Hospital mortality rate is considered one of the convincing criteria to assess the efficacy of the treatment for ST-elevation myocardial infarction (STEMI). Among the predictors of the mortality risk (MR), the age over 75 years is the most significant one. The aim of the study was to comparatively assess the treatment efficacy in patients with recurrent STEMI considering the hospital mortality with regard to the baseline MR and/or the age over 75 years in different timeframes in the period from 2008 to 2017. We studied 743 patients with recurrent STEMI admitted at our Institute clinic in the period from 2008 to 2017. The first group consisted of 312 patients hospitalized from 2008 to 2011; 51 of them were over 75 years old. PCI was performed in 71 and 51 cases in the first 12 and 12–72 hours, respectively. The second group included 157 patients who were admitted in the period from 2012 to 2014; 40 of them were over 75 years old, early and delayed PCIs were performed in 57 and 32 patients, respectively. And the third group consisted of 263 patients admitted from 2015 to 2017, among whom 128 patients were over 75 years old; early and delayed PCIs were performed to 82 and 80 patients, respectively. Baseline MR was determined by TIMI. Over 10 years, the number of primary PCIs had increased from 39 % in the first period to 62 % in the third one, and from 3 % to 32 % in patients older than 75 years old. The use of delayed PCI had doubled their total number. Meanwhile, although the angiographic success rate remained unchanged, there was no decrease in hospital mortality. The explanation for this lies in the increased proportion of the hospitalized patients over 75 years of age and higher mortality rates compared to those younger 75 years of age. So, in the older age group, the baseline MR was scored 7.5 or made 25 % by TIMI, the mortality was 18.3 %, making 11.6 % and 25.2 % when the PCI performance and non-performance were taken into account. These figures were 2 times lower among patients younger 75 years of age: initial MR was scored 5 making 12.5 % by TIMI; mortality was 9.6 %, making 6.5 % and 12.5 % for PCI and non-PCI cases, respectively. In this regard, with an increase in the number of hospitalized patients over 75 years of age, a higher number of PCIs performed, which was considered as associated with an increased treatment efficacy, may have not been accompanied by a decrease in hospital mortality. With similar evaluated parameters, the treatment efficacy turns to be higher among the patients with higher MR. The mortality reduction proportional to the baseline MR in different age groups indicates the results of interventions that are similar in their efficacy. These data indicate that the hospital mortality assessment with taking into account the baseline MR and/or age over 75 years, makes it possible to assess the efficacy of treatment for STEMI more objectively, to outline the ways for increasing its efficacy by using PCI in late admission, similar to that in early procedures used without age restrictions.

Aim. To study the role of the rs5186 polymorphism of the AGTR1 gene in the progression and development of complications of atrial fibrillation in combination with hypertension.
Methods. A prospective cohort study included 86 patients with paroxysmal and persistent AF and stage II hypertension, grade I–II hypertension, with Echocardiography signs of LVH, without significant comorbidity, without coronary artery disease. All patients were followed up for 12 months to assess the development of complications such as AF recurrence, cardioembolism, hospitalization and chronic heart failure (CHF). The mean age of the studied patients was 53.3 ± 7.1 years.
Results. During the observation period, out of 86 patients, 16 people developed a recurrence of AF. Cases of cardioembolism were recorded in 17 people. Of the 86 observed patients, 43 were rehospitalized. When evaluating the association of the rs5186 polymorphism of the AGTR1 gene with the risk of readmission within a year, it was found that the CT genotype of the rs5186 polymorphism of the AGTR1 gene (RR = 2.28; p = 0.004) and the CC genotype (RR = 0.44; p = 0.005) significantly increase the risk of hospitalization. CHF was registered in 26 (30.2 %) patients out of 86 observed. Thus, the study of the role of the rs5186 polymorphism of the AGTR1 gene in the progression and development of complications of atrial fibrillation in combination with hypertension, according to the present study, does not make it possible to determine a significant predictor of AF progression, however, a predictor of the risk of hospitalization ACTR1/CT was identified (2.28 [1.30; 4.05], p < 0.004; 2.45 [1.33; 4.61], p < 0.004; 2.61 [1.44; 4.81], p < 0.002) in all models of the logical regression is statistically significant.

