kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2024-13-3S-120-135kpccz-1496Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОР. КардиологияREVIEW. CardiologyПРОБЛЕМЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ОСТРОГО КОРОНАРНОГО СИНДРОМА У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕКPROBLEMS OF DIAGNOSIS AND TREATMENT OF ACUTE CORONARY SYNDROME IN PATIENTS WITH CHRONIC KIDNEY DISEASEhttps://orcid.org/0009-0006-9179-955XЖивцоваНаталья ЮрьевнаZhivtsovaNatalia Yu.

врач приемного отделения государственного бюджетного учреждения Ростовской области «Городская больница № 4» в г. Ростове-на-Дону, Ростов-на-Дону

Emergency Physician at the Emergency Department, State Budgetary Institution of the Rostov Region City Hospital No. 4, Rostov-on-Don, Russian Federation

lolemost@ro.ruhttps://orcid.org/0009-0004-6597-310XБрежневаЕлизавета МихайловнаBrezhnevaElizaveta M.

студент федерального государственного бюджетного образовательного учреждения высшего образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации, Волгоград, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “Volgograd State Medical University” of the Ministry of Health of the Russian Federation, Volgograd, Russian Federation

https://orcid.org/0009-0005-7117-415XЛысенкоАлександра АндреевнаLysenkoAlexandra A.

студент федерального государственного бюджетного образовательного учреждения высшего образования «Ростовский государственный медицинский университет» Министерства здравоохранения Российской Федерации, Ростов-на-Дону, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “Rostov State Medical University” of the Ministry of Health of the Russian Federation, Rostov-on-Don, Russian Federation

https://orcid.org/0009-0001-7333-8091МустафинаГульназ РадиковнаMustafinaGulnaz R.

студент федеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской Федерации, Уфа Республика Башкортостан, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of the Russian Federation, Ufa, Republic of Bashkortostan, Russian Federation

https://orcid.org/0009-0009-1545-7330СабитовДинис МаратовичSabitovDinis M.

ординатор кафедры госпитальной терапии №2 федеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской Федерации, Уфа Республика Башкортостан, Российская Федерация

Resident at the Advanced Therapy Faculty, Federal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of the Russian Federation, Ufa, Republic of Bashkortostan, Russian Federation

https://orcid.org/0009-0004-7276-3864ГаллямоваЭльвира РифовнаGallyamovaElvira R.

студент федеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской Федерации, Уфа Республика Башкортостан, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of the Russian Federation, Ufa, Republic of Bashkortostan, Russian Federation

https://orcid.org/0009-0008-1767-7786ГерманАнастасия ВладиславовнаGermanAnastasia V.

студент федерального государственного бюджетного образовательного учреждения высшего образования «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарёва», Ковылкино, Республика Мордовия, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “National Research Mordovian State University named after N.P. Ogarev”, Kovylkino, Republic of Mordovia, Russian Federation

https://orcid.org/0009-0002-6109-9668РодионовИлья АндреевичRodionovIlya A.

студент федерального государственного бюджетного образовательного учреждения высшего образования «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарёва», Ковылкино, Республика Мордовия, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “National Research Mordovian State University named after N.P. Ogarev”, Kovylkino, Republic of Mordovia, Russian Federation

https://orcid.org/0009-0000-6059-5075КриулькинВладислав АлександровичKriulkinVladislav A.

студент федерального государственного бюджетного образовательного учреждения высшего образования «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарёва», Ковылкино, Республика Мордовия, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “National Research Mordovian State University named after N.P. Ogarev”, Kovylkino, Republic of Mordovia, Russian Federation

https://orcid.org/0009-0007-7550-0762СабриСофьяSabriSofia

студент федерального государственного бюджетного образовательного учреждения высшего образования «Северо-Западный государственный медицинский университет имени И.И.Мечникова» Министерства здравоохранения Российской Федерации, Санкт-Петербург, Российская Федерация

Student at the Federal State Budgetary Educational Institution of Higher Education “North-West State Medical University named after I.I. Mechnikov” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

https://orcid.org/0009-0008-9326-5994ИбрагимоваПарвина РустамовнаIbragimovaParvina R.

студент федерального государственного автономного образовательного учреждения высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

Student at the Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

https://orcid.org/0009-0005-0882-8894АведикянЭльвира КареновнаAvedikyanElvira K.

студент федерального государственного автономного образовательного учреждения высшего образования «Крымский федеральный университет имени В. И. Вернадского», Симферополь, Республика Крым, Российская Федерация

Student at the Federal State Autonomous Educational Institution of Higher Education “V. I. Vernadsky Crimean Federal University, Simferopol, Republic of Crimea, Russian Federation

