clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-GCP-0014KIWAANclinvest-843Research ArticleВНУТРЕННИЕ БОЛЕЗНИINTERNAL MEDICINEТактика и особенности применения инструментальных и медикаментозных методов лечения у госпитализированных пациентов с COVID-19 и инфарктом миокарда с подъёмом сегмента ST: обзор литературыTactics and features of the use of instrumental and drug treatment methods in hospitalized patients with COVID-19 and myocardial infarction with ST segment elevation: a literature reviewhttps://orcid.org/0009-0009-2612-913XВарданянА. Г.VardanyanA. G.

Варданян Аргишти Гагикович — ассистент кафедры клинической фармакологии им. Ю. Б. Белоусова ИКМ

Москва

Argishti G. Vardanyan — assistant, Department of Clinical Pharmacology named after Yu. B. Belousov

Moscow

argisht@mail.ruhttps://orcid.org/0000-0003-4259-0945ТепловаН. В.TeplovaN. V.

Теплова Наталья Вадимовна — д. м. н., профессор, зав. кафедрой клинической фармакологии им. Ю. Б. Белоусова ИКМ

Москва

Natalia V. Teplova — Dr. Sci. (Med.), professor, Head of the Department of Clinical Pharmacology named after Yu. B. Belousov

Moscow

teplova.nv@yandex.ruЕвсиковЕ. М.EvsikovE. M.

Евсиков Евгений Михайлович — д. м. н., профессор кафедры клинической фармакологии им. Ю. Б. Белоусова ИКМ

Москва

Evgeny M. Evsikov — Dr. Sci. (Med.), professor, Department of Clinical Pharmacology named after Yu. B. Belousov

Moscow

dr.Evsikov@gmail.comhttps://orcid.org/0009-0004-6732-0655ЕршовА. С.ErshovA. S.

Ершов Артём Сергеевич — ординатор 2-го года кафедры клинической фармакологии имени Ю. Б. Белоусова ИКМ

Москва

Artyom S. Ershov — 2nd year resident, Department of Clinical Pharmacology named after Yu. B. Belousov, Institute of Clinical Pharmacology

Moscow

ershik-2001@mail.ruhttps://orcid.org/0009-0007-9130-3267БелоусоваЛ. Б.BelousovaL. B.

Белоусова Людмила Борисовна — лаборант, кафедра клинической фармакологии имени Ю. Б. Белоусова ИКМ 

Москва

Ludmila B. Belousova — laboratory assistant, Department of Clinical Pharmacology named after Yu. B. Belousov

Moscow

ershik-2001@mail.ruФГАОУ  ВО «Российский  национальный  исследовательский  медицинский  университет  им.  Н. И. Пирогова»РоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ ВО «Российский  национальный  исследовательский  медицинский  университет  им.  Н. И. Пирогова»РоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ  ВО  «Российский  национальный  исследовательский  медицинский  университет  им.  Н. И. Пирогова»РоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ  ВО  «Российский  национальный  исследовательский  медицинский  университет им.  Н. И. Пирогова»РоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ  ВО  «Российский  национальный  исследовательский  медицинский  университет  им.  Н. И. Пирогова»РоссияPirogov Russian National Research Medical UniversityRussian Federation202630032026014564Copyright © Варданян А.Г., Теплова Н.В., Евсиков Е.М., Ершов А.С., Белоусова Л.Б., 20262026Варданян А.Г., Теплова Н.В., Евсиков Е.М., Ершов А.С., Белоусова Л.Б.Vardanyan A.G., Teplova N.V., Evsikov E.M., Ershov A.S., Belousova L.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/843Актуальность

Актуальность. Сочетание острого инфаркта миокарда с подъёмом сегмента ST (ИМпST) и инфекции COVID-19 представляет собой серьёзную клиническую проблему, характеризующуюся более тяжёлым течением, высокой тромботической нагрузкой и ухудшением прогноза. Пандемия COVID-19 существенно повлияла на систему оказания помощи пациентам с острыми коронарными синдромами.

Цель

Цель. Провести обзор современной литературы для анализа особенностей тактики ведения, инструментальных и медикаментозных методов лечения у госпитализированных пациентов с сочетанной патологией (COVID-19 и ИМпST), а также оценить влияние пандемии на доступность и исходы реперфузионной терапии.

Основные результаты

Основные результаты. Обзор демонстрирует, что у пациентов с COVID-19 и ИМпST наблюдается более высокая распространённость повреждения миокарда (5–38 %), более выраженная тромботическая нагрузка (многососудистые тромбозы, тромбозы стентов) и нарушение коронарной микроциркуляции. Пандемия привела к снижению числа госпитализаций по поводу ИМпST (до ~20 %), увеличению времени до оказания помощи и, как следствие, к росту частоты осложнений и госпитальной летальности, которая у таких пациентов достигает 28–41 %. Несмотря на возросшие сложности, первичное чрескожное коронарное вмешательство (ЧКВ) остаётся предпочтительным методом реперфузии. Подчёркивается роль гиперкоагуляции и необходимость тщательного подбора антитромботической терапии (включая гепарины и двойную антиагрегантную терапию) с учётом взаимодействий с противовирусными препаратами.

Заключение

Заключение. Ведение пациентов с ИМпST на фоне COVID-19 требует мультидисциплинарного подхода, учиты вающего повышенный тромбогенный риск и системное воспаление. Оптимизация сроков реперфузии, адаптация протоколов антикоагуляции и поддержание доступности инвазивных процедур являются ключевыми факторами улучшения исходов в условиях пандемии.

Background

Background. The co-occurrence of ST-segment elevation myocardial infarction (STEMI) and COVID-19 poses a significant clinical challenge, characterized by more severe disease, higher thrombotic burden, and worse prognosis. The COVID-19 pandemic has substantially impacted the delivery of care for patients with acute coronary syndromes.

Objective

Objective. To review current literature analyzing the management strategies, instrumental and pharmacological treatment approaches in hospitalized patients with concomitant COVID-19 and STEMI, and to assess the pandemic's impact on the accessibility and outcomes of reperfusion therapy.

Key findings

Key findings. The review indicates that patients with COVID-19 and STEMI exhibit a higher prevalence of myocardial injury (5–38 %), more pronounced thrombotic burden (multi-vessel thrombosis, stent thrombosis), and impaired coronary microcirculation. The pandemic led to a decrease in STEMI hospitalizations (up to ~20 %), increased time to treatment, and consequently, a rise in complication rates and in-hospital mortality, which reaches 28–41 % in these patients. Despite increased procedural challenges, primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy. The role of hypercoagulability and the need for careful tailoring of antithrombotic therapy (including heparins and dual antiplatelet therapy), considering drug interactions with antivirals, are emphasized.

Conclusion

Conclusion. Management of STEMI patients with COVID-19 requires a multidisciplinary approach that accounts for heightened thrombogenic risk and systemic inflammation. Optimizing reperfusion timelines, adapting anticoagulation protocols, and maintaining access to invasive procedures are key factors for improving outcomes during the pandemic.

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