cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2015-30-2-87-96cardiotomsk-174Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУTIPS TO HELP A PRACTICAL DOCTORПрофилактика острого повреждения миокарда при плановых эндоваскулярных вмешательствах на коронарных артерияхPrevention of acute myocardial damage in elective percutaneous coronary interventionsВершининаЕлена ОлеговнаVershininaE. O.oliver@cardio.tsu.ruСальниковаЕлена СергеевнаSalnikovaE. S.elena.salnikova.mp@mail.ruРепинАлексей НиколаевичRepinA. N.ran_12@mail.ruФедеральное государственное бюджетное научное учреждение "Научно-исследовательский институт кардиологии"РоссияFederal State Budgetary Scientific Institution "Research Institute for Cardiology"Russian Federation2015060920163028796Copyright © Вершинина Е.О., Сальникова Е.С., Репин А.Н., 20162016Вершинина Е.О., Сальникова Е.С., Репин А.Н.Vershinina E.O., Salnikova E.S., Repin A.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/174

Данные многих исследователей свидетельствуют о том, что во время эндоваскулярных вмешательств на коронарных артериях (КА) происходит увеличение уровня сердечных биомаркеров, что свидетельствует о некрозе кардиомиоцитов. Риск последующих серьезных сердечных событий, таких как смерть, инфаркт миокарда (ИМ), связан со степенью повышения кардиоспецифических ферментов после вмешательства. Поэтому терапевтические стратегии, которые в состоянии уменьшить частоту перипроцедурного повреждения миокарда, могут положительно влиять на клинические исходы после эндоваскулярных вмешательств. Авторами показано, что применение высоких нагрузочных доз сильнодействующих статинов (аторвастатина и розувастатина) при плановом эндоваскулярном вмешательстве на КА у пациентов, уже длительно получающих стандартную липидснижающую терапию, оказывает сходное влияние на динамику сердечных биомаркеров после чрескожного коронарного вмешательства (ЧКВ). При этом применение нагрузочной дозы розувастатина имеет некоторое преимущество в связи с достоверно меньшим повышением тропонина I (TnI) и Мв фракции креатинфосфокиназы (КФК МВ) на 26,7 и 27,1% соответственно в течение первых 12 ч после процедуры. Второй раздел работы демонстрирует, что добавление триметазидина (ТМЗ) к стандартной терапии при эндоваскулярной реваскуляризации миокарда у пациентов с нарушениями углеводного обмена способствует уменьшению острого повреждения миокарда, хотя клиническое значение влияния этой защиты на отдаленные исходы заболевания еще требует изучения.

Data of many researchers suggest that the level of cardiac biomarkers indicating necrosis of cardiomyocytes increases during endovascular procedures on the coronary arteries. The risk of subsequent major cardiac events including death and myocardial infarction is associated with the degree of elevation of cardiac enzymes after surgery. Therefore, therapeutic strategies attenuating the frequency of procedural myocardial injury can have a positive impact on clinical outcomes after endovascular interventions. The authors demonstrated that the use of high loading doses of potent statins (atorvastatin and rosuvastatin) with a planned endovascular coronary intervention in patients who already receive standard lipidlowering therapy long-term, has a similar effect on the dynamics of cardiac biomarkers after PCI. At the same time, administration of a loading dose of rosuvastatin has an advantage due to a significantly smaller increase in the levels of creatine kinase-MB and TnI (26.7% and 27.1%, respectively) during the first 12 hours after the procedure. The second part of the work demonstrates that the addition of trimetazidine to standard therapy in endovascular revascularization in patients with impaired glucose metabolism reduces acute myocardial damage, although the clinical significance of the effect of that protection on remote patient outcomes requires more studies.

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