cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2547cardio-264Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESКлинико-демографические особенности пациентов с инсультами и сопутствующей фибрилляцией предсердийClinical and demographic features of patients with stroke and atrial fibrillationАкпановаД. М.AkpanovaD. M.noemail@neicon.ruБеркинбаевС. Ф.BerkinbayevS. F.noemail@neicon.ruМусагалиеваА. Т.MussagaliyevaA. T.noemail@neicon.ruОспановаД. А.OspanovaD. A.noemail@neicon.ruЖусуповБ. С.ZhussupovB. S.noemail@neicon.ruНаучно-исследовательский институт кардиологии и внутренних болезней МЗРКРоссияScientific Research Institute of Cardiology and Internal diseasesRussian FederationКазахский медицинский университет непрерывного образованияРоссияKazakh Medical University of Continuing EducationRussian FederationРГП «КазНМУ им. С. Д. Асфендиярова»РоссияKazakh National Medical University named after S. D. AsfendiyarovRussian Federation201818112018589S4857Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/264

Актуальность. Инсульт занимает 2-е место среди всех причин кардиоваскулярной смертности и 1-е место по смертности и инвалидизации среди других заболеваний нервной системы. В настоящее время фибрилляция предсердий (ФП) является общепризнанным независимым ФР развития ишемического инсульта, она увеличивает риск неблагоприятного исхода в 5 раз. Профилактика инсульта на сегодняшний день является сложной медико-социальной задачей. Цель. Изучение распространенности ФП среди пациентов с инсультом/транзиторной ишемической атакой (ТИА) и проводимой антикоагулянтной терапии до госпитализации. Материалы и методы. Проведен ретроспективный анализ историй болезни пациентов с диагнозом острое нарушение мозгового кровообращения и ТИА, получавших лечение в период с января 2013 г. по декабрь 2015 г. (n=7921). Из них было отобрано 849 историй болезни пациентов с сопутствующим диагнозом ФП. Результаты. Частота ФП у пациентов с инсультом/ТИА составила 10,72%. При оценке риска по шкале CHA2DS2-VASc доля пациентов низкого риска (0 баллов) составила 0,8%, промежуточного риска (1 балл) - 5,3%, высокого риска (≥2 баллов) - 93,8%; профилактику тромбоэмболических осложнений получали 4,7% пациентов с ФП. Летальность пациентов с ФП и инсультом/ТИА составила 15,78%, тогда как у пациентов без ФП госпитальная летальность составила 7,01 %. Таким образом, ФП является статистически значимым ФР госпитальной летальности среди пациентов с инсультом/ТИА (отношение шансов 2,485; 95% доверительный интервал 2,023-3,053; p<0,001;). Обнаружено влияние на внутригоспитальную летальность пациентов с ишемическим инсультом и сопутствующей ФП таких факторов, как тяжелая ХСН, СД 2 типа, периферические тромбозы, чрескожное коронарное вмешательство в анамнезе, онкологические заболевания, снижение скорости клубочковой фильтрации. Заключение. Отмечены влияние ФП на госпитальную летальность пациентов с ишемическим инсультом и низкий охват профилактической антикоагулянтной терапией пациентов с ФП.

Background. Stroke takes the second place among all causes for cardiovascular death and the first place in mortality and disability among other nervous system diseases. Atrial fibrillation (AF) is presently is a commonly recognized, independent risk factor for ischemic stroke, which fivefold increases the risk of an unfavorable outcome. Prevention of stroke is a complicated medical and social challenge. Aim. To study AF prevalence among patients with stroke/ transient ischemic attack (TIA) who had received an anticoagulant therapy before hospitalization. Materials and methods. A retrospective analysis of case reports was performed for patients diagnosed with acute cerebrovascular disease and TIA who had received a therapy from January, 2013 through December, 2015 (n=7921). From these case reports, 849 case reports of patients with concurrent AF were selected. Results. In patients with stroke/TIA, the AF incidence was 10.72%. Risk assessment using the CHA2DS2-VASc scale showed that the percentage of low-risk patients (score 0) was 0.8%, intermediate risk patients (score 1) - 5.3%, and high-risk patients (score ≥2) - 93.8%; 4.7% of patients with AF received preven tive therapy for thromboembolic complications. The death rate of patients with AF and stroke/TIA was 15.78% whereas in-hospital death rate of patients without AF was 7.01%. Therefore, AF is a statistically significant risk factor of in-hospital mortality for patients with stroke/TIA (OR=2.485, 95% CI: 2.023-3.053, p<0.001,). The following factors influenced the in-hospital mortality of patients with ischemic stroke and concurrent AF: severe CHF, type 2 diabetes mellitus, peripheral thrombosis, history of a transcutaneous coronary intervention, oncological disease, and impaired glomerular filtration rate. Conclusion. The study demonstrated an effect of AF on in-hospital mortality of patients with ischemic stroke and a low rate of preventive anticoagulant therapy in patients with AF.

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