cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2026.4.n3085cardio-3085Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESЧто отличает пациентов с острым коронарным синдромом при наличии аортального стеноза?The Distinguishing Characteristics of Patients With Acute Coronary Syndrome and Aortic Stenosishttps://orcid.org/0000-0003-4918-3795КонстантиноваЕ. В.KonstantinovaE. V.

д.м.н., доцент кафедры факультетской терапии имени акад. А.И. Нестерова лечебного факультета, профессор кафедры интервенционной кардиологии и кардиореабилитации РНИМУ им. Н.И. Пирогова; врач-кардиолог ГКБ № 1 им. Н.И. Пирогова

Москва, Россия

 

MD, PhD, Associate Professor, Chair of Faculty Therapy named after Acad. A.I. Nesterov; Professor, Chair of Interventional Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University; cardiologist, N.I. Pirogov City Clinical Hospital №1,

Moscow, Russia

katekons@mail.ruhttps://orcid.org/0009-0000-0492-9878ЧерниковА. О.ChernikovA. O.

старший лаборант кафедры интервенционной кардиологии и кардиореабилитации РНИМУ им. Н.И. Пирогова; врач-кардиолог ГКБ № 1 им. Н.И. Пирогова

SPIN-код: 4924-6008

Москва, Россия

 Senior laboratory assistant, Chair of Interventional Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University; cardiologist, N.I. Pirogov City Clinical Hospital №1,

Moscow, Russia

chernikovtema@mail.ruhttps://orcid.org/0009-0009-5664-8766РахимиН. А.RakhimiN. A.

аспирант кафедры интервенционной кардиологии и кардиореабилитации РНИМУ им. Н.И. Пирогова

Москва, Россия

Graduate student, Chair of Interventional Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University

Moscow, Russia

rahimi.2024@mail.ruhttps://orcid.org/0009-0006-3655-1586ВеликоцкийА. А.VelikotskiyA. A.

врач-рентгенхирург ГКБ № 1 им. Н.И. Пирогова

Москва, Россия

Surgeon, Department of Interventional Radiology, City Clinical Hospital №1 named after N.I. Pirogov

Moscow, Russia

vel_aa@mail.ruhttps://orcid.org/0009-0007-4694-6140ПлощенковЕ. В.PloshchenkovE. V.

заведующий отделением рентгенхирургических методов диагностики и лечения ГКБ № 1 им. Н.И. Пирогова

Москва, Россия

Head of Department of Interventional Radiology, City Clinical Hospital №1 named after N.I. Pirogov

Moscow, Russia

Jenya-09@inbox.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава РФ (Пироговский университет); ГБУЗ «Городская клиническая больница № 1 им. Н. И. Пирогова Департамента здравоохранения города Москвы»РоссияPirogov Russian National Research Medical University (Pirogov University); N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare DepartmentRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава РФ (Пироговский университет)РоссияPirogov Russian National Research Medical University (Pirogov University)Russian FederationГБУЗ «Городская клиническая больница № 1 им. Н. И. Пирогова Департамента здравоохранения города Москвы»РоссияN.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare DepartmentRussian Federation2026040620266645865Copyright © Kardiomag, 20262026KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/3085

