Н.Л. Цапаева, Е.Б. Петрова, А.А. Плешко
УО «Белорусский государственный медицинский университет», ГУ «Республиканский научно-практический центр «Кардиология»
Увеличение количества пожилых людей в медицинском аспекте – это преобладание в структуре заболеваемости патологии, которая определяется коморбидностью, системностью поражения и неблагоприятным прогнозом. Коморбидные пациенты являются наиболее уязвимой группой, у которой риск фатальных исходов особенно высок. В представленном обзоре рассмотрена проблема ведения острого коронарного синдрома (ОКС) у пожилых пациентов в условиях пандемии COVID-19. Приведены результаты рандомизированных клинических исследований и регистров последних лет, целенаправленно включивших пациентов с ОКС пожилого возраста. Особое внимание уделено необходимости гериатрической оценки пациентов, наличию и выраженности старческой астении и ее влиянию на выбор тактики лечения и прогноз. Рассмотрена проблема выбора метода реваскуляризации миокарда и схем медикаментозной терапии у пожилых пациентов в условиях пандемии. Отражены вопросы, касающиеся лекарственного взаимодействия препаратов для лечения острых форм ишемической болезни сердца и препаратов для лечения COVID-19. В этой ситуации особое значение имеет учет рисков возможных межлекарственных взаимодействий, что особенно актуально у пожилых коморбидных пациентов. Рассмотрены основные тенденции в выборе тактики лечения пожилых пациентов с ОКС в период пандемии COVID-19.
ключевые слова: острый коронарный синдром, коронавирусная инфекция, COVID-19, пожилой пациент, гериатрический синдром, реваскуляризация миокарда, антитромботическая терапия

для цитирования: Н.Л. Цапаева, Е.Б. Петрова, А.А. Плешко. Пожилой пациент с острым коронарным синдромом: особенности ведения в период пандемии COVID-19. Неотложная кардиология и кардиоваскулярные риски, 2021, Т. 5, № 2, С. 1395–1405

An elderly patient with acute coronary syndrome: management during COVID-19 pandemic
N.L. Tsapaeva, Е.B. Petrova, A.A. Pleshko
An increased number of elderly people in the medical terms means the predominance of pathology in the morbidity structure, which is determined by comorbidity, systemic lesions and an unfavorable prognosis. Comorbid patients are the most vulnerable group with a particularly high risk of adverse outcomes. In the presented review, the problem of management of acute coronary syndrome (ACS) in elderly patients in the context of the COVID-19 pandemic is addressed. The review demonstrates results of randomized clinical trials and registries of recent years, which purposefully included patients with ACS aged ≥ 75 years. Particular attention is paid to the need for a geriatric assessment of patients, the presence and severity of senile asthenia and its influence on the choice of treatment tactics and prognosis. The problem of choosing a method of myocardial revascularization and drug therapy schemes in elderly patients is considered under pandemic conditions. Issues related to drug interactions between drugs for the treatment of acute forms of coronary heart disease and drugs for the treatment of COVID-19 are reflected. In this situation, taking into account the risks of possible drug-drug interactions is of particular importance, which is especially challenging in elderly comorbid patients. Based on the available data, we have analyzed the main trends in the choice of treatment tactics for elderly patients with ACS during the COVID-19 pandemic.
keywords: acute coronary syndrome, COVID-19, elderly patients, geriatric syndrome, myocardial revascularization, antithrombotic therapy

for references: N.L. Tsapaeva, Е.B. Petrova, A.A. Pleshko. An elderly patient with acute coronary syndrome: management during COVID-19 pandemic. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2021, vol. 5, no. 2, pp. 1395–1405

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