clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2020-98-5-341-348clinmed-58Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSПрогностическое значение комплекса биомаркеров в оценке исходов острого коронарного синдрома до 12 месяцевThe prognostic value of the biomarker complex in assessing the outcomes of acute coronary syndrome up to 12 monthsЗвездочетоваН. А.ZvezdochetovaN. A.

Звездочетова Наталья Анатольевна — аспирант кафедры госпитальной терапии и общей врачебной практики им. В.Г. Вогралика Нижегородской государственной медицинской академии, заведующая кардиологическим отделением Нижегородской областной клинической больницы им. Н.А. Семашко

603950, Нижний Новгород

603126, Нижний Новгород

 

Natalya A. Zvezdochetova — graduate student of the Department of Hospital Therapy and General Medical Practice name after V.G. Vogralika; State Budgetary Institution of Health Nizhny Novgorod region « Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko», Head of the Cardiology Department

603950, Nizhny Novgorod

603126, Nizhny Novgorod

natzvezdochetova@yandex.ruКоролеваЛ. Ю.KorolevaL. Yu.

603950, Нижний Новгород

603950, Nizhny Novgorod

ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России; ГБУЗ НО «Нижегородская областная клиническая больница им. Н.А. Семашко»РоссияPrivolzhsky Research Medical University of the Ministry of Health of the Russian Federation; Nizhny Novgorod Regional Clinical Hospital named after N.A. SemashkoRussian FederationФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава РоссииРоссияPrivolzhsky Research Medical University of the Ministry of Health of the Russian FederationRussian Federation202028102020985341348Copyright © Звездочетова Н.А., Королева Л.Ю., 20202020Звездочетова Н.А., Королева Л.Ю.Zvezdochetova N.A., Koroleva L.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.clinmedjournal.com/jour/article/view/58

Высокочувствительные тесты для определения уровня сердечного тропонина в крови имеют ряд преимуществ и в настоящее время рекомендованы для использования в клинической практике. С целью своевременной диагностики и выявления пациентов с высоким риском неблагоприятных исходов острого коронарного синдрома принимаются попытки комплексного подхода с применением нескольких биологических маркеров.

Цель — изучить прогностическую значимость определения высокочувствительного тропонина (high sensitive cardiac troponin — hs-cTnI) в комплексе с натрийуретическим пептидом (NT-proBNP) в оценке исходов острого коронарного синдрома (ОКС).

Материал и методы

Материал и методы. В условиях ГБУЗ НО «Нижегородская областная клиническая больница им. Н.А. Семашко» проведен анализ возможности использования комплекса биологических маркеров у пациентов с ОКС (n = 120), экстренно госпитализированных в отделение неотложной кардиологии (РСЦ № 2). Группу сравнения составили пациенты с различными функциональными классами стабильной ИБС (n = 37), госпитализированные в кардиологическое отделение. Период наблюдения составил 42–72 мес. (с февраля 2014 по февраль 2020 г.). Пациентам проведено общеклиническое обследование, а также исследование уровня тропонина I (cTnI), hs-cTnI, NT-proBNP, выполнены электрокардиография (ЭКГ), эхокардиография (ЭхоКГ), коронароангиография (КАГ). При помощи статистического анализа оценивали прогностическую ценность комплекса биологических маркеров при ОКС. Анализ полученного материала проводился с применением прикладных программ IBM SPSS Statistics for Mac, version 26.0 (IBM Corporation, www.ibm.com (2019), Microsoft Offi ce Excel for Mac (2016), Prism 8 for macOS, version 8.4.2 (464), April 7, 2020 (1994–2020 GraphPad Software, LLC).

Результаты

Результаты. Построена прогностическая модель ближайших исходов ОКС (госпитальных и до 12 мес.), которая включает концентрацию hs-cTnI (количественный показатель), значение NT-proBNP (качественный показатель), элевацию сегмента ST, многососудистое поражение, повышение уровня глюкозы. Значение интегрального показателя «PROGNOSIS FOR ACS+5» ≥ 0,5926 ассоциируется с высоким риском развития неблагоприятного прогноза ОКС в течение 12 мес., а значение показателя меньше 0,5926 свидетельствует о низком риске развития неблагоприятного прогноза.

