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b-Адреноблокаторы: нереализованность задач или неготовность врачей в Российской Федерации к оптимизации лечения?
b-Адреноблокаторы: нереализованность задач или неготовность врачей в Российской Федерации к оптимизации лечения?
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Аннотация
Цель исследования. Эффективным контролем частоты сердечных сокращений (ЧСС) считается достижение пульса до 50–60 уд/мин у пациентов после перенесенного острого инфаркта миокарда и до 50–70 уд/мин для больных со стабильной стенокардией. Предполагая, что в Российской Федерации часто используют низкие дозы b-адреноблокаторов (b-АБ), был поставлен вопрос: «Насколько часто встречается тахикардия среди больных с ишемической болезнью сердца (ИБС) и хронической сердечной недостаточностью (ХСН), существуют ли стратегические подходы к достижению целевых показателей ЧСС у данной категории пациентов в реальной клинической практике и как часто используются b-АБ у пациентов, для которых эта группа лекарственных препаратов является базисными средствами?»
Материалы и методы. Работа осуществлена в рамках российского эпидемиологического исследования репрезентативной выборки Европейской части РФ «ЭПОХА». Все пациенты с ИБС и ХСН были разделены на две подгруппы: не получающие хрононегативных лекарственных средств и получающие хотя бы один хрононегативный препарат (b-АБ, антагонисты кальция 1 и 3-го типов, гликозиды).
Результаты и обсуждение. В репрезентативной выборке «ЭПОХА» у здоровых лиц (без клинических проявлений ИБС) тахикардия была диагностирована в 7,1% случаев. Почти все респонденты без ИБС (87,3%) имели нормальную ЧСС от 61 до 80 уд/мин. Число респондентов без ИБС, имеющих ЧСС от 70 до 79 уд/мин (54,1%), оказалось достоверно меньше, чем пациентов с таковым ритмом при любой форме ИБС (р<0,001).
В популяции больных с ХСН был установлен клинический симптом тахикардии среди 73,5% пациентов.
Анализ назначенной терапии b-АБ у больных с ХСН показал, что в 54% случаев применение b-АБ не привело к эффективному контролю ритма у больных с ХСН. Рекомендованные b-АБ для лечения ХСН применяли только 36,2% пациентов.
Выводы. Раннее внутривенное введение b-АБ (препарата Беталок) перед чрескожным вмешательством на коронарных артериях уменьшает размер инфаркта и увеличивает фракцию выброса левого желудочка у пациентов с инфарктом миокарда с подъемом сегмента ST. Отвечая на поставленный вопрос в названии статьи, можно ответить: врачи сегодня не готовы к активному назначению и достижению целевых доз b-АБ. Эта ситуация сразу же формирует нереализованность задач в плане оптимизации терапии и снижения рисков сердечно-сосудистой смертности при ИБС и ХСН.
Ключевые слова: тахикардия, контроль частоты сердечных сокращений, ишемическая болезнь сердца, сердечная недостаточность.
Materials and Methods. Work carried out in the framework of the Russian epidemiological study of a representative sample of the European part of the Russian Federation. All patients with CHF and coronary artery disease were divided into two subgroups: heart rate reducers not receiving medicines and receiving at least one heart rate reducing drug (a b-blocker, calcium channel 1 and 3rd type (AK) blockers, glycosides).
Results and discussion. In a representative sample of the program in healthy individuals (without clinical manifestations of coronary artery disease) tachycardia was diagnosed in 7,1% of cases. Almost all respondents without CHD (87,3%) had normal heart rate from 61 to 80 beats per minute. Number of respondents without CHD with heart rate of 70 to 79 bpm. per min. (54,1%) turned out to be significantly less than that of patients with rhythm in any form of coronary artery disease (p<0,001).
In a population of patients with CHF a clinical symptom of tachycardia was established in 73,5% of patients.
Analysis of the prescribed b-blockers therapy in patients with CHF showed that in 54% of cases the use of beta-blockers did not result in effective control of the rhythm in patients with CHF. b-Blockers recommended for the treatment of CHF were used only 36,2% of patients.
Conclusions. Early intravenous b-blockers (drug Betalok) use before percutaneous coronary intervention reduces infarct size and increases left ventricular ejection fraction in patients with myocardial infarction of ST segment elevation. Answering the question posed in the title, you can say: doctors are not ready to take an active position in prescribing and achievingthe target doses of b-blockers. This situation immediately generates the lack of task implementation in terms of optimization of therapy and reduces the risk of cardiovascular mortality in coronary artery disease and heart failure.
Key words: tachycardia, heart rate monitoring, coronary heart disease, heart failure
Материалы и методы. Работа осуществлена в рамках российского эпидемиологического исследования репрезентативной выборки Европейской части РФ «ЭПОХА». Все пациенты с ИБС и ХСН были разделены на две подгруппы: не получающие хрононегативных лекарственных средств и получающие хотя бы один хрононегативный препарат (b-АБ, антагонисты кальция 1 и 3-го типов, гликозиды).
Результаты и обсуждение. В репрезентативной выборке «ЭПОХА» у здоровых лиц (без клинических проявлений ИБС) тахикардия была диагностирована в 7,1% случаев. Почти все респонденты без ИБС (87,3%) имели нормальную ЧСС от 61 до 80 уд/мин. Число респондентов без ИБС, имеющих ЧСС от 70 до 79 уд/мин (54,1%), оказалось достоверно меньше, чем пациентов с таковым ритмом при любой форме ИБС (р<0,001).
В популяции больных с ХСН был установлен клинический симптом тахикардии среди 73,5% пациентов.
Анализ назначенной терапии b-АБ у больных с ХСН показал, что в 54% случаев применение b-АБ не привело к эффективному контролю ритма у больных с ХСН. Рекомендованные b-АБ для лечения ХСН применяли только 36,2% пациентов.
Выводы. Раннее внутривенное введение b-АБ (препарата Беталок) перед чрескожным вмешательством на коронарных артериях уменьшает размер инфаркта и увеличивает фракцию выброса левого желудочка у пациентов с инфарктом миокарда с подъемом сегмента ST. Отвечая на поставленный вопрос в названии статьи, можно ответить: врачи сегодня не готовы к активному назначению и достижению целевых доз b-АБ. Эта ситуация сразу же формирует нереализованность задач в плане оптимизации терапии и снижения рисков сердечно-сосудистой смертности при ИБС и ХСН.
Ключевые слова: тахикардия, контроль частоты сердечных сокращений, ишемическая болезнь сердца, сердечная недостаточность.
________________________________________________
Materials and Methods. Work carried out in the framework of the Russian epidemiological study of a representative sample of the European part of the Russian Federation. All patients with CHF and coronary artery disease were divided into two subgroups: heart rate reducers not receiving medicines and receiving at least one heart rate reducing drug (a b-blocker, calcium channel 1 and 3rd type (AK) blockers, glycosides).
Results and discussion. In a representative sample of the program in healthy individuals (without clinical manifestations of coronary artery disease) tachycardia was diagnosed in 7,1% of cases. Almost all respondents without CHD (87,3%) had normal heart rate from 61 to 80 beats per minute. Number of respondents without CHD with heart rate of 70 to 79 bpm. per min. (54,1%) turned out to be significantly less than that of patients with rhythm in any form of coronary artery disease (p<0,001).
In a population of patients with CHF a clinical symptom of tachycardia was established in 73,5% of patients.
Analysis of the prescribed b-blockers therapy in patients with CHF showed that in 54% of cases the use of beta-blockers did not result in effective control of the rhythm in patients with CHF. b-Blockers recommended for the treatment of CHF were used only 36,2% of patients.
Conclusions. Early intravenous b-blockers (drug Betalok) use before percutaneous coronary intervention reduces infarct size and increases left ventricular ejection fraction in patients with myocardial infarction of ST segment elevation. Answering the question posed in the title, you can say: doctors are not ready to take an active position in prescribing and achievingthe target doses of b-blockers. This situation immediately generates the lack of task implementation in terms of optimization of therapy and reduces the risk of cardiovascular mortality in coronary artery disease and heart failure.
