medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-448medsovet-9516Research ArticleОСТРЫЙ КОРОНАРНЫЙ СИНДРОММетод кардиопротекции при чрескожном коронарном вмешательстве у пациентов старческого возраста с острым коронарным синдромомCardioprotection method for percutaneous coronary interventions in elderly patients with acute coronary syndromehttps://orcid.org/0000-0003-4168-1853СемиголовскийН. Ю.SemigolovskiiN. Yu.

Семиголовский Никита Юрьевич, д.м.н., профессор, профессор кафедры пропедевтики внутренних болезней, Медицинский институт; старший научныйсотрудник

194017, Россия, Санкт-Петербург, пр. Тореза, д. 72 

199034, Россия, Санкт-Петербург, Университетская наб., д. 7/9

Nikita Yu. Semigolovskii, Dr. Sci. (Med.), Professor, Professor of the Department of Internal Diseases Propedeutics; Senior Researcher

72, Torez Ave., St Petersburg, 194017, Russia

7–9, Universitetskaya Emb., St Petersburg, 199034, Russia

semigolovski@yandex.ruhttps://orcid.org/0000-0001-8896-0126СеменоваИ. Г.SemenovaI. G.

Семенова Ирина Германовна, к.м.н., заведующая кардиологическим отделением

194017, Россия, Санкт-Петербург, пр. Тореза, д. 72 

Irina G. Semenova, Cand. Sci. (Med.), Head of the Cardiology Department

72, Torez Ave., St Petersburg, 194017, Russia

ira2@list.ruhttps://orcid.org/0000-0002-1945-4243КозаевА. В.KozaevA. V.

Козаев Андрей Викентиевич, рентгенангиохирург, заведующий отделением эндоваскулярной хирургии

194017, Россия, Санкт-Петербург, пр. Тореза, д. 72 

Andrey V. Kozaev, Angiosurgeon, Head of the Department of Endovascular Surgery

72, Torez Ave., St Petersburg, 194017, Russia

andrei_kozaev@mail.ruhttps://orcid.org/0000-0002-0846-3814ГуслевА. Б.GuslevA. B.

Гуслев Александр Борисович, к.м.н., заместитель главного врача по науке; доцент кафедры факультетской хирургии, Медицинский институт 

194017, Россия, Санкт-Петербург, пр. Тореза, д. 72 

199034, Россия, Санкт-Петербург, Университетская наб., д. 7/9

Alexandr B. Guslev, Cand. Sci. (Med.), Deputy Chief Physician for Science; Associate Professor of the Department of Faculty Surgery

72, Torez Ave., St Petersburg, 194017, Russia

7–9, Universitetskaya Emb., St Petersburg, 199034, Russia 

aguslev@mail.ruhttps://orcid.org/0000-0002-1915-2237МазуренкоС. О.MazurenkoS. O.

Мазуренко Сергей Олегович, д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней

199034, Россия, Санкт-Петербург, Университетская наб., д. 7/9

Sergey O. Mazurenko, Dr. Sci. (Med.), Professor, Head of the Department of Propaedeutic of Internal Diseases

7–9, Universitetskaya Emb., St Petersburg, 199034, Russia 

dr_mazurenko@mail.ruhttps://orcid.org/0009-0004-1948-5383БердикуловаТ. Т.BerdikulovaT. T.

Бердикулова Тахмина Таштемировна, врач-терапевт, аспирант кафедры пропедевтики внутренних болезней

199034, Россия, Санкт-Петербург, Университетская наб., д. 7/9

Takhmina T. Berdikulova, Therapist, Postgraduate Student of the Department of Propaedeutic of Internal Diseases

7–9, Universitetskaya Emb., St Petersburg, 199034, Russia 

berdikulovatahmina690@gmail.comСанкт-Петербургская клиническая больница Российской академии наук; Медицинский институт Санкт-Петербургского государственного университетаРоссияClinical Hospital of the Russian Academy of Sciences; Saint Petersburg State UniversityRussian FederationСанкт-Петербургская клиническая больница Российской академии наукРоссияClinical Hospital of the Russian Academy of SciencesRussian FederationСанкт-Петербургская клиническая больница Российской академии наук; Медицинский институт Санкт-Петербургского государственного университетаРоссияClinical Hospital of the Russian Academy of Sciences; Saint Petersburg State UniversityRussian FederationМедицинский институт Санкт-Петербургского государственного университетаРоссияSaint Petersburg State UniversityRussian Federation2025201120250166168Copyright © Семиголовский Н.Ю., Семенова И.Г., Козаев А.В., Гуслев А.Б., Мазуренко С.О., Бердикулова Т.Т., 20252025Семиголовский Н.Ю., Семенова И.Г., Козаев А.В., Гуслев А.Б., Мазуренко С.О., Бердикулова Т.Т.Semigolovskii N.Y., Semenova I.G., Kozaev A.V., Guslev A.B., Mazurenko S.O., Berdikulova T.T.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/9516