Заключение

Заключение. Результаты исследования свидетельствуют о высокой значимости прогностической модели в оценке исходов ОКС в течение 12 мес.

Introduction

Introduction. Highly sensitive tests to determine the level of cardiac troponin in the blood are currently recommended and have a number of advantages. For the purpose of timely diagnosis and identifi cation of patients with a high risk of adverse outcomes of acute coronary syndrome, attempts are made to take a comprehensive approach using several biological markers.

The purpose of the study

The purpose of the study. To study the prognostic signifi cance of the determination of highly sensitive troponin (highly sensitive cardiac troponin — hs-cTn) in the complex with natriuretic peptide (NT-proBNP) in assessing the outcomes of acute coronary syndrome (ACS).

Material and methods

Material and methods. The analysis of the possibility of using a complex of biological markers in patients with ACS (n = 120), urgently hospitalized in the State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko. Comparison Group for Existing Patients IHD (n = 37), hospitalized in the cardiology department of the State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko». Observation period showed 42–72 months (from February 2014 to August 2016). Patients underwent a general clinical examination, determination of the level of troponin I (cTnI), hs-cTnI, NT-proBNP, electrocardiogram (ECG), echocardiography, coronary angiography. Using statistical analysis, the prognostic value of the complex of biological markers in ACS was evaluated. The analysis of the obtained material was carried out using the application programs IBM SPSS Statistics for Mac, version 26.0 (IBM Corporation, www.ibm.com (2019), Microsoft Offi ce Excel for Mac (2016), Prism 8 for macOS, version 8.4.2 (464), April 7, 2020 (1994–2020 GraphPad Software, LLC).

Results

Results. A prognostic model of the immediate outcomes of ACS (hospital and up to 12 months) was constructed, which includes the concentration of hs-cTnI (quantitative), the value of NT-proBNP (qualitative), ST segment elevation, and multi-vessel lesion, hyperglycemia. It is shown that the value of the integral index «PROGNOSIS FOR ACS+5» ≥ 0.5926 is associated with a high risk of poor prognosis in ACS for 12 months, and the index value < 0.5926 indicates a low risk of an adverse forecast.

Conclusion

Conclusion. The results of the study indicate the high importance of the prognostic model in assessing the outcomes of acute coronary syndrome (ACS) for 12 months.

