Статья
Инфаркт миокарда, осложненный ишемическим инсультом: факторы риска, прогноз, нерешенные проблемы и перспективы профилактики
Настоящая работа представляет собой анализ современных публикаций, посвященных различным аспектам развития и течения ишемического инсульта на фоне острого инфаркта миокарда (ИМ). Поиск литературы был проведен на сайтах кардиологических и неврологических обществ, а также по базам данных PubMed, EMBASE, eLibrary с использованием ключевых слов: инфаркт миокарда, острый коронарный синдром, инсульт, острое нарушение мозгового кровообращения, myocardial infarction, acute coronary syndrome, stroke. Авторами настоящего обзора установлено, что, хотя инсульт и относится к достаточно редким осложнениям ИМ, его профилактика является важной задачей, поскольку он ассоциируется с высокой летальностью, инвалидизацией и значительным повышением стоимости лечения. Так, важно своевременно выявить тромбоз полости левого желудочка, зарегистрировать существующую ранее или впервые возникшую фибрилляцию предсердий с последующим назначением антикоагулянтной терапии. Своевременное реперфузионное лечение, назначение статинов и современной двойной антитромботической терапии может снизить риск развития нарушения мозгового кровообращения у больных ИМ. Вполне вероятно, что снижение активности субклинического воспаления после ИМ также позволит снизить риска инсульта, что было недавно показано в исследовании COLCOT. Таким образом, в настоящее время остается актуальным поиск новых знаний о факторах риска инсульта, осложнившего течение ИМ, что позволит разработать более эффективные и персонализированные меры профилактики у пациента с острой коронарной катастрофой.
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