losartan (37,3%), valsartan (29,9%). Central drug class included moxonidine (74,1%), rilmenidine (8%), clopheline (18%). The part of physicians compliant to fixed drug combinations increased to 52,6%; the part of ACE inhibitors with calcium channel blockers increased to 29,1%, and decrease found for b-blockers with diuretic — 15,6%. Physicians use more adequate criteria for AHT and recommended criteria for treatment effectiveness control (target BP).Conclusion. Analysis of physicians compliance showed the relevance to national guidelines for diagnostics and treatment of AH; physicians actively use combination therapy and modern fixed dose compounds.

While planning treatment and prevention in cardiovascular disorders (CVD) it is important to take into account the data on stability of clinical course of the main risk factors (RF). Until recently there is no such data on Russian population. Aim. To study the stability of arterial hypertension (AH), overweight (OW), hypercholestrolemia (HCE), hypertriglyceridemia (HTE) among men and women in 17-year observation. Material and methods. Baseline testing on the base of randomly assigned selection from the city of Tomsk citizens was performed in 1988-1991 (1546 men and women 20-59 y.  o.). Second test was done in 2002-2005, and the data obtained on RF and endpoints in 81,2% persons from the first step. A stability factor (St) was defined as relation of repeated RF (RF2) to the general selection (RF1), in percent — St=RF2/RF1 x 100%. Also the regression of RF was calculated. As regression we defined the cases of nonfinding of RF in the second measurement while having this in the first, and calculated by 1000 person-years of observation (PEO). Results. Seventeen-years lasting prospective study, performed on the cohort of men and women 20-59 y.  o. showed a high stability of AH, OW, HCE. The St values for AH was 96,6% (regressed 2,31 cases by 1000 PEO), for HCE; St for OW — 92,7% (regressed 4,70 by 1000 PEO); St for HCE — 92,9% (regressed 4,53 by 1000 PEO). HTE was not so stable RF: St = 75,0%. In age subgroup of 20-29 y. the interrelation of lower stability for HCE and HTE was found — St for HCE was 85,0% (regression 9,37 cases by 1000 PEO); St for HTE — 50,0% (regression 30,38 per 1000 PEO). It suggests that the nonmedication methods for dyslipoproteidemia correction, as diet, physical exertion increase, smoking cessation, body mass decrease can be highly effective in young people.

Aim. To reveal the personal-behavioral predictors of later than 6 hours after onset MI hospitalization and to compare these with parameters and predictors of mortality during 5 year follow-up.Material and methods. In 203 men (mean age 58,34±10,44 y.), had being treated for MI, the timing of hospitalization compared depending on psychological testing parameters at the moment of somatic stabilization achievement, as the lethal cases, during 5-year period. Results. On time hospitalization (OH) — in 6 hours from the onset of heart attack — took place in 28,08% of patients, and delayed (DH) —  later than 6 hours —  in 71,92% (p=0,001). During 5 years of follow-up 28,57% of patients died, of those in OH group 15,79% and in DH group — 33,56% (p=0,037). Psychological predictors of DH cases as long-term mortality were the prevalence of behavioral type A, aggressiveness increase as alexithymia with a decrease of subjective control in misfalls and harmony of disease relationship.Conclusion. The problem of on time MI treatment is still non-solvable without psychology of coronary patient, their personality-behavioral properties, which might become a psychological supplement for OH and be against this. Psychotherapeutical reliance on the former and correction of the latter should be used in psychoprophylaxy of DH in high risk ACS patients.

