rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2023-01-04rpcardio-2886Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯAcute Coronary Syndrome during the Pandemic New Coronavirus InfectionОстрый коронарный синдром в период пандемии новой коронавирусной инфекцииhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана Михайловна.

Москва

Oxana M. Drapkina.

Moscow

https://orcid.org/0000-0003-0297-1735КравченкоА. Я.KravchenkoA. Ya.

Кравченко Андрей Яковлевич.

Воронеж

Andrey Ya. Kravchenko.

Voronezh

drkay@yandex.ruhttps://orcid.org/0000-0002-1171-2746БудневскийА. В.BudnevskiyA. V.

Будневский Андрей Валериевич.

Воронеж

Andrey V. Budnevskiy.

Voronezh

https://orcid.org/0000-0003-2062-1536КонцеваяА. В.KontsevayaA. V.

Концевая Анна Васильевна.

Москва

Anna V. Kontsevaya.

Moscow

https://orcid.org/0000-0002-8545-6255ОвсянниковЕ. С.OvsyannikovE. S.

Овсянников Евгений Сергеевич.

Воронеж

Evgeniy S. Ovsyannikov.

Voronezh

https://orcid.org/0000-0003-2132-8374ДробышеваЕ. С.DrobyshevaE. S.

Дробышева Елена Сергеевна.

Воронеж

Elena S. Drobysheva.

Voronezh

Национальный медицинский исследовательский центр терапии и профилактической медициныРоссияNational Research Center for Therapy and Preventive MedicineRussian FederationВоронежский государственный медицинский университет им. Н.Н. БурденкоРоссияVoronezh State Medical University named after N.N. BurdenkoRussian Federation2023070320231916570Copyright © Drapkina O.M., Kravchenko A.Y., Budnevskiy A.V., Kontsevaya A.V., Ovsyannikov E.S., Drobysheva E.S., 20232023Драпкина О.М., Кравченко А.Я., Будневский А.В., Концевая А.В., Овсянников Е.С., Дробышева Е.С.Drapkina O.M., Kravchenko A.Y., Budnevskiy A.V., Kontsevaya A.V., Ovsyannikov E.S., Drobysheva E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2886

The experience of managing patients with COVID-19 around the world has shown that, although  respiratory symptoms predominate  during the manifestation of infection, then many patients can develop serious damage  to the cardiovascular system. However, coronary artery disease (CHD) remains the leading cause of death worldwide. The purpose of the review is to clarify the possible pathogenetic links between COVID-19 and acute coronary syndrome (ACS), taking into account which will help to optimize the management of patients with comorbid  pathology. Among the body's responses to SARS-CoV-2 infection, which increase the likelihood of developing  ACS,  the role of systemic inflammation, the quintessence  of which is a "cytokine storm" that can destabilize  an atherosclerotic  plaque is discussed.  Coagulopathy, typical for patients with Covid-19, is based on immunothrombosis, caused by a complex  interaction between neutrophilic  extracellular  traps and von Willebrandt  factor in conditions  of systemic inflammation. The implementation  of a modern strategy  for managing patients with ACS,  focused on the priority of percutaneous interventions (PCI), during  a pandemic is experiencing great  difficulties  due to the formation  of time delays  before  the start of invasive  procedures  due to the epidemiological situation. Despite this, the current European,  American and Russian recommendations for the management of infected patients with ACS confirm the inviolability of the position of PCI as the first choice for treating patients with ACS and the undesirability  of replacing  invasive treatment with thrombolysis.

Опыт ведения пациентов с новой коронавирусной инфекцией (COVID-19) во всем мире показал,  что при манифестации инфекции превалируют респираторные симптомы, однако, у многих пациентов может развиться серьезное поражение сердечно-сосудистой системы. Вместе с тем, основной причиной смертности во всем мире по-прежнему остаётся ишемическая болезнь сердца (ИБС). Цель обзора – описать  возможные патогенетические связи между COVID-19 и острым коронарным синдромом (ОКС), учет которых будет способствовать оптимизации ведения пациентов с коморбидной патологией. Обращено внимание на высокую частоту (от 7,2% до 12%) острого повреждения миокарда у больных  COVID-19 с возрастанием в структуре  острой  коронарной патологии удельного веса инфаркта миокарда (ИМ) 2-го типа. Среди ответных  реакций  организма на инфицирование SARS-CoV-2,  повышающих вероятность развития острого  коронарного синдрома (ОКС), обсуждается роль системного воспаления, результатом которого  является «цитокиновый шторм»,  способный дестабилизировать атеросклеротическую бляшку.  Типичная для больных  COVID-19  коагулопатия имеет своей  основой  иммунотромбоз, обусловленный сложным  взаимодействием между нейтрофильными внеклеточными ловушками и фактором фон Виллебрандта в условиях системного воспаления. Реализация  современной стратегии ведения  пациентов с ОКС, ориентированной на приоритет чрескожных вмешательств (ЧКВ), в период пандемии  испытывает большие  трудности в связи с формированием задержек  времени  до начала  проведения инвазивных процедур, обусловленных эпидемиологической обстановкой. Несмотря  на это, актуальные европейские, американские и российские рекомендации по ведению инфицированных пациентов с ОКС подтверждают незыблемость положения  о ЧКВ как средстве первого выбора для лечения пациентов с ОКС.

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