??????????? ?????? ?????? - ???????????? ???????????: ??????? ????????????????

???????????? ???????????: ??????? ???????????????? – “??”

???????????? ??????????? / ??????? ???????? ??? ????? Q (??/?? ??? Q) ???????? ??????????? ?????????, ??????? ??????, ?? ?? ??????, ???????????? ??????????????????? ?????????? ?????????? ??????? ? ?????????????? ?????????? ?????? ?????????? ??????. ?????????? ???????????????? ? ???????????????? ???????????? ???????????????, ??? ??? ??/?? ??? Q ?????????? ?????? ??????????????????? ?????? ? ??????????? ???????? ?????????????? ?????????, ??????? ? ???????? ??????????? ?????????. ??????????? ????????? ? ??/?? ??? Q ??????? ???????? ??? ? ????????? ??????? (???????????????) ??. ??????????? ??????????? ? ??????????? ??????? ????? ????????? ?????? ???????????? ?? ??????, ?????????? ??? ????????? ??????????? ???????. ??????, ????? ????? ????????? ????? ?? ?????? ???????????????? ? ?? ?? ?????? ??????????? ???????? ? ???????. ??????? ???????????? ???????? ??????????? ????? ????????? ? ?????? ??????? ??????????? ????????.

? ?????????? ??/?? ??? Q ????? ???????? ?????????? ????? ?????????? ? ???????????? ????????? ????????? ? ??????. ??????? ???????? ???? ???????????? ?????? ????? ?????????.

- ???????? ?????? ???????? ??/?? ??? Q ???????? ???????? ?????????????? ????????, ?????????? ??????? ?????????? ??????? ??????????????? ??????? ?? ??????????? “??????????” ??????????????????? ??????. ???????????????? ??????????????? ?????????? ? ???????????? “??????????” ?????? ???????? ????? ? ?????? ????????? ?????????????? ?????????????? ???????? ? ????? ???????.

- ????????? ???????? ????? ???? ???????????? ??????????, ?????????? ??????????? ????????? ??????? ?????????????? ???????? ?????????????? ?????????? ??????? (??????????? ???????????). ? ?????? ?????????? ?????? ????? ????????????????? ?????????? ??????? ??????????? ?/??? ?????????? ?????????. ???????????? ?????????? ?????????? ????? ????? ???? ??????? ?????????? ?????????????? ????????? ? ?????? ?????????????? ????????.

- ?????? ??????? ?? – ???????????? ??????? ??????? ??? ?????? ??? ????????. ??? ??????????? ? ????????? ??????? ? ??????????????? ?????????????? ? ??? ?????????? ????? ????????????? ?????????? ?????????????? (???).

- ????????? ???????? ???????? ?????????? ???????????? ??????, ?????????? ???????????? ????????? ? ??????? ? ??????? ???????, ?????????????? ?????? ? ??????????? ???????. ???????? ????????? ? ?-????????? ?? ??????????? ?????? ??????????? ?????????? ???????, ??????? ???????? ?????????? ??????????? ? ?????? ?????? ? ????????? ??/?? ??? Q.

- ????? ??????? ?????????? ???????? ?.?. “?????????” ??. ???????? ????? ???????? ????????? ? ?????? ?????????? ??????????? ? ?????????? ??????????????, ?????????????? ?????????? ????????. ????????? ?? ? ???? ??????? ??????????: 1) ??????????? ?????????????? ??????????? ? ????????? ??? ?????????, ?????????? ? ??????????????, 2) ????????? ??????????? ????????? ??? ????????? ??? 3) ??????????? ???????? ????????? ? ???????? ??? ?????? ? ??????????.

?????????????? ????? ??????? ????????????? ???????? ??? ??????????? ?????????? ???????? ? ????????? ??????? ? ??????? ??????, ??????????? ? ???????????????? ??? ??/?? ??? Q. ?????????? ???????????????? (??? ??? ?????????? ???????????? (??)) ??????????? ??? ????????? ????????, ??????????? ?????????, ?????????????? ??????????? ?????????? ? ??? ????????? ??????????????? ????????? ?????????. ??????? ? ?????? ????????????????, ??????????? ????? ??????????????, ???????????? ?? ?????? ?? ?????? ?????????? ????????, ?? ????? ?? ???? ?????????????? ????????, ????? ??? ??????? ?????? ????????? (??), ????????????? ???????????, ???????????? ????????? ? ????? ???????????????? ??????????????? ????????. ????????? ? ?????????? ??????????????? ? ??????? ? ??/?? ??? Q ?????? ? ??????????? ? ???????????????? ? ????????? ? ??????????? ?????????? ???????????? ? ???????? ???????????? ?? ?????? ????????????.

