cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2017-4-88-92cardiovascular-627Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMИНФАРКТ МИОКАРДА И ПРОБЛЕМА ИНДИВИДУАЛИЗАЦИИ ЛЕЧЕНИЯ. КЛИНИЧЕСКИЙ ПРИМЕР СПОНТАННОЙ ДИССЕКЦИИ ДВУХ КОРОНАРНЫХ АРТЕРИЙMYOCARDIAL INFARCTION AND THE ISSUE OF INDIVIDUALIZED MANAGEMENT. CLINICAL CASE OF SPONTANEOUS DISSECTION IN TWO CORONARY ARTERIESАрефьев М. Н.ArefievM. N.

зав. отделением кардиореанимации,

Москва

Moscow

Клыков Л. Л.KlykovL. L.

к.м.н., зав. отделением рентген-хирургических методов лечения,

Москва

Moscow

Крылов В. В.KrylovV. V.

к.м.н., врач отделения рентген-хирургических методов лечения,

Москва

Moscow

РусинаВ. А.RusinaV. A.

к.м.н., врач функциональной диагностики,

Москва

Moscow

ТаратухинЕвгений ОлеговичTaratukhinE. O.

к.м.н., магистр психологии, доцент кафедры госпитальной терапии № 1 лечебного факультета,

Москва

Moscow

cardio03@list.ruГБУЗ “Городская клиническая больница №15 им. О.М. Филатова” ДЗМSBHI City Clinical Hospital № 15 n.a. O.M. FilatovФГБОУ ВО “Российский национальный исследовательский медицинский университет им. Н.И. Пирогова” Минздрава РоссииN. I. Pirogov Russian National Research Medical University (RNRMU)2017200820171648892Copyright © Арефьев  М.Н., Клыков  Л.Л., Крылов  В.В., Русина В.А., Таратухин Е.О., 20172017Арефьев  М.Н., Клыков  Л.Л., Крылов  В.В., Русина В.А., Таратухин Е.О.Arefiev M.N., Klykov L.L., Krylov V.V., Rusina V.A., Taratukhin E.O.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/627

Статья посвящена проблеме соотношения доказательных данных и индивидуального подхода к пациенту в частности, притом, что пациент находится на периферии статистических разбросов. Приводятся данные современной литературы о возможностях индивидуализации подхода к больным. Описан клинический при- мер молодой пациентки с рецидивирующими спонтанными диссек- циями коронарных артерий и развитием инфаркта миокарда. 

The article is focused on the problem of evidence-based and individual approach relations in patient management, especially if a patient is on the periphery of statistical ranges. Recent literary data analyzed, on the opportunities for management individualization. Clinical case is provided of young female patient with spontaneous dissections of coronary arteries and myocardial infarction development.

