В статье изложен анализ собственного опыта работы в Региональном сосудистом центре и научного материала из периодических изданий, рекомендаций Европейского общества кардиологов, Американской Ассоциации Сердца, Российского кардиологического общества, результатов международных клинических исследований и монографий по проблеме эффективности различных технологий лечения пациентов с острым коронарным синдромом (ОКС). Авторами показана приоритетность инвазивных технологий ведения пациентов с ОКС как со стойким подъемом сегмента ST, так и без стойкого подъема сегмента ST. Указано на необходимость четкого соблюдения временных критериев при выборе той или иной тактики ведения. Подчеркнута важность рациональной фармакотерапии: двойной антитромбоцитарной, антикоагулянтной терапии, применения статинов, в-блокаторов и ингибиторов АПФ. Авторы обращают внимание на то, что, несмотря на существующие рекомендации, в России большому числу пациентов не проводятся ни ангиография, ни реваскуляризация во время госпитализации. В этих условиях необходимо наиболее тщательно оценивать риск неблагоприятных исходов острого коронарного синдрома, что позволит выбрать оптимальную стратегию лечения пациентов с ОКС с учетом особенностей российской популяции и удаленности от специализированных кардиоваскулярных центров.
The article describes the analysis of personal working experience in the Regional Vascular Centre and scientific material from periodicals, the recommendations of the European Society of Cardiology (ESC), the American Heart Association (AHA), the Russian Society of Cardiology, the results of international clinical studies and monographs on the effectiveness of various techniques in treatment of patients with acute coronary syndrome (ACS).T he authors showed the priority of invasive technologies in the treatment of ACS patients with the persistent ST-segment elevation and without the persistent ST elevation. The necessity to follow the strict compliance with the time criteria for choosing a tactics. We underline the importance of rational pharmacotherapy: dual antiplatelet, anticoagulant therapy, the use of statins, b-blockers and ACE inhibitors. The authors pay attention to the fact that in Russia, despite the recommendations, a large number of patients do not set any angiography or revascularization during their hospitalization. In these circumstances, it is necessary to assess carefully the risk of adverse outcomes of the acute coronary syndrome that will help select the optimal treatment strategy in patients with ACS according to peculiarities of the Russian population and the remoteness from specialized cardiovascular centers.
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