инфаркт миокардаострый коронарный синдромвысокочувствительный тропонин (hs-cTn)натрийуретический пептид (NT-proBNP)ReferencesМалков П.В., Баранов Э.Ф., Безбородова Т.С. и др. Российский статистический ежегодник. Крат. стат. сб. Росстат. М., 2019; 549 с. Doi: https://gks.ru/storage/mediabank/rus19.pdfMalkov P.V., Baranov E.F., Bezborodova T.S. et al. Russian Statistical Yearbook. Krat. stat. Sat / Rosstat. M., 2019; 549. (in Russian). Doi: https://gks.ru/storage/mediabank/rus19.pdf.Theo V. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100): 1211–59. Doi: 10.1016/S0140-6736(17)32154-2Theo V. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–59. Doi: 10.1016/S0140-6736(17)32154-2.Piepoli M.F., Hoes A.W., Agewall S. и др. Европейские рекомендации по профилактике сердечно-сосудистых заболеваний в клинической практике (пересмотр 2016). Российский кардиологический журнал. 2017;6(146):7–85.Piepoli M.F., Hoes A.W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 2016;37(29);2315–81. Doi: 10.1093/eurheartj/ehw106.Thygesen K., Alpert J.S., Jaff e A.S. и др. Четвертое универсальное определение инфаркта миокарда. Российский кардиологический журнал. 2019;24(3):107–38. Doi: 10.15829/1560-4071-2019-3- 107-138.Thygesen K., Alpert J.S., Jaff e A.S. et al. Fourth universal defi nition of myocardial infarction (2018). Eur Heart J. 2019; 40(3): 237–269. Doi: 10.1093/eurheartj/ehy462.Thygesen K., Alpert J.S., Jaff e A.S. и др. Третье универсальное определение инфаркта миокарда. Российский кардиологический журнал. 2013;2(100), прил. 1:1–16.Thygesen K., Alpert J.S., Jaff e A.S. et al. Writing Group on the Joint ESC/ACC/AHA/WHF Task Force for the Universal Defi nition of Myocardial Infarction. Third universal defi nition of myocardial infarction. Eur Heart J. 2012;33(20):–67. Doi: 10.1093/eurheartj/ehs184.Thygesen K., Mair J., Giannitsis E. et al. Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur. Heart J. 2012;(33):2252–7.Thygesen K., Mair J., Giannitsis E. et al. Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur. Heart J. 2012;(33):2252–7.Rittoo D., Jones A., Lecky B., Neithercut D. Elevation of cardiac troponin T, but not cardiac troponin I, in patients with neuromuscular diseases: Implications for the diagnosis of myocardial infarction. J. Am. Coll. Cardiol. 2014;(63):2411–20. Doi: 10.1016/j. jacc.2014.03.027.Rittoo D., Jones A., Lecky B., Neithercut D. Elevation of cardiac troponin T, but not cardiac troponin I, in patients with neuromuscular diseases: Implications for the diagnosis of myocardial infarction. J. Am. Coll. Cardiol. 2014;(63):2411–20. Doi: 10.1016/j.jacc.2014.03.027.Goodman S.G., Steg P.G., Eagle K.A. et al. GRACE Investigators. The diagnostic and prognostic impact of the redefi nition of acute myocardial infarction: Lessons from the Global Registry of Acute Coronary Events (GRACE). Am. Heart J. 2006;151:654–60. Doi: 10.1016/j.ahj.2005.05.014.Goodman S.G., Steg P.G., Eagle K.A. et al. GRACE Investigators. The diagnostic and prognostic impact of the redefi nition of acute myocardial infarction: Lessons from the Global Registry of Acute Coronary Events (GRACE). Am. Heart J. 2006;151:654–60. Doi: 10.1016/j.ahj.2005.05.014.Amsterdam E.A., Wenger N.K., Brindis R.G. et al. 2014 AHA/ACC Guidelines for the management of patients with non–ST-elevation acute coronary syndrome: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2014;130:344–426. Doi: 10.1016/j. jacc.2014.09.017.Amsterdam E.A., Wenger N.K., Brindis R.G. et al. 2014 AHA/ACC Guidelines for the management of patients with non–ST-elevation acute coronary syndrome: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2014;130:344–426. Doi: 10.1016/j. jacc.2014.09.017.Roffi M., Patrono C., Collet J.-P. et al. Рекомендации ESC по ведению пациентов с острым коронарным синдромом без стойкого подъема сегмента ST 2015. Российский кардиологический журнал. 2016;(3):9–63.Roffi M., Patrono C., Collet J.P. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2016;37(3):267–315. Doi: 10.1093/ eurheartj/ehv320.Wu A.H.B., Christenson R.H., Greene D.N. et al. Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine, Clinical Chemistry. 2018;64(4):645–55. Doi: 10.1373/ clinchem.2017.277186.Wu A.H.B., Christenson R.H., Greene D.N. et al. Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clinical Chemistry. 2018;64(4):645–55. Doi: 10.1373/ clinchem.2017.277186.Kavsak P.A., Neumann J.T., Cullen L., Than M., Shortt C., Greenslade J.H. et al. Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department. CMAJ. 2018;190(33):974–84. Doi: 10.1503/ cmaj.180144.Kavsak P.A., Neumann J.T., Cullen L. et al. Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department. CMAJ. 2018;190(33): 74–84. Doi: 10.1503/cmaj.180144.Morrow D.A., Antman E.M., Charlesworth A. et al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation. An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy. Circulation. 2000;102(17):2031–7. Doi: 10.1161/01. CIR.102.17.2031.Morrow D.A., Antman E.M., Charlesworth A. et al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation. An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy. Circulation. 2000;102(17):2031–7. Doi: 10.1161/01. CIR.102.17.2031.Granger C.B. Goldberg R.J., Dabbous O. et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch. Intern. Med. 2003;163(19):2345–53. Doi: 10.1001/archinte.163.19.2345.Granger C.B. Goldberg R.J., Dabbous O. et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(19):2345–53. Doi: https://doi.org/10.1001/ archinte.163.19.2345.Boersma E., Pieper K.S., Steyerberg E.W. et al. Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-segment Elevation. Results From an International Trial of 9461 Patients. The PURSUIT Investigators. Circulation. 2000;101(22):2557–67. Doi: 10.1161/01.CIR.101.22.2557.Boersma E., Pieper K.S., Steyerberg E.W. et al. Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-segment Elevation. Results From an International Trial of 9461 Patients. The PURSUIT Investigators. Circulation. 2000;101(22):2557–67. Doi: 10.1161/01.CIR.101.22.2557.Эрлих А.Д. Шкала для ранней оценки риска смерти и развития инфаркта миокарда в период пребывания в стационаре больных с острыми коронарными синдромами (на основе данных регистра РЕКОРД). Кардиология. 2010;50(10):11–6.Erlich A.D. Scale for early assessment of the risk of death and the development of myocardial infarction during a hospital stay in patients with acute coronary syndromes (based on RECORD registration data). Cardiology. 2010;50(10):11–6. (in Russian)Gaggin H.K., Januzzi J.L. Natriuretic peptides in heart failure and acute coronary syndrome. Clin. Lab. Med. 2014;34(1):43–58. Doi: 10.1016/j.cll.2013.11.007.Gaggin H.K., Januzzi J.L. Natriuretic peptides in heart failure and acute coronary syndrome. Clin. Lab. Med. 2014;34(1):43–58. Doi: 10.1016/j.cll.2013.11.007.Хафизов Р.Р. Загидуллин Б.И., Загидуллин Н.Ш. и др. «Новые» биомаркеры при инфаркте миокарда с подъемом сегмента ST. Практическая медицина. 2014;6(82):48–52.Khafi zov R.R. Zagidullin B.I., Zagidullin N.Sh. et al. «New» biomarkers for myocardial infarction with ST segment elevation. Practical medicine. 2014;6(82):48–52. (in Russian)Khan S.Q., Dhillon O., Kelly D. et al. Plasma N-Terminal B-Type Natriuretic Peptide as an Indicator of Long-Term Survival After Acute Myocardial Infarction: Comparison With Plasma Midregional Pro-Atrial Natriuretic Peptide. JACC. 2008;51(19):1857–64. Doi: 10.1016/j.jacc.2008.01.041.Khan S.Q., Dhillon O., Kelly D. et al. Plasma N-Terminal B-Type Natriuretic Peptide as an Indicator of Long-Term Survival After Acute Myocardial Infarction: Comparison With Plasma Midregional Pro-Atrial Natriuretic Peptide. JACC. 2008;51(19):1857–64. Doi: 10.1016/j.jacc.2008.01.041.Dong M.A. Liao J.K., Yan B. et al. A combination of increased Rho kinase activity and N-terminal pro-B-type natriuretic peptide predicts worse cardiovascular outcome in patients with acute coronary syndrome. Int .J. Cardiol. 2013;167(6):2813–9. Doi: 10.1016/j. ijcard.2012.07.007.Dong M.A., Liao J.K., Yan B. et al. A combination of increased Rho kinase activity and N-terminal pro-B-type natriuretic peptide predicts worse cardiovascular outcome in patients with acute coronary syndrome. Int. J. Cardiol. 2013;167(6):2813–9. Doi: 10.1016/j. ijcard.2012.07.007.Lindholm D., James S.K., Bertilsson M. et al. Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non-ST-Elevation Acute Coronary Syndrome. Clin. Chem. 2017;63(2):573–84. Doi: 10.1373/clinchem.2016.261271.Lindholm D., James S.K., Bertilsson M. et al. Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non-STElevation Acute Coronary Syndrome. Clin. Chem. 2017;63(2):573– 84. Doi: 10.1373/clinchem.2016.261271.Shamir R.M., Eikelbppm J.W., Rao-Melacini P. et al. A Risk Assessment Tool Incorporating New Biomarkers for Cardiovascular Events in Acute Coronary Syndromes: The Organization to Assess Strategies in Ischemic Syndromes (OASIS) Risk Score Canadian Journal of Cardiology. Can. J. Card. 2016;32(11):1332–9. Doi: 10.1016/j.cjca.2016.01.029.Shamir R.M. Eikelbppm J.W., Rao-Melacini P. et al. A Risk Assessment Tool Incorporating New Biomarkers for Cardiovascular Events in Acute Coronary Syndromes: The Organization to Assess Strategies in Ischemic Syndromes (OASIS) Risk Score Canadian Journal of Cardiology. Can. J. Card. 2016;32(11):1332–9. Doi: 10.1016/j.cjca.2016.01.029.Kavsak P.A., Neumann J.T., Cullen L. et al. Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department. CMAJ. 2018;190(33):974–84. Doi: https://doi.org/10.1503/cmaj.180144.Kavsak P.A., Neumann J.T., Cullen L. et al. Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department. CMAJ. 2018;190(33):974–84. Doi: 10.1503/cmaj.180144Ibanez B., James S., Agewall S. et al. Рекомендации ЕОК по ведению пациентов с острым инфарктом миокарда с подъемом cегмента ST 2017. Российский кардиологический журнал. 2018;23(5):103–58. Doi: 10.15829/1560-4071-2018-5-103-158.Ibanez B., James S., Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2017;39(2):119–77. Doi: 10.1093/eurheartj/ehx393.Montalescot G., Sechtem U., Achenbach S. et al. Рекомендации по лечению стабильной ишемической болезни сердца. Российский кардиологический журнал. 2014;7(111):7–79.Montalescot G., Sechtem U., Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur. Heart J. 2013;34(38):2949–3003. Doi: 10.1093/eurheartj/eht296.The Center for Outcomes Research (COR). Risk Assessment Models. University of Massachusetts Medical School. [сайт: https://www. outcomes-umassmed.org/risk_models_grace_orig.aspx].The Center for Outcomes Research (COR): [https://www.outcomesumassmed.org/risk_models_grace_orig.aspx]. Risk Assessment Models. University of Massachusetts Medical School.Granger C.B., Goldberg R.J., Dabbous O. et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch. Intern. Med. 2003;163(19):2345–53. Doi: https://doi.org/10.1001/ archinte.163.19.2345.Granger C.B., Goldberg R.J., Dabbous O. et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch. Intern. Med. 2003;163(19):2345–53. Doi: 10.1001/archinte.163.19.2345.Fox K.A., Dabbous O.H., Goldberg R.J. et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;(333):1091. Doi: 10.1136/ bmj.38985.646481.55.Fox K.A., Dabbous O.H., Goldberg R.J. et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;(3331091. Doi: 10.1136/ bmj.38985.646481.55.Мареев В.Ю., Фомин И.В., Агеев Ф.Т. и др. Клинические рекомендации ОССН-РКО-РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018;58(6S):8– 158. Doi: 10.18087/cardio.2475.Mareev V.Yu., Fomin I.V., Ageev F.T. et al. Clinical recommendations OSSN-RKO-RNMOT. Heart failure: chronic heart failure (CHF) and acute heart failure (AHF). Diagnosis, prevention and treatment. Cardiology. 2018;58(6S):8–158. Doi: 10.18087/cardio.2475.Ланг Т.А., Сесик М. Как описывать статистику в медицине: руководство для авторов, редакторов и рецензентов. пер. с англ. под ред. В.П. Леонова. М.: Практическая медицина, 2016; 480 с. ISBN 978-1-930513-69-3.Lang T. A., Sesik M. How to describe statistics in medicine: The management for authors, editors and reviewers. The translation for English by Leonov V.P. Moscow: Practical medicine. 2016.. ISBN 978-1-930513-69-3.Smith S.C., Feldman T.E., Hirshfeld J.W. et al. ACC/AHA/SCAI 2005 Guidline update for percutaneous coronary intervention a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAIWriting Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J. Am. Coll. Cardiol. 2006;47(1):1–121. Doi: 10.1016/j.jacc.2005.12.001Smith S.C., Feldman T.E., Hirshfeld J.W. et al. ACC/AHA/SCAI 2005 Guidline update for percutaneous coronary intervention a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J. Am. Coll. Cardiol. 2006;47(1):1–121. Doi: 10.1016/j.jacc.2005.12.001.

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