???? ???????????? ???????? ?????? ?????????:
1. ?? ? ??????? ? ?????????? ?????????? ?????? ????? ?????????? ???????.
2. ?? ? ??????? ? ?????????????? ?????????? ?????????? ???????; ?????? ?? ???????????????? ???? ? ?????? ????????? ?? ????????? ???????? ?? (EF < 0.50).
3. ?? ? ??????? ? ?????????????? ?????????? ? ?????????? ???????? ????????????? ????? ???????? ?????????? ??????? (???) ??? ????????? ???????? ?? (EF < 0.50).
4. ??? ??? ?? ? ??????? ? ????- ??? ?????????????? ??????????, ? ??????? ??????? ???????????????? ??????????????? ????????.
5. ??? ? ??????? ? ??????????????? ?????????? ? ????????? ?????????? ?????????, ? ?????????? ???????? ??, ??? ????????? ???????.
6. ????????????? ?????????? IIb/IIIa GP ?????????? ??????????? ? ??????? ? ?? ??? ?????????? ???.
7. ????????? ?? ? ??????? ? ?????????????? ????????? ???????? ??????, ???????? ??? ???????????? ?????????????? ????? ? ???.
8. ??? ??? ????????? ???????? ???????? ?????? ??? ??? ????????????? ???????? ? ???????, ?????????? ??????? ??????????? ?? ????????? ??.
9. ??? ??? ?? ? ??????? ? ????- ??? ?????????????? ?????????? ??? ??????????? ????????? ????????????? ????? ???, ? ????????? ??????? ???????????????? ??????????????? ????????.
10. ??? ??? ?? ? ??????? ? ?????????? ?????????? ????????????? ????? ???.
11. ??? ? ??????? ???????? ???????? ? ????????????? ?????????? ?????????? ???????.
12. ??? ? ??????? ???????? ???????? ??? ????????? ???????? ?? ? ????- ? ?????????????? ??????????, ? ?????????? ???????? ????????????? ????? ??? ? ?????????? ?????????? ????????? ??? ?????????? ????????????? ?????????? ????????????.

?????????????? ?????????? ????????????? ??? ??. ? ????????? ???? ??????????????? ?????????? ? ????????? ? ??????? ??????? ???????????????? ????????????? ??????????? ? ?????? ?????? ?????????? ??????? ? ????????????? ????????? ???? ??? ? ??????? ? ??/?? ??? Q. ??????? ????????????? ??????? ? ?????????? ??????????? ??? ????? ????????? ???????????? ? ????????????? ????? ????????????.

?????? “?????????????? ?????????? ?????????????” ???????? ????? ???????, ????? ??? ??????????? ????????? ????????????? (????), ??????????????? ????????????? ? ???????????????? ?????????? (???????????, ????????????, ?????). ??????????? ???????????? ??? ???????????? ????????? ?????????????? ? ??????????????. ????????????? ??????????? ??? ???????? ????? ?????? ???????? ??????? ? ???????? ??????? ??????????. ????????????? ????? ???????? ?????? ???????????? ?????????? ???????? ? ? 1998 ???? ???????????? ? 525000 ?? 750000 ??????? ??? ? ???.

??? ?????????? ??????????? ????????, ??????????? ??????????? ??????????? ? ???????? ? ??????? ??????? ?????????????? ????????? ????? ??????????? ????????? ????????????? ? ?????????????. ????? ?????? ??????????? ???? ??? ????????? ???????????????? ?????????, ??? ???????? ???????????? ????? ?? ??????? ???????? ????????????????. ??????????? ??????????? ???? ? ??????? ?? ?????????? ???????????? ????? ???????? ? ????????? ?????? ??-??????? ?? ????? ?????????????? ?????????????. ??????? ????????????? ???????? ?????????? ??????????? ??????????? ? ?????????????? ?????????? IIb/IIIa GP ?????????? ???????????.