дизайн “n равное 1”спонтанная диссекциястент с лекарственным покрытиемголометаллический стентреканализацияпациент-центрированная медицинаперсонифицированная медицинаthe n-of-1 studyspontaneous dissectiondrug eluting stentbare metallic stentrecanalizationpatient-centered medicinepersonified medicineReferencesTaratukhin ЕО. Patient’s personality: an interdisciplinary approach to cardiovascular pathology. Russ J Cardiol 2014; 113 (9): 22-5. DOI: 10.15829/1560-4071-2014-9-22-25 (Russian: Таратухин Е.О. Личность больного: междисциплинарный подход в работе с кардиологической патологией. Российский кардиологический журнал 2014; 113 (9): 22-5).Taratukhin ЕО. Patient’s personality: an interdisciplinary approach to cardiovascular pathology. Russ J Cardiol 2014; 113 (9): 22-5. DOI: 10.15829/1560-4071-2014-9-22-25 (Russian: Таратухин Е.О. Личность больного: междисциплинарный подход в работе с кардиологической патологией. Российский кардиологический журнал 2014; 113 (9): 22-5).Jorgensen JT. New era of personalized medicine: a 10-year anniversary. Oncologist 2009; 14 (5): 557-8. http://dx.doi.org/10.1634/theoncologist.2009-0047.Jorgensen JT. New era of personalized medicine: a 10-year anniversary. Oncologist 2009; 14 (5): 557-8. http://dx.doi.org/10.1634/theoncologist.2009-0047.Langreth R, Waldholz M. New era of personalized medicine: targeting drugs for each unique genetic profile. The Oncologist 1999; 5 (4): 426-7.Langreth R, Waldholz M. New era of personalized medicine: targeting drugs for each unique genetic profile. The Oncologist 1999; 5 (4): 426-7.Guyatt GH, Sackett D, Taylor DW, et al. Determining optimal therapy: randomized trials in individual patients. NEJM 1986; 314889-92.Guyatt GH, Sackett D, Taylor DW, et al. Determining optimal therapy: randomized trials in individual patients. NEJM 1986; 314889-92.Sedgwick P. What is an n-of-1 trial? BMJ 2014; 348g2674 http://dx.doi.org/ 10.1136/bmj.g2674.Sedgwick P. What is an n-of-1 trial? BMJ 2014; 348g2674 http://dx.doi.org/ 10.1136/bmj.g2674.Xie Tailiang, Yu Zhuoxin. N-of-1 Design and Its Applications to Personalized Treatment Studies. Statistics in Biosciences 2016; 1-14. — 10.1007/s12561-016-9165-9.Xie Tailiang, Yu Zhuoxin. N-of-1 Design and Its Applications to Personalized Treatment Studies. Statistics in Biosciences 2016; 1-14. — 10.1007/s12561-016-9165-9.Schork NJ. Personalized medicine: Time for one-person trials. Nature 2015; 520609-11.Schork NJ. Personalized medicine: Time for one-person trials. Nature 2015; 520609-11.Vohra S, Shamseer L, Sampson M, et al. CONSORT extension for reporting N-of-1 trials (CENT) 2015 Statement. BMJ 2015; 350h1738 http://dx.doi.org/10.1136/bmj.h1738.Vohra S, Shamseer L, Sampson M, et al. CONSORT extension for reporting N-of-1 trials (CENT) 2015 Statement. BMJ 2015; 350h1738 http://dx.doi.org/10.1136/bmj.h1738.Ebrahim S, Davey G. Statins for people at low risk. N-of-1 approach to determine when adverse effects are caused by statins. Bmj-British Medical Journal 2015; 351http://dx.doi.org/10.1136/bmj.h5281.Ebrahim S, Davey G. Statins for people at low risk. N-of-1 approach to determine when adverse effects are caused by statins. Bmj-British Medical Journal 2015; 351http://dx.doi.org/10.1136/bmj.h5281.Joy TR, Monjed A, Zou GJ. N-of-1 (Single-Patient) Trials for Statin-Related Myalgia. Ann Intern Med 2014; 160301-10.Joy TR, Monjed A, Zou GJ. N-of-1 (Single-Patient) Trials for Statin-Related Myalgia. Ann Intern Med 2014; 160301-10.Nurmi Johanna, Knittle Keegan, Helf Christopher, et al. A Personalised, SensorBasedSmart Phone Intervention for Physical Activity and Diet ? PRECIOUS N-of-1 Trial. Frontiers in public health 2016; http://dx.doi.org/10.3389/conf.FPUBH.2016.01.00098.Nurmi Johanna, Knittle Keegan, Helf Christopher, et al. A Personalised, SensorBasedSmart Phone Intervention for Physical Activity and Diet ? PRECIOUS N-of-1 Trial. Frontiers in public health 2016; http://dx.doi.org/10.3389/conf.FPUBH.2016.01.00098.Nyman SR, Goodwin K, Kwasnicka D, et al. Increasing walking among older people: A test of behaviour change techniques using factorial randomised N-of-1 trials. Psychol Health 2016; 31 (3): 313-30 http://dx.doi.org/ 10.1080/08870446.2015.1088014.Nyman SR, Goodwin K, Kwasnicka D, et al. Increasing walking among older people: A test of behaviour change techniques using factorial randomised N-of-1 trials. Psychol Health 2016; 31 (3): 313-30 http://dx.doi.org/ 10.1080/08870446.2015.1088014.Davidson KW, Alcantara C, Diaz K, et al. Observational N-of-1 studies of health behaviors: can this advance the science of behavior change? International J Behavioral Medicine 2016; 23S-38.Davidson KW, Alcantara C, Diaz K, et al. Observational N-of-1 studies of health behaviors: can this advance the science of behavior change? International J Behavioral Medicine 2016; 23S-38.McDonald S, Quinn F, Vieira R, et al. N-of-1 methods in health behavior research: a systematic review. International J Behavioral Medicine 2016; 23S236-S.McDonald S, Quinn F, Vieira R, et al. N-of-1 methods in health behavior research: a systematic review. International J Behavioral Medicine 2016; 23S236-S.Byard RW, Gilbert JD, Langlois NEI. Spontaneous coronary artery dissection. Forensic Sci Med Pathol 2017; 13 (2): 248-51 http://dx.doi.org/ 10.1007/s12024-017-9845-x.Byard RW, Gilbert JD, Langlois NEI. Spontaneous coronary artery dissection. Forensic Sci Med Pathol 2017; 13 (2): 248-51 http://dx.doi.org/ 10.1007/s12024-017-9845-x.Garcia M, Mulvagh SL, Merz CNB, et al. Cardiovascular Disease in Women: Clinical Perspectives. Circulation Research 2016; 118(8):1273-93 — 10.1161/circresaha.116.307547.Garcia M, Mulvagh SL, Merz CNB, et al. Cardiovascular Disease in Women: Clinical Perspectives. Circulation Research 2016; 118(8):1273-93 — 10.1161/circresaha.116.307547.Saw J, Mancini GBJ, Humphries KH. Contemporary Review on Spontaneous Coronary Artery Dissection. JACC 2016; 68(3):297-312 — 10.1016/j.jacc.2016.05.034.Saw J, Mancini GBJ, Humphries KH. Contemporary Review on Spontaneous Coronary Artery Dissection. JACC 2016; 68(3):297-312 — 10.1016/j.jacc.2016.05.034.

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