Цель    Оценка распространенности аортального стеноза (АС) среди пациентов с острым коронарным синдромом (ОКС) в клинической практике и клинико-инструментальное сопоставление пациентов в зависимости от наличия у них данного порока сердца.Материал и методы    В исследование включены 1447 пациентов (средний возраст 66,8±12,8 года) с ОКС (нестабильная стенокардия, инфаркт миокарда с подъемом сегмента ST – ИМпST, инфаркт миокарда без подъема сегмента ST – ИМбпST), последовательно госпитализированные в ГКБ № 1 им. Н. И. Пирогова с 01.01.2022 по 31.12.2023. В зависимости от наличия АС пациенты были разделены на две группы: 1 я группа – 61 пациент с ОКС и АС, 2 я – 1386 с ОКС без АС. Проводилась сравнительная оценка клинико-демографических характеристик пациентов, анализ результатов лабораторного и инструментального обследования. Статистическая обработка полученных данных проводилась в программе Jamovi 2.3.28. Cтатистически значимыми считались различия при p<0,05.Результаты    АС встречался у 4,2 % пациентов с ОКС: у пациентов с ИМпST – в 2,5 % случаев, у пациентов с ОКС без подъема сегмента ST (ОКСбпST) – в 6,9 % (p<0,001). У пациентов с ОКС моложе 60 лет АС встречался в 0,8 % случаев, у пациентов с ОКС в возрасте от 60 до 74 лет – в 3,7 %, у пациентов в возрасте 75 лет и старше – в 8,5 % (p<0,001). У пациентов 1 й группы по сравнению с пациентами 2 й группы чаще встречалась хроническая болезнь почек (ХБП) стадии С3 – С5 – в 26,2 и 11 % случаев соответственно (p<0,001), анемия – в 45,9 и 24,5 % (p<0,001), фибрилляция предсердий (ФП) – в 36,1 и 17,5 % (p<0,001), ранее перенесенный инфаркт миокарда (ИМ) – в 29,5 и 17 % случаев соответственно (p=0,012), острая левожелудочковая недостаточность II–III класса по Killip – у 34,4 и 10,5 % пациентов (p<0,001). При анализе ангиографических данных у пациентов 1 й группы по сравнению с пациентами 2 й группы поражение правой коронарной артерии (ПКА) наблюдалось в 70 и 50,9 % случаев соответственно (p=0,006), передней межжелудочковой артерии – в 48,3 и 61,4 % случаев (p=0,031). Частота летального исхода в стационаре не различалась и составила у пациентов 1 й группы – 14,8 %, 2 й группы – 9,4 % (p=0,148).Заключение    АС встречается у 4,2 % пациентов с ОКС, при этом у пациентов с ОКСбпST чаще, чем при ИМпST. Наличие АС у пациентов с ОКС ассоциировано с более высокой распространенностью ХБП, анемии, ФП, ранее перенесенным ИМ, ОЛЖН II–III класса по Killip и ассоциировано со статистически значимо более частым поражением ПКА.

 

Aim    To evaluate the prevalence of aortic stenosis (AS) among patients with acute coronary syndrome (ACS) in clinical practice and to compare the clinical and instrumental characteristics of patients based on the presence of this valvular heart disease.Material and methods    The study included 1,447 patients (mean age 66.8±12.8 years) with ACS (unstable angina, ST-elevation myocardial infarction [STEMI], or non-ST-elevation myocardial infarction [NSTEMI]) consecutively hospitalized at the N.I. Pirogov City Clinical Hospital No. 1 between January 1, 2022, and December 31, 2023. Based on the presence of AS, patients were divided into two groups: Group 1 comprised 61 patients with ACS and AS, and Group 2 comprised 1,386 patients with ACS without AS. A comparative evaluation of clinical and demographic characteristics was performed, alongside an analysis of laboratory and instrumental examination findings. Statistical analysis was conducted using Jamovi 2.3.28 software. Differences were considered statistically significant at p<0.05.Results    AS was prevalent in 4.2% of patients with ACS, occurring in 2.5% of STEMI cases and 6.9% of non-ST-elevation ACS (NSTE-ACS) cases (p<0.001). Among ACS patients aged under 60 years, AS was observed in 0.8% of cases; it was present in 3.7% of patients aged 60-74 years, and in 8.5% of those aged 75 years and older (p<0.001). Compared to Group 2, Group 1 patients had a significantly higher prevalence of stage G3-G5 chronic kidney disease (CKD) (26.2% vs. 11.0%, p<0.001), anemia (45.9% vs. 24.5%, p<0.001), atrial fibrillation (AF) (36.1% vs. 17.5%, p<0.001), prior myocardial infarction (MI) (29.5% vs. 17.0%, p=0.012), and Killip class II–III acute left ventricular heart failure (34.4% vs. 10.5%, p<0.001). Angiographic analysis revealed that right coronary artery (RCA) involvement was more frequent in Group 1 than in Group 2 (70.0% vs. 50.9%, p=0.006), whereas left anterior descending (LAD) artery involvement was less frequent (48.3% vs. 61.4%, p=0.031). In-hospital mortality rates did not differ between the groups: 14.8% in Group 1 and 9.4% in Group 2 (p=0.148).Conclusion    AS is prevalent in 4.2% of patients with ACS, occurring more frequently in those with NSTE-ACS than with STEMI. The presence of AS in ACS patients is associated with a higher prevalence of CKD, anemia, AF, prior MI, and Killip class II–III acute left ventricular heart failure, as well as a statistically significant increase in RCA involvement.

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