Atrial fibrillation (AF) is one of the most common forms of cardiac arrhythmia among the population, especially in middle-aged and elderly people. Recently enough data has been accumulated to indicate the difference in the mechanisms of AF occurrence depending on the individual hormonal status, which requires a personalized approach to assessing AF risk factors. The purpose of this article is to analyze the current state of the issue regarding the role of endocrinopathies in the pathogenesis of AF. The authors have presented modern clinical data indicating the influence of endocrine pathology on the risk of AF and its outcomes. It has been shown that diabetes mellitus, obesity and related metabolic syndrome, thyroid dysfunction, sex hormones abnormalities in women are associated with an increased risk of AF, as well as with a high risk of adverse cardiovascular events in the setting of AF. Along with this, the contribution of traditional factors of cardiovascular risk and the importance of their modification to reduce the incidence of AF is shown. The presented analysis shows the importance of taking into account endocrine pathology for the prevention of AF, timely diagnosis and rational therapy of this arrhythmia.

The importance and effectiveness of rehabilitation programs after cardiac surgery is undeniable, proven and widely known. At the same time, the patients’ compliance at the outpatient stage is the same relevant and well-known. In our research we analyzed the opinion of 84th cardiologists of the outpatient stage regarding the effectiveness and safety of cardiac rehabilitation programs and assessed the five-year dynamics of the changes in the their attitude to this problem. Convinced of a positive shift in the cardiologists’ perception of cardiac rehabilitation programs after coronary artery bypass grafting, we analyzed the compliance of 329 patients undergone coronary artery bypass grafting to the recommended rehabilitation programs at the outpatient stage. The obtained data were summarized to the further prospects of cardiac rehabilitation development in the outpatient clinic.

Research hypothesis. Maintenance of the target albumin level of less than 25 g/l in the postoperative period in children under 1 year of age does not affect the results of treatment.
Materials and methods. A prospective randomized study included 70 patients after open cardiac surgery from January 2020 to June 2021. Two groups of 35 people were formed. Patients of the main group were transfused with albumin at its level below 25 g/l, the control group – less than 25 g/l. The median age at the time of surgery was 1.0 month in patients of both groups (p = 0.860), the median weight was 3.6 kg (3.0; 5.2) and 3.8 kg (3.1; 5.0) in patients of the main and control groups, respectively (p = 0.900).
Results. At the preoperative stage, as well as in intraoperative parameters reflecting the complexity of the operation (Aristotle score, time of cardiopulmonary bypass and aortic clamping, delayed chest closure), the groups did not differ. On the 3rd and 4th days of the postoperative period, the level of albumin in patients of the main group was significantly lower (p = 0.027 and p = 0.034). Albumin transfusion in the ICU was more often performed in patients of the control group (p = 0.031). We did not find significant differences (time of inotropes use, artificial lung ventilation, stay in the intensive care unit, lethality).
Conclusions. There were no significant differences in mortality between groups with different target levels of albumin. Also, no differences were found that could affect the outcome of the disease. Based on our study, it is impossible to draw conclusions about the course of the postoperative period in children with an albumin level of 25 g/l and below, since such an albumin level was not registered.

Objective. To study changes in the qualitative and quantitative composition of the microbiome of the gastrointestinal tract as one of the main factors affecting the state of general and local immunity in patients with acute myocardial infarction.
Methods. According to the recommendations of the European Society of Cardiology 2019, the cardiological status of the subjects was established. Based on the methodology proposed by the Moscow Research Institute of Epidemiology and Microbiology n. a. G. N. Gabrichevsky, the qualitative and quantitative composition of the intestinal microbiota was determined, followed by an assessment of the degree of microbiological disorders according to the industry standard ‘Protocol of patient management. Intestinal dysbiosis’.
Results and conclusions. A bacteriological study revealed a reduction in the main representatives of the normobiota: Bifidobacterium, Eubacterium, Lactobacterium, Enterococcus spp., forming the ‘metabolic core’ of intestinal microbiocenosis. The results obtained are part of a clinical and laboratory study of changes in the microbiota of the body in diseases of the circulatory system and can serve as a basis for developing recommendations for effective treatment and prevention of cardiovascular pathology, taking into account the state of intestinal microbiocenosis.