?????? ??????????, ????? ??? ????????????????? ??????? Angiojet ? ?????????????? ??????????? (?????????????? ?????????????? ???????) ???????????? ? ??????? ??????????? ???????? ?? ????? ?????????????? ????????. ? ????????? ??????? ?????????????? ??????????? ????? ???? ???????????? ??? ????????? ???????? ?????? ??? ???????? ??????????????? ????????? ? ???????. ? ????? ????????? ??? ??????? ???????????? ? ????????? ? ????????? ?????????????? ? ??????????????.

?? ?????? ?????? ???????????? ??????????? ????????????? ??? ??? ??/?? ??? Q ?????????. ????? ??? ??????? ?? ??????? ? ??????? ????????????, ???????? ?????????, ?????? ????????? ? ????? ?????????. ??? ?? ?????, ?????????? ??? ? ??????? ? ??/?? ??? Q ???????? ?????????? ???????. ????????, ? ???????????? TIMI IIIB ???????????????? ????? ????????????? ?????????? ? 96% ??????? ? ????. ?? ??????????? ?????????, ???????????????? ?? ?????? ? 2%, ?????????? ???????? ?? ????????????? ? 1,4%, ? ????????? ????? ???????????? ???? ? 0,5%.

????????????? ?????????? ????????? ????????????? ? ??????? ? ?? ? ????????? ?? ?????????? ???????????? ???? ??????? ? ???? ????????????. ?? ???? ???????? ??????????? ??????? ?????????? ???????????? ?????? ????????????? (92% ??? ??, 94% ??? ?????????? ???????????), ???????????? ??????????? (0,3% ? 0,1%) ? ?????????? ???????? ???????? ?? ?????????? 6-????????? ??????? ??????????. ????? ??????? ???? ????????, ??? ???? ???????? ?????? ???????????????? ? ?????????? ?????????????? ? ??????? ? ???????????? ? ?????????? ????????????. ?????????????? ??????????????? ?????? ??????? ??????????????? ??????????? ??????? (< 48 ????? ????? ??????????????) ? ???????????? (> 48 ?????) ???????????? ? ??????? ? ??.

????????? ???????????? (?????????? ? 1980-? ????) ??????????????????, ??? ? ??????? ? ?? ???????????? ???? ???? ??????????? ??. ??????????? ???? ?????????????? ?????? ????????? ??????? ? 5% ? ????????? ????????? ? 35% — 45% ?? ?????????? 6-????????? ???????. ?????????? ????????????? ????? ???????? ????????????? ????, ?.?. ??????????? ?????? ??????? ? ????????????? ?????????? ??????? ?????? ???????? ? ???????? ?????????. ? ?????? ???????, ????????? ???????????? ????????, ??? ??????????? ?????? ? ??????? ? ?? ?????? ?????????????? ????? ???????? ??????????????? ????????, ??? ?????????? ??????????? ? ????????.

?????????? ??????????? ? ?????????????? ????????????????. ???????????? ??????????? ? ??????? ??????? ? ??/?? ??? Q ? ??????? ??? ????? ?????????? ?????????? ?????????? IIb/IIIa GP ?????????? ???????????. ???????????? ?????? ??????? ???????? ?? ???, ??? ?????????? ?????? ?????? ???? ? ???????? ??????????? ?????????? ? ??????? ? ??/?? ??? Q ??? ?? ????? ???. ? ????????? ????? ? ??? ???????? ? ???????????? ?????????? ??? ????????? IIb/IIIa GP ?????????? ???????????: ?????????? (??????), ????????? (?????????) ? ??????????? (??????????). ??? ???????? ????????????? ??????????? ???? ????????? ????????????: Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC), Evaluation of PTCA and Improve Long-term Outcome by c7E3 GP IIb/IIIa receptor blockade (EPILOG), CAPTURE ? Evaluation of Platelet IIb/IIIa Inhibitor for STENTing (EPISTENT). ????????????? ?????????? ????????? ? ????????????? PRISM, PRISM-PLUS ? Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis (RESTORE). ???????? ???????????? ??????????? ? ????????????? Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis (IMPACT) ? PURSUIT. ??? ??? ????????? ?? ??????????? ???????????? ???????? ??????? ????????????? ? ???????? ??????????? ?????????? ? ??????? ? ?? ??? ?????????? ???.