Key words: tachycardia, heart rate monitoring, coronary heart disease, heart failure
Полный текст
Список литературы
1. Kristal-Boneh E, Silber H, Harari G, Froom P. The association of resting heart rate with cardiovascular, cancer and all-cause mortality. Eight year follow-up of 3527 male Isreali employees (the CORDIS study). Eur Heart J 2000; 21: 116–24.
2. Seccareccia F, Pannozzo F, Dima F et al. Heart rate as a predictor of mortality: the MATISS project. Am J Public Health 2001; 91: 1258–63.
3. Jouven X, Empana JP, Escolano S et al. Relation of heart rate at rest and long-term (20 years) death rate in initially healthy middle-aged men. Am J Cardiol 2009; 103: 279–83.
4. Reunanen A, Karjalainen J, Ristola P et al. Heart rate and mortality. J Intern Med 2000; 247: 231–9.
5. Nauman J, Janszky I, Vatten LJ, Wisloff U. Temporal changes in resting heart rate and deaths from ischemic heart disease. JAMA 2011; 306: 2579–87.
6. Fox K, Ford I, Steg PG et al. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet 2008; 372: 817–21.
7. Heidland UE, Strauer BE. Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption. Circulation 2001; 104: 1477–82.
8. CIBIS Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999; 353: 9–13.
9. The MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
10. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J 2012; 33: 1787–847.
11. Ferrari R. Prognostic benefits of heart rate reduction in cardiovascular disease. Eur Heart J 2003; 5 (Suppl. G): G10–G4.
12. Kannel WB. Heart rate and cardiovascular mortality. The Framingham Study. Am Heart J 1987; 113: 1489–94.
13. 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: 2949–3003.
14. Swedberg K, Komajda M, Bohm M et al. SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled trial. Lancet 2010; 376: 875–85.
15. Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. и др. Этиологические причины формирования ХСН в Европейской части Российской Федерации (госпитальный этап). Сердечная недостаточность. 2011; 6: 460–7.
16. Мареев В.Ю., Беленков Ю.Н., Агеев Ф.Т. и др. Первые результаты Российского эпидемиологического исследования по ХСН (ЭПОХА–ХСН). Сердечная недостаточность. 2003; 4 (1): 17–8.
17. Bangalore S, Steg G, Deedwania P et al. b-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery. JAMA 2012; 308 (13): 1340–9.
18. Wikstrand J, Hjalmarson A, Waagstein F et al. Dose of Metoprolol CR/XL and Clinical Outcomes in Patients With Heart Failure. J Am Coll Cardiol 2002; 40: 491–8.
19. Gottlieb S, Fisher ML, Kjekshus J et al. Tolerability of beta-blocker initiation and titration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Circulation 2002; 105: 1182–8.
20. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665; doi: 10.1136/bmj.b1665
21. Larose E, Rodes-Cabau J, Pibarot P et al. Predicting late myocardial recovery and outcomes in the early hours of ST-segment elevation myocardial infarction traditional measures compared with microvascular obstruction, salvaged myocardium, and necrosis characteristics by cardiovascular magnetic resonance. J Am Coll Cardiol 2010; 55: 2459–69.
22. Freemantle N, Cleland J, Young P et al. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318: 1730–7.
23. Chen ZM, Pan HC, Chen YP et al. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomized placebo-controlled trial. Lancet 2005; 366: 1622–32.
24. Roberts R, Rogers WJ, Meuller HS et al. Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) II-B Study. Circulation 1991; 83: 422–37.
25. Bates ER. Role of Intravenous b-Blockers in the Treatment of ST-Elevation Myocardial Infarction: Of Mice (Dogs, Pigs) and Men. Circulation 2007; 115: 2904–6.