Введение. Острый коронарный синдром (ОКС) – основная причина смерти возрастных пациентов, хуже переносящих чрескожные коронарные вмешательства (ЧКВ), и новые методики кардиопротекции крайне востребованы.Цель. Изучить эффективность применения левокарнитина для предотвращения осложнений в ходе ЧКВ при ОКС у пациентов старческого возраста.Материалы и методы. 80 больных ОКС были рандомизированы на две группы по 40 человек: основная – средний возраст 78 лет (75, 93), получившие внутрикоронарно 1,0 г левокарнитина с последующей внутривенной инфузией по 2,0 г/сут в течение 3 дней; контрольная –средний возраст 77 лет (75, 91), введение плацебо. ЧКВ выполнялось в среднем через 3,5 ч от появления симптомов ОКС. Определяли МБ-фракцию креатинфосфокиназы (КФК-МБ) и высокочувствительного тропонина I (hsТрI), показатели ЭКГ и ЭхоКГ в динамике, течение и исходы.Результаты. Динамика уровня биомаркеров была более благоприятной в основной группе, где отмечен меньший прирост hsТрI на 1-е сут. после ЧКВ и ускоренное снижение на 3-и. КФК-МБ на 3-и сут. в основной группе была достоверно ниже контрольного уровня (р < 0,001). Исходно достоверно более низкая средняя фракция выброса левого желудочка в основной группе (р < 0,023) на 3-и сут. достоверно превысила контрольный уровень (р < 0,001). Отмечены более быстрая положительная динамика ЭКГ и тенденция к снижению частоты аритмических эпизодов в основной группе по сравнению с контрольной. Госпитальная летальность в основной группе отсутствовала, в контрольной она составила 10,0%. Выводы. Описанная методика адъювантной кардиопротекции при ЧКВ представляется доступным, эффективным и безопасным дополнением стандартного обеспечения реперфузии у больных старческого возраста с ОКС.

Introduction. Acute coronary syndrome (ACS) is the main cause of death in elderly patients who suffer worse from percutaneous coronary interventions (PCI), and new cardioprotection techniques are in high demand.Aim. To study the efficacy of levocarnitine in preventing complications due to PCI in elderly patients with acute coronary syndrome.Materials and methods. 80 ACS patients were randomized into 2 groups of 40 people: the main group was the average age of 78 (75, 93), received 1.0 g of levocarnitine intracoronary, followed by an intravenous infusion of 2.0 g/day for 3 days; and the control group of age 77 (75, 91) received placebo administration. PCI was performed an average of 3.5 hours after the onset of ACS symptoms. The MB fraction of creatine phosphokinase (CPK-MV) and highly sensitive troponin I (hsTrI), ECG and EchoCG parameters in dynamics, course and outcomes were determined.Results. The dynamics of biomarker levels was more favorable in the main group, where there was a smaller increase in hsTrI at 1 day after PCI and an accelerated decrease at 3 day after PCI. CPK-MB on day 3 in the main group was significantly lower than the control level (p < 0.001). The significantly lower average left ventricular ejection fraction in the main group initially (p < 0.023) significantly exceeded the control level on day 3 after PCI (p < 0.001). There was a faster positive dynamics of the ECG and a tendency to decrease the frequency of arrhythmic episodes in the main group compared with the control group. There was no hospital mortality in the main group, and it was 10.0% in the control group.Conclusions. The described technique of adjuvant cardioprotection in PCI appears to be an available, effective and safe addition to the standard provision of reperfusion in elderly patients with ACS.

ИБСострый инфаркт миокардаадъювантная кардиопротекциялевокарнитининтракоронарное введениеcoronary artery diseaseacute myocardial infarctionadjuvant cardioprotectionlevocarnitineintracoronary administrationИсследование проводилось в рамках Государственного задания 075-01609-23-04 «Адъювантная цитопротекция левокарнитином методом интракоронарного введения при реваскуляризации у больных с острым и хроническим коронарным синдромом».The study was conducted as part of Government Assignment 075-01609-23-04 Adjuvant cytoprotective effect of intracoronary levocarnitine during revascularization in patients with acute and chronic coronary syndrome.ReferencesAl Suwaidi J, Holmes DR Jr, Salam AM, Lennon R, Berger PB. Impact of coronary artery stents on mortality and nonfatal myocardial infarction: metaanalysis of randomized trials comparing a strategy of routine stenting with that of balloon angioplasty. 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The authors declare that there are no conflicts of interest present.