The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press41810.17650/1818-8338-2020-14-1-2-24-33REVIEWОБЗОРCardiac risk stratification in stable coronary artery diseaseСтратификация риска сердечно‑сосудистых осложнений при стабильной ишемической болезни сердцаhttps://orcid.org/0000-0003-0160-0158TolpyginaS. N.ТолпыгинаС. Н.
Russian Federation

10 Build 3 Petroverigskiy Pereulok, Moscow 101990

Светлана Николаевна Толпыгина

101990 Москва, Петроверигский пер. 10, стр. 3

stolpygina@gnicpm.ruhttps://orcid.org/0000-0002-7717-4362MartsevichS. Yu.МарцевичС. Ю.
Russian Federation

10 Build 3 Petroverigskiy Pereulok, Moscow 101990

101990 Москва, Петроверигский пер. 10, стр. 3

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России15042020141-224330705202007052020Copyright ©; 2020, Tolpygina S.N., Martsevich S.Y.Copyright ©; 2020, Толпыгина С.Н., Марцевич С.Ю.2020Tolpygina S.N., Martsevich S.Y.Толпыгина С.Н., Марцевич С.Ю.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/418

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.

Несмотря на постепенное снижение уровня смертности от сердечно-сосудистых заболеваний, включая ишемическую болезнь сердца (ИБС), они остаются основной причиной смерти населения в мире. В ближайшие десятилетия ожидается увеличение распространенности ИБС. На фоне использования более чувствительных методов диагностики ИБС и снижения летальности при ее острых формах за счет применения высокотехнологичных методов лечения распространенность хронических форм ИБС постепенно растет. Согласно современным клиническим рекомендациям тактика обследования и лечения конкретного пациента со стабильной ИБС зависит от прогноза заболевания, поскольку только у пациентов группы высокого риска реваскуляризация миокарда способна улучшить прогноз жизни, однако большинство пациентов получают унифицированную терапию. Несмотря на то что известно множество прогностически значимых факторов, моделей и индексов, разработанных для оценки риска смерти и сердечно-сосудистых осложнений при ИБС, единого подхода к стратификации риска в настоящее время не существует. В данной статье представлен обзор данных литературы об исторических аспектах выявления основных прогностически значимых признаков (клинико-анамнестических и психосоциальных характеристик, коморбидности), данных неинвазивных инструментальных исследований, таких как электрокардиография, эхокардиография, тесты с дозированной физической нагрузкой, инвазивной коронароангиографии и некоторых из существующих прогностических моделей и индексов, которые могут помочь практическому врачу в стратификации риска сердечно-сосудистых осложнений у конкретного пациента со стабильной ИБС.

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