Государственное бюджетное учреждение Ростовской области «Городская больница № 4» в г. Ростове-на-ДонуРоссияState Budgetary Institution of the Rostov Region City Hospital No. 4Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education “Volgograd State Medical University” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Ростовский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education “Rostov State Medical University” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education “Bashkir State Medical University” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарёва»РоссияFederal State Budgetary Educational Institution of Higher Education “National Research Mordovian State University named after N.P. Ogarev”Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Северо-Западный государственный медицинский университет имени И.И.Мечникова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Higher Education “North-West State Medical University named after I.I. Mechnikov” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Крымский федеральный университет имени В. И. Вернадского»РоссияFederal State Autonomous Educational Institution of Higher Education “V. I. Vernadsky Crimean Federal University”Russian Federation202401112024133Sприложение120135Copyright © Живцова Н.Ю., Брежнева Е.М., Лысенко А.А., Мустафина Г.Р., Сабитов Д.М., Галлямова Э.Р., Герман А.В., Родионов И.А., Криулькин В.А., Сабри С., Ибрагимова П.Р., Аведикян Э.К., 20242024Живцова Н.Ю., Брежнева Е.М., Лысенко А.А., Мустафина Г.Р., Сабитов Д.М., Галлямова Э.Р., Герман А.В., Родионов И.А., Криулькин В.А., Сабри С., Ибрагимова П.Р., Аведикян Э.К.Zhivtsova N.Y., Brezhneva E.M., Lysenko A.A., Mustafina G.R., Sabitov D.M., Gallyamova E.R., German A.V., Rodionov I.A., Kriulkin V.A., Sabri S., Ibragimova P.R., Avedikyan E.K.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1496Основные положения

Основные положения

В современной литературе алгоритмы ведения пациентов с хронической болезнью почек при остром коронарном синдроме освещены недостаточно. Тем не менее примерно каждый третий больной острым коронарным синдромом имеет хроническую болезнь почек. На сегодняшний день возрастает частота использования лучевого артериального доступа и внутрисосудистой визуализации у данной группы пациентов в клинической практике, что значительно улучшает исходы. При этом сохраняется большое количество пробелов в знаниях: так, необходимо проведение специализированных исследований среди стадий хронической болезни почек не только с учетом расчетной скорости клубочковой фильтрации, но и тяжести альбуминурии.

 

 

Резюме

Резюме

Количество пациентов, страдающих хронической болезнью почек (ХБП), прогрессивно растет – в половине случаев они умирают от сердечно-сосудистых заболеваний, не доживая до терминальной стадии почечной недостаточности. Пациенты с ХБП относятся к особой группе населения при рассмотрении вопроса терапии ОКС. ХБП усложняет диагностику, стратификацию риска, фармакологическую терапию, инвазивное лечение и исходы ОКС. Цель обзора – проанализировать отечественную и зарубежную литературу, посвященную ведению пациентов с ХБП, страдающих ОКС, а также предложить рекомендации для практикующих врачей и выявить современные пробелы в знаниях, требующие проведения дальнейших исследований. ОКС вносит значительный вклад в заболеваемость и смертность пациентов с ХБП, что делает крайне актуальным исследование особенностей ведения данной группы больных. Нередко пациенты и клиницисты отказываются от научно обоснованных диагностических и терапевтических методов из-за опасений по поводу ухудшения течения почечной недостаточности. Хотя преодоление этого явления частично зависит от соблюдения рекомендаций, полное решение проблемы в равной степени обусловлено правильной оценкой рисков, фармакологических и инвазивных факторов, характерных для лиц ХБП. На сегодняшний день возрастает частота использования лучевого артериального доступа и внутрисосудистой визуализации у пациентов с ОКС и ХБП в клинической практике, что значительно улучшает исходы. Тем не менее сохраняется большое количество пробелов в знаниях: в частности, необходимы специализированные исследования всех стадий ХБП не только с учетом расчетной скорости клубочковой фильтрации, но и тяжести альбуминурии. Важно отметить, что это потребует лучшей представленности пациентов с ХБП в рандомизированных исследованиях.

Highlights

Highlights

In the modern literature, the algorithms for managing patients with CKD and ACS are not fully covered. However, approximately one in three ACS patients has CKD. To date, the frequency of using radial arterial access and intravascular imaging in patients with ACS and CKD in clinical practice is increasing, which significantly improves outcomes. However, many topics related to these issues remain poorly understood, so it is necessary to conduct specialized studies among all stages of CKD, taking into account eGFR, and the severity of albuminuria.

 

 

Abstract

Abstract

The number of patients suffering from chronic kidney disease (CKD) is growing progressively, in half of the cases they die from cardiovascular diseases (CVD) before they reach the terminal stage of renal failure. Patients with CKD belong to a special group of the population when considering ACS therapy. CKD complicates diagnosis, risk stratification, pharmacological therapy, invasive treatment, and ACS outcomes. The purpose of the review is to analyze the domestic and foreign literature on the management of ACS in patients with CKD, as well as to offer practical recommendations for practitioners and identify current knowledge gaps that require further research. ACS makes a significant contribution to the morbidity and mortality of patients with CKD, which makes it extremely relevant to study the features of ACS management in this group of patients. It is not uncommon for patients and clinicians to reject scientifically based diagnostic and therapeutic methods due to concerns about worsening renal failure. Although overcoming this phenomenon partly depends on following the recommendations, a complete solution to the problem will equally depend on a proper assessment of the risks, pharmacological and invasive factors characteristic of patients with CKD. To date, the frequency of using radial arterial access and intravascular imaging in patients with ACS and CKD in clinical practice is increasing, which significantly improves outcomes. Nevertheless, a large number of knowledge gaps remain, so it is necessary to conduct specialized studies among all stages of CKD, not only taking into account eGFR, but also the severity of albuminuria. It is important to note that this will require better representation of CKD patients in randomized trials.

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