fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2025-10-2-82-95fcmedicine-1022Research ArticleКАРДИОЛОГИЯCARDIOLOGYПредикторы прогрессирования стабильной ишемической болезни сердца в постковидном периодеPredictors of stable coronary artery disease progression in the post-COVID period.https://orcid.org/0000-0002-5097-1855ДеришеваД. А.DerishevaD. A.

Деришева Дарья Александровна, кандидат медицинских наук, доцент кафедры фармакологии, клинической фармакологии и доказательной медицины фармакологического факультета

пр-т Красный, д. 52, г. Новосибирск, 630091

Dr. Daria A. Derisheva, MD, Cand. Sci. (Medicine), Associate Professor, Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine, Faculty of Pharmacology

Krasnyi Prospekt, 52, Novosibirsk, 630091

one.d@mail.ruhttps://orcid.org/0000-0003-4735-5178ЯхонтовД. А.YakhontovD. A.

Яхонтов Давыд Александрович, доктор медицинских наук, профессор кафедры фармакологии, клинической фармакологии и доказательной медицины фармакологического факультета

пр-т Красный, д. 52, г. Новосибирск, 630091

Prof. David A. Yakhontov, MD, Dr. Sci. (Medicine), Professor, Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine, Faculty of Pharmacology

Krasnyi Prospekt, 52, Novosibirsk, 630091

https://orcid.org/0000-0002-3411-508XЛукиновВ. Л.LukinovV. L.

Лукинов Виталий Леонидович, кандидат физико-математических наук, ведущий научный сотрудник лаборатории численного анализа стохастических дифференциальных уравнений

пр-т академика Лаврентьева, д. 6, г. Новосибирск, 630090

 Dr. Vitaliy L. Lukinov, Cand. Sci. (Physical and Mathematical Sciences), Leading Researcher, Laboratory of Numerical Analysis of Stochastic Differential Equations

Akademika Lavrentieva Prospekt, 6, Novosibirsk, 630090

Новосибирский государственный медицинский университетРоссияNovosibirsk State Medical UniversityRussian FederