medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-244medsovet-9339Research ArticleКАРДИОЛОГИЯCARDIOLOGYРоль острого респираторного дистресс-синдрома в неблагоприятных исходах острого инфаркта миокарда у пациентов с SARS-CoV-2-пневмонией на фоне коморбидной патологииThe role of acute respiratory distress syndrome in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathologyhttps://orcid.org/0000-0002-4658-4975МайерМ. В.MayerM. V.

Майер Марк Витальевич, аспирант кафедры госпитальной терапии и кардиологии имени М.С. Кушаковского

195067, Санкт-Петербург, Пискаревский проспект, д. 47

Mark V. Mayer, Postgraduate Student of the Department of Hospital Therapy and Cardiology named after M.S. Kushakovsky

47, Piskarevsky Ave., St Petersburg, 195067

maier-mark@mail.ruhttps://orcid.org/0000-0002-0284-9521ТалибовФ. А.TalibovF. A.

Талибов Фаиз Альсовбятович, аспирант кафедры госпитальной терапии и кардиологии имени М.С. Кушаковского

195067, Санкт-Петербург, Пискаревский проспект, д. 47

Faiz A.Talibov, Postgraduate Student of the Department of Hospital Therapy and Cardiology named after M.S. Kushakovsky

47, Piskarevsky Ave., St Petersburg, 195067

faiz-talibov@mail.ruhttps://orcid.org/0000-0003-3819-486XМакееваТ. И.MakeevaT. I.

Макеева Татьяна Ивановна, д.м.н., профессор кафедры госпитальной терапии и кардиологии имени М.С. Кушаковского

195067, Санкт-Петербург, Пискаревский проспект, д. 47

Tatyana I. Makeeva, Dr. Sci. (Med.), Professor, Department of Hospital Therapy and Cardiology named after M.S. Kushakovsky

47, Piskarevsky Ave., St Petersburg, 195067

tatianamakeeva@gmail.comhttps://orcid.org/0000-0002-2565-3548ЗбышевскаяЕ. В.ZbyshevskayaE. V.

Збышевская Елизавета Владимировна, к.м.н., доцент кафедры госпитальной терапии и кардиологии имени М.С. Кушаковског

195067, Санкт-Петербург, Пискаревский проспект, д. 47

Elizaveta V. Zbyshevskaya, Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy and Cardiology named after M.S. Kushakovsky

47, Piskarevsky Ave., St Petersburg, 195067

zbyshev@hotmail.comhttps://orcid.org/0000-0001-9671-462XГневышевЕ. Н.GnevyshevE. N.

Гневышев Евгений Николаевич, к.м.н., заведующий неврологическим отделением

196143, Санкт-Петербург, площадь Победы, д. 2

Evgeniy N. Gnevyshev, Cand. Sci. (Med.), Head of the Neurological Department

2, Pobedy Square, St Petersburg, 196143

evg-gnevyshev@yandex.ruhttps://orcid.org/0000-0002-8435-7562ЯковлевЕ. В.YakovlevE V.

Яковлев Евгений Васильевич, д.м.н., доцент, доцент кафедры медицинской реабилитации и спортивной медицины, Санкт-Петербургский государственный педиатрический медицинский университет;  заведующий кафедрой психофизиологии, Институт прикладного психоанализа и психологии Университета при Межпарламентской ассамблее ЕврАзЭС;  врач-невролог высшей категории, заведующий неврологическим отделением, многопрофильная инновационная клиника ООО «Поток»

194100, Санкт-Петербург, ул. Литовская, 2 д.; 199226, Санкт-Петербург, Галерный проезд, д. 3; 199226, Санкт-Петербург, ул. Кораблестроителей, д. 21, корп. 1в

 

Evgeny V. Yakovlev, 3, Galerniy Proezd, St Petersburg, 199226, Russia; Dr. Sci. (Med.), Associate Professor, Associate Professor Department of Medical Rehabilitation and Sports Medicine, Saint Petersburg State Pediatric Medical University; Head of the Department of Psychophysiology of the Institute of Applied Psychoanalysis and Psychology of the University under the Interparliamentary Assembly of the EurAsEC; Neurologist of the Highest Category, Head of the Neurological Department, Multidisciplinary Innovative Clinic “Potok”

2, Lithuania St., St Petersburg, 194100; 3, Galerniy Proezd, St Petersburg, 199226; 21 Bldg. 1b, Korablestroiteley St., St Petersburg, 199226

vmeda-ev@mail.ruhttps://orcid.org/0000-0001-6284-0943БуткоД. Ю.ButkoD. Y.

Бутко Дмитрий Юрьевич, д.м.н., профессор, заведующий кафедрой медицинской реабилитации и спортивной медицины

194100, Санкт-Петербург, ул. Литовская, 2 д.

Dmitry Y. Butko, Dr. Sci. (Med.), Professor, Head of the Department of Medical Rehabilitation and Sports Medicine

; 2, Lithuania St., St Petersburg, 194100

prof.butko@mail.ruСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationОтраслевой клинико-диагностический центр «Газпрома»РоссияGazprom Branch Clinical and Diagnostic CenterRussian FederationСанкт-Петербургский государственный педиатрический медицинский университет; Институт прикладного психоанализа и психологии Университета при Межпарламентской ассамблее ЕврАзЭС; Многопрофильная инновационная клиника «Поток»РоссияSaint Petersburg State Pediatric Medical University; nstitute of Applied Psychoanalysis and Psychology of the University under the Interparliamentary Assembly of the EurAsEC; Multidisciplinary Innovative Clinic “Potok”Russian FederationСанкт-Петербургский государственный педиатрический медицинский университетРоссияSaint Petersburg State Pediatric Medical UniversityRussian Federation20251009202519131328Copyright © Майер М.В., Талибов Ф.А., Макеева Т.И., Збышевская Е.В., Гневышев Е.Н., Яковлев Е.В., Бутко Д.Ю., 20252025Майер М.В., Талибов Ф.А., Макеева Т.И., Збышевская Е.В., Гневышев Е.Н., Яковлев Е.В., Бутко Д.Ю.Mayer M.V., Talibov F.A., Makeeva T.I., Zbyshevskaya E.V., Gnevyshev E.N., Yakovlev E.V., Butko D.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9339Введение

Введение. Высокий показатель внезапной сердечной смерти у пациентов с тяжелой SARS-CoV-2-пневмонией является актуальной проблемой.

Цель

Цель. Оценить роль острого респираторного дистресс-синдрома в неблагоприятных исходах острого инфаркта миокарда у пациентов с SARS-CoV-2-пневмонией на фоне коморбидной патологии.

Материалы и методы

Материалы и методы. В когортное исследование по типу «случай – контроль» вошли пациенты (n = 83, средний возраст 72 ± 19 лет) с острым инфарктом миокарда на фоне SARS-CoV-2-пневмонии и коморбидной патологии. I группа (n = 56) – с острым респираторным дистресс-синдромом и без чрескожного коронарного вмешательства (умершие), II группа (n = 17) – без острого респираторного дистресс-синдрома и чрескожного коронарного вмешательства (выжившие), III группа (n = 10) – с острым респираторным дистресс-синдромом и чрескожным коронарным вмешательством (умершие). Всем пациентам выполнено комплексное лабораторное обследование, электрокардиография, трансторакальная эхокардиография, компьютерная томография грудной клетки, измерение сатурации и индекса оксигенации. 28 пациентам выполнена экстренная коронарография с последующей тромбэкстракцией и установкой стента в инфаркт-связанную артерию. Всего умерших пациентов 67 (из них 11 пациентов с чрескожным коронарным вмешательством). Умершим пациентам выполнено патолого-морфологическое исследование сердца.

Результаты

Результаты. Все умершие пациенты (n = 66) были с острым респираторным дистресс-синдромом и составили 79,5% от общего числа. Большинство имели острый инфаркт миокарда без подъема сегмента ST и многососудистое поражение, тогда как выжившие пациенты имели острый инфаркт миокарда с подъемом ST и однососудистое поражение. Выжившие пациенты, прошедшие успешное чрескожное коронарное вмешательство – тромбэкстракцию с последующей установкой стента в инфаркт-связанную артерию, имели более низкие показатели маркеров воспаления и гиперкоагуляции. Уровень PaO2/Fi02 ниже 234 мм рт. ст. оказался надежным предиктором неблагоприятного исхода.

Выводы

Выводы. Острый респираторный дистресс-синдром средней и тяжелой степени играет важнейшую роль в неблагоприятных исходах острого инфаркта миокарда у пациентов с SARS-CoV-2-пневмонией на фоне коморбидной патологии.

Introduction

Introduction. The high rate of sudden cardiac death in patients with severe SARS-CoV-2 pneumonia is an urgent problem. Aim. To evaluate the role of acute respiratory distress syndrome in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology.

Materials and methods

Materials and methods. The case-control cohort study included patients (n = 83, mean age 72 ± 19 years) with acute myocardial infarction on the background of SARS-CoV-2-pneumonia and comorbid pathology. Group I (n = 56) – with acute respiratory distress syndrome and without percutaneous coronary intervention (deceased), group II (n = 17) – without acute respiratory distress syndrome and percutaneous coronary intervention (survivors), group III (n = 10) – with acute respiratory distress syndrome and percutaneous coronary intervention (deceased). All patients underwent a comprehensive laboratory examination, electrocardiography, transthoracic echocardiography, computed tomography of the chest, measurement of saturation and oxygenation index. Emergency coronary angiography was performed in 28 patients, followed by thrombectomy and stent insertion into an infarct-related artery. There were a total of 67 deceased patients (11 of them patients with percutaneous coronary intervention). The deceased patients underwent a pathological and morphological examination of the heart.

Results

Results. All deceased patients (n = 66) had acute respiratory distress syndrome and accounted for 79,5% of the total number. The majority had acute non-ST segment elevation myocardial infarction and multivessel lesion, while the surviving patients had acute ST elevation myocardial infarction and single-vessel lesion. The surviving patients who underwent successful percutaneous coronary intervention (thrombextraction followed by stent insertion into an infarct–related artery) had lower markers of inflammation and hypercoagulation. The PaO2/Fi02 level is below 234 mmHg. It proved to be a reliable predictor of an unfavorable outcome. Conclusions. Moderate to severe acute respiratory distress syndrome plays an important role in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology.

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