???? ???????, ?????????? ??? ????????????????? ??? ? ??????????????? ??????????? ???????????? ????????, ??? ??? ???????? ? ???????????? ? ????????????????? ?????? ? ??????????? ??????? ? ??/?? ??? Q. ???????????? ???? ???????????? ????? ???? ???????? ??? ?????????????? ????????????? ??????????? IIb/IIIa GP ?????????? ??????????? ? ??????????? ??????? ?????????, ????????? ? ???????????????? ???????????.

??????????

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2. Theroux P., Fuster V. Acute coronary syndro-mesunstable angina and non–Q-wave myocardial infarction. Circulation 1998;97:1195-1206

3. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non–Q-wave myocardial infarction [erratum appears in N Engl J Med 1998;339:415]. N Engl J Med 1998;338:1488-1497

4. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. The EPIC Investigation. N Engl J Med 1994;330:956–61.

5. EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med 1997;336:1689-1696

6. EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet 1998;352:8

7. Jones R.H., Kesler K., Phillips H.R., et al. Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease. J Thorac Cardiovasc Surg 1996;111:1013-1025

8. Hannan E.L., Racz M.J., McCallister B.D., et al. A comparison of three-year survival after coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1999;33:63-72

9. Rahimtoola S.H., Nunley D., Grunkemeier G., Tepley J., Lambert L., Starr A. Ten-year survival after coronary bypass surgery for unstable angina. N Engl J Med 1983;308:676-681

10. Moreyra A.E., Palmeri S.T., Wilson A.C., Kulkarni A., Kulkarni R. Coronary angioplasty in unstable anginacontemporary experience. Can J Cardiol 1995; 11:385-390

11. Stammen F., De Scheerder I., Glazier J.J., et al. Immediate and follow-up results of the conservative coronary angioplasty strategy for unstable angina pectoris. Am J Cardiol 1992;69:1533-1537

12. Perry R.A., Seth A., Hunt A., Shiu M.F. Coronary angioplasty in unstable angina and stable angina: a comparison of success and complications. Br Heart J 1988;60:367-372

13. Safian R.D., Snyder L.D., Synder B.A., et al. Usefulness of percutaneous transluminal coronary angioplasty for unstable angina pectoris after non-Q-wave acute myocardial infarction. Am J Cardiol 1987;59:263-266

14. Kamp O., Beatt K.J., De Feyter P.J., et al. Short-, medium-, and long-term follow-up after percutaneous transluminal coronary angioplasty for stable and unstable angina pectoris. Am Heart J 1989;117:991-996

15. Cairns J., Theroux P., Armstrong P., et al. Unstable anginareport from a Canadian expert roundtable. Can J Cardiol 1996;12:1279-1292

16. Khan M.M., Ellis S.G., Aguirre F.V., et al. Does intracoronary thrombus influence the outcome of high risk percutaneous transluminal coronary angioplasty? Clinical and angiographic outcomes in a large multicenter trial. EPIC Investigators. Evaluation of IIb/IIIa Platelet Receptor Antagonist 7E3 in Preventing Ischemic Complications. J Am Coll Cardiol 1998;31:31-36

17. Schuhlen H., Kastrati A., Dirschinger J., et al. Intracoronary stenting and risk for major adverse cardiac events during the first month. Circulation 1998;98:104-111

18. Angidi M., Danchin N., Gangtoff C., et al. Ticlopidine-aspirin as anti-thrombotic regimen for intracoronary stenting for unstable anginais there a need for further antiplatelet therapy (abstr)?. J Am Coll Cardiol 1998;31:100A

19. Topol E.J., Califf R.M., Weisman H.F., et al. Randomised trial of coronary intervention with antibody against platelet IIb/IIIa integrin for reduction of clinical restenosisresults at six months. The EPIC Investigators. Lancet 1994;343:881-886

20. Topol E.J., Ferguson J.J., Weisman H.F., et al. Long-term protection from myocardial ischemic events in a randomized trial of brief integrin ?3 blockade with percutaneous coronary intervention. EPIC Investigator Group. Evaluation of Platelet IIb/IIIa Inhibition for Prevention of Ischemic Complication. JAMA 1997;278:479-484

21. Kong D.F., Califf R.M., Miller D.P., et al. Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation 1998;98:2829-2835

?????????? ?.?., ????????? ?????????? ??????????? ???????? ?????? ??????????? ??????????? ? ????????-?????????? ???????? (?????. ?????? ????. ????????? ?.?.), ??????? ??????????? ???????? ?1 (??. ???? ???????? ?.?.
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