Aim. To study the relationship of cardiac-ankle vessel index (CAVI) and the results of coronary bypass grafting in CHD. Material and methods. 356 patients after CABG were selected into two groups according to CAVI: 1st group  — CAVI≥9,0 (n=231), 2nd group  — CAVI<9,0 (n=125). As end points after CABG in 1 year we used death, myocardial infarction (MI), acute cerebrovascular accident (CVA), transitory ischemic attack (TIA), rhythm disorders, polyorganic dysfunction syndrome development (PDS) and combination of these. Additionally the analysis performed to analyse the influence of various pre- and perioperational factors on the development of the endpoints. Results. In patients with normal CAVI there was more prevalent one-vessel diseases and bypass to one artery, compared to those with pathological CAVI. Groups did not show a significant difference in the quantity of shunts, duration of artificial circulation, and quantity of operations. It was revealed that the presence of pathological CAVI in CHD patients does negatively influence the short-term results of the operation. In these patients there were more perioperational complications of bypass grafting including strokes and deaths (p=0,05 and 0,02, resp.) Conclusion. In CHD patients pathological CAVI was found in 35% cases of coronary bypass grafting. CHD patients with higher CAVI were older, more often they had arterial hypertension, diabetes mellitus and lesions of no coronary arterial pools. Presence of pathological CAVI was associated with higher prevalence of perioperational complications of CABG, especially deaths and strokes perioperational complications of bypass grafting including strokes and deaths (p=0,05 and 0,02, resp.) Conclusion. In CHD patients pathological CAVI was found in 35% cases of coronary bypass grafting. CHD patients with higher CAVI were older, more often they had arterial hypertension, diabetes mellitus and lesions of no coronary arterial pools. Presence of pathological CAVI was associated with higher prevalence of perioperational complications of CABG, especially deaths and strokes.

Aim. To evaluate coronary bypass grafting under artificial circulation conditions on endothelial and erectile dysfunction in patients with ischemic heart disease (CHD). Material and methods. Totally 117 patients participated in the study, with stable CHD at the mean age 55,8±5,3 y.  o.,  planned to CBG. In all patients we used questionnaire “International Index of Erectile dysfunction” (IIED), registration of nocturnal penile tumescenses (NPT), post compression tests on brachial and cavernous arteries. All patients were divided into two groups, those with and without erectile dysfunction (ED) (n=60, n=57, resp.). Results. By the results of the investigation in patients with ED after CBG there was significant worsening of erectile function. It was found, that the existence of ED before operation is an important prognostic factor for its progression after the operation. Others, with non-affected erectile function, after the operation had higher chances to save it. Even more, it was found that in patients without preoperational ED by 6 months after CBG there was tendency to improvement of EZVD comparing with baseline values, but in group with ED this tendency was not found. Also in patients without ED in all stages of study there was significantly better vasoregulating function of endothelium on brachial artery comparing to ED patients. The same tendency was found and on cavernous arteries. While analyzing the prevalence of cardiovascular events after CBG it was found that in ED group 4 patients (7%) cardiovascular events developed, but without ED — did not. Conclusion. So the presence of ED might be a significant marker of worse outcome in CHD patients, underwent CBG.

The article is on some contemporary data about genetic specifics of patients with sleep apnea syndrome. The data discussed is concerned on either adult and newborn subjects with the syndrome.

The second part of the review of peripartum cardiomyopathy includes contemporary views of a specifics of disease onset. Detailed specifics of the disease onset is provided according to their specificity and diagnostical value. The approaches to diagnostics described beginning from physical examination to instrumental methods. Taking into account of the microparticles role on the disease onset, the importance ov their measurement is highlighted in peripartum cardiomyopathy, especially peripheral vasodilators, diuretics, ACE inhibitors, antiarrhythmic drugs, anticoagulants, pentoxyphilline, bromocryptine, cabergoline. The methods selected of artificial circulation in severe disease course and the data provided on plasmapheresis usage and implantable cardioverter-defibrillator. In general the points of delivery problems discussed.

The review takes into consideration the novel data on heart failure treatment: application of mineralocorticoid antagonists. The pathogenetic points are highlighted that are proved by clinical trials, as epidemiological concerns. Further opportunites are sketched for this special kind of treatment by the growth of receptor interaction selectiveness.