Objective. To analyze the long-term results of the effect of mini-bypass surgery for morbid obesity on the state of carbohydrate metabolism and the dynamics of changes of BMI.
Materials and methods. A prospective uncontrolled randomized study was conducted on the basis of the Clinical Hospital ‘Russian Railways – Medicine’ of
City of Barnaul (Russia), which included patients aged 22 to 56 years with an average body mass index of 45.23 kg/m2 and having a violation of carbohydrate metabolism: 17 patients with an established diagnosis of type 2 diabetes, 20 patients with insulin resistance. Patients with DM were canceled prior to surgery and short-acting insulin preparations were prescribed situationally. Laparoscopic minigastric bypass surgery was performed, for which anesthesia with limited use of opioids was used. Indicators were determined: fasting blood glucose in the pre- and early postoperative period, after 6 months and 2 years, glycated hemoglobin, HOMA-IR index, BMI before surgery and in control measurements.
Results. The positive dynamics of the studied indicators was demonstrated in patients with impaired carbohydrate metabolism by the time of discharge from the hospital, which was performed on 4–5 days from the moment of surgery. In most patients, this trend persisted for 2 years after surgery. Positive changes in carbohydrate metabolism occurred against the background of a significant decrease of BMI.
Conclusions. Laparoscopic mini-bypass surgery is an effective method of treating morbid obesity with concomitant metabolic syndrome for a long time.

Severe combined trauma is characterized by high mortality both among young people (above 20 %) and among the older age group (about 45 %). Correction of metabolic disorders is the most difficult task, especially in the first hours after injury.
Objective. To demonstrate the effectiveness of early initiation of veno-venous hemodiafiltration on the example of successful treatment of a patient with severe combined trauma (ISS is 57 points).
Clinical observation. Patient A., 19 years old, was taken to the surgical intensive care unit by an ambulance team with a directional diagnosis of ‘severe combined injury’ as a result of falling from a height of the 6th floor in a state of alcoholic intoxication. Considering the impossibility of correcting waterelectrolyte and metabolic disorders by conservative methods, it was decided to start extracorporeal treatment early in the volume of prolonged venovenous hemodiafiltration with citrate-calcium anticoagulation (Ci-Ca CVVHD). In addition, the patient received therapy within the framework of the current recommendations for the treatment of severe combined trauma. Against the background of the ongoing treatment, there was a distinct positive trend. Vasopressor support was discontinued on day 3, and on day 15 the patient was transferred to independent breathing. In total, one CVVHD session was conducted, with a total duration of 62 hours. The patient’s stay in the intensive care unit was 29 days, in the profile distance – 4 days with subsequent discharge.
Conclusions. The use of the CVVHD method in a patient with severe combined trauma in the early period without the phenomena of acute kidney injury contributed to the relief of metabolic disorders with the stabilization of the homeostasis system. However, in order to form conclusions and expand indications for the use of extracorporeal detoxification methods in patients with severe combined trauma, further study of this issue is necessary.

Drug interactions are a critical problem in clinical pharmacology and daily clinical practice. Physicians often face the need to prescribe a combination of two or more drugs (polypharmacy), especially when treating patients with several comorbidities. In some combinations, drugs, being chemically active substances, can enter into multi-drug interactions often with clinically significant adverse effects and/or reduction of therapy effectiveness, increasing the cost of treatment. Potential multi-drug interaction refers to the possibility of changing the pharmacological effect of one or more drugs when they are prescribed simultaneously or sequentially. Depending on the final result, the interaction may be synergistic (with increasing effect) or antagonistic (weakening or blockage of the effect).