26. O’Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e362–e425.
27. Steg PG, James SK, Atar D et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569–619.
28. Ibanez B, Macaya C, Sanchez-Brunete V et al. Effect of Early Metoprolol on Infarct Size in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary PCI: The METOCARD-CNIC Trial. Circulation 2013; 128: 1495–503.
2. Seccareccia F, Pannozzo F, Dima F et al. Heart rate as a predictor of mortality: the MATISS project. Am J Public Health 2001; 91: 1258–63.
3. Jouven X, Empana JP, Escolano S et al. Relation of heart rate at rest and long-term (20 years) death rate in initially healthy middle-aged men. Am J Cardiol 2009; 103: 279–83.
4. Reunanen A, Karjalainen J, Ristola P et al. Heart rate and mortality. J Intern Med 2000; 247: 231–9.
5. Nauman J, Janszky I, Vatten LJ, Wisloff U. Temporal changes in resting heart rate and deaths from ischemic heart disease. JAMA 2011; 306: 2579–87.
6. Fox K, Ford I, Steg PG et al. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet 2008; 372: 817–21.
7. Heidland UE, Strauer BE. Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption. Circulation 2001; 104: 1477–82.
8. CIBIS Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999; 353: 9–13.
9. The MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
10. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J 2012; 33: 1787–847.
11. Ferrari R. Prognostic benefits of heart rate reduction in cardiovascular disease. Eur Heart J 2003; 5 (Suppl. G): G10–G4.
12. Kannel WB. Heart rate and cardiovascular mortality. The Framingham Study. Am Heart J 1987; 113: 1489–94.
13. 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: 2949–3003.
14. Swedberg K, Komajda M, Bohm M et al. SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled trial. Lancet 2010; 376: 875–85.
15. Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. и др. Этиологические причины формирования ХСН в Европейской части Российской Федерации (госпитальный этап). Сердечная недостаточность. 2011; 6: 460–7.
16. Мареев В.Ю., Беленков Ю.Н., Агеев Ф.Т. и др. Первые результаты Российского эпидемиологического исследования по ХСН (ЭПОХА–ХСН). Сердечная недостаточность. 2003; 4 (1): 17–8.
17. Bangalore S, Steg G, Deedwania P et al. b-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery. JAMA 2012; 308 (13): 1340–9.
18. Wikstrand J, Hjalmarson A, Waagstein F et al. Dose of Metoprolol CR/XL and Clinical Outcomes in Patients With Heart Failure. J Am Coll Cardiol 2002; 40: 491–8.
19. Gottlieb S, Fisher ML, Kjekshus J et al. Tolerability of beta-blocker initiation and titration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Circulation 2002; 105: 1182–8.
20. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665; doi: 10.1136/bmj.b1665
21. Larose E, Rodes-Cabau J, Pibarot P et al. Predicting late myocardial recovery and outcomes in the early hours of ST-segment elevation myocardial infarction traditional measures compared with microvascular obstruction, salvaged myocardium, and necrosis characteristics by cardiovascular magnetic resonance. J Am Coll Cardiol 2010; 55: 2459–69.
22. Freemantle N, Cleland J, Young P et al. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318: 1730–7.
23. Chen ZM, Pan HC, Chen YP et al. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomized placebo-controlled trial. Lancet 2005; 366: 1622–32.
24. Roberts R, Rogers WJ, Meuller HS et al. Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) II-B Study. Circulation 1991; 83: 422–37.
25. Bates ER. Role of Intravenous b-Blockers in the Treatment of ST-Elevation Myocardial Infarction: Of Mice (Dogs, Pigs) and Men. Circulation 2007; 115: 2904–6.
26. O’Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e362–e425.
27. Steg PG, James SK, Atar D et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569–619.
28. Ibanez B, Macaya C, Sanchez-Brunete V et al. Effect of Early Metoprolol on Infarct Size in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary PCI: The METOCARD-CNIC Trial. Circulation 2013; 128: 1495–503.
2. Seccareccia F, Pannozzo F, Dima F et al. Heart rate as a predictor of mortality: the MATISS project. Am J Public Health 2001; 91: 1258–63.
