cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2186Research ArticleОБЗОРЫREVIEWSФакторы периоперационного сердечно-сосудистого риска и пути его снижения у больных ишемической болезнью сердца при чрескожных коронарных вмешательствахPeriinterventional cardiovascular risk and the methods for its reduction in coronary heart disease patients undergoing percutaneous coronary interventionНазароваК. А.NazarovaK. A.

врач-кардиолог

ХилькевичО. В.KhilkevichO. V.

врач-кардиолог

КиякбаевГ. К.KiyakbaevG. K.

профессор кафедры факультетской терапии

gayratk@rambler.ruКобалаваЖ. Д.KobalavaZh. D.

зав. кафедрой пропедевтики внутренних болезней

МоисеевВ. С.MoiseevV. S.

зав. кафедрой факультетской терапии

ФГУ “Центральный Военный Клинический Госпиталь ФСБ России”. МоскваCentral Military Clinical Hospital, Russian Federal Security Service. MoscowРоссийский университет дружбы народовRussian University of People’s Friendship201001011970988695Copyright © Назарова К.А., Хилькевич О.В., Киякбаев Г.К., Кобалава Ж.Д., Моисеев В.С., 19701970Назарова К.А., Хилькевич О.В., Киякбаев Г.К., Кобалава Ж.Д., Моисеев В.С.Nazarova K.A., Khilkevich O.V., Kiyakbaev G.K., Kobalava Z.D., Moiseev V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2186

Такие перипроцедурные осложнения чрескожных коронарных вмешательств (ЧКВ), как инфаркт миокарда (ИМ), феномен “no-reflow/slow flow” и инсульт оказывают неблагоприятное влияние на отдаленную выживаемость. Это определяет необходимость оптимизации стратификации риска и профилактики их развития. Существующие подходы прогнозирования периоперационных осложнений ориентированы в основном на оценку вероятности смертельного исхода и не учитывают модифицируемые факторы риска, что ограничивает их значение рамками оценки пользы/риска ЧКВ. Назначение статинов в периоперационном периоде снижает риск перипроцедурного ИМ у больных стабильной стенокардией и при остром коронарном синдроме. Полагают, что такой благоприятный эффект обусловлен наличием у препарата противовоспалительных, антиокислительных, антитромботических, NO- и иммуномодулирующих свойств. Сведения о кардиопротективной перипроцедурной эффективности β-адреноблокаторов при ЧКВ неоднозначны. Данные о способности этих препаратов повышать риск развития феномена “slow flow”, спазма коронарных артерий, сердечной недостаточности и артериальной гипотонии делают необходимой оптимизацию пульс-урежающей составляющей фармакологического обеспечения процедуры ЧКВ. В качестве одного из перспективных подходов к решению этой проблемы может рассматриваться применение ивабрадина — препарата с доказанными антиишемическими и антиангинальными свойствами, не влияющего на сократительную способность миокарда и уровень артериального давления.

Such periinterventional complications of percutaneous coronary intervention (PCI) as myocardial infarction (MI), “no-reflow/slow-flow” phenomenon, and stroke, affect long-term survival. Therefore, their risk should be effectively stratified and reduced. The existing approaches for predicting the risk of periinterventional complications are typically focussed on assessing the fatal outcome probability and do not consider modifiable risk factors, which restricts their use to evaluation of PCI benefits and risk only. Periinterventional statin therapy reduces the risk of periinterventional MI both in patients with stable angina and individuals with acute coronary syndrome. This beneficial action could be related to anti-inflammatory, antioxidant, antithrombotic, NO- and immunomodulating effects of statins. The evidence on cardioprotective effects of periinterventional beta-blocker therapy is contradictory for PCI patients. Existing data on the link between beta-blocker treatment and increased risk of “slow flow” phenomenon, coronary artery spasm, heart failure, and arterial hypotension point to the need for optimisation of the pulse-reducing component of pharmaceutical PCI support. One of the promising methods for solving this problem could be administration of ivabradine – a medication with confirmed anti-ischemic and antianginal action, but no effects on myocardial contractility or blood pressure level.

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