3. Jouven X, Empana JP, Escolano S et al. Relation of heart rate at rest and long-term (20 years) death rate in initially healthy middle-aged men. Am J Cardiol 2009; 103: 279–83.
4. Reunanen A, Karjalainen J, Ristola P et al. Heart rate and mortality. J Intern Med 2000; 247: 231–9.
5. Nauman J, Janszky I, Vatten LJ, Wisloff U. Temporal changes in resting heart rate and deaths from ischemic heart disease. JAMA 2011; 306: 2579–87.
6. Fox K, Ford I, Steg PG et al. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet 2008; 372: 817–21.
7. Heidland UE, Strauer BE. Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption. Circulation 2001; 104: 1477–82.
8. CIBIS Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999; 353: 9–13.
9. The MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
10. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J 2012; 33: 1787–847.
11. Ferrari R. Prognostic benefits of heart rate reduction in cardiovascular disease. Eur Heart J 2003; 5 (Suppl. G): G10–G4.
12. Kannel WB. Heart rate and cardiovascular mortality. The Framingham Study. Am Heart J 1987; 113: 1489–94.
13. 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: 2949–3003.
14. Swedberg K, Komajda M, Bohm M et al. SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled trial. Lancet 2010; 376: 875–85.
15. Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. и др. Этиологические причины формирования ХСН в Европейской части Российской Федерации (госпитальный этап). Сердечная недостаточность. 2011; 6: 460–7.
16. Мареев В.Ю., Беленков Ю.Н., Агеев Ф.Т. и др. Первые результаты Российского эпидемиологического исследования по ХСН (ЭПОХА–ХСН). Сердечная недостаточность. 2003; 4 (1): 17–8.
17. Bangalore S, Steg G, Deedwania P et al. b-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery. JAMA 2012; 308 (13): 1340–9.
18. Wikstrand J, Hjalmarson A, Waagstein F et al. Dose of Metoprolol CR/XL and Clinical Outcomes in Patients With Heart Failure. J Am Coll Cardiol 2002; 40: 491–8.
19. Gottlieb S, Fisher ML, Kjekshus J et al. Tolerability of beta-blocker initiation and titration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Circulation 2002; 105: 1182–8.
20. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665; doi: 10.1136/bmj.b1665
21. Larose E, Rodes-Cabau J, Pibarot P et al. Predicting late myocardial recovery and outcomes in the early hours of ST-segment elevation myocardial infarction traditional measures compared with microvascular obstruction, salvaged myocardium, and necrosis characteristics by cardiovascular magnetic resonance. J Am Coll Cardiol 2010; 55: 2459–69.
22. Freemantle N, Cleland J, Young P et al. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318: 1730–7.
23. Chen ZM, Pan HC, Chen YP et al. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomized placebo-controlled trial. Lancet 2005; 366: 1622–32.
24. Roberts R, Rogers WJ, Meuller HS et al. Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) II-B Study. Circulation 1991; 83: 422–37.
25. Bates ER. Role of Intravenous b-Blockers in the Treatment of ST-Elevation Myocardial Infarction: Of Mice (Dogs, Pigs) and Men. Circulation 2007; 115: 2904–6.
26. O’Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e362–e425.
27. Steg PG, James SK, Atar D et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569–619.
28. Ibanez B, Macaya C, Sanchez-Brunete V et al. Effect of Early Metoprolol on Infarct Size in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary PCI: The METOCARD-CNIC Trial. Circulation 2013; 128: 1495–503.
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2. Seccareccia F, Pannozzo F, Dima F et al. Heart rate as a predictor of mortality: the MATISS project. Am J Public Health 2001; 91: 1258–63.
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Авторы
И.В.Фомин*, Д.С.Поляков
ГБОУ ВПО Нижегородская государственная медицинская академия Минздрава России
*fomin-i@yandex.ru
*fomin-i@yandex.ru
ГБОУ ВПО Нижегородская государственная медицинская академия Минздрава России
*fomin-i@yandex.ru
________________________________________________
*fomin-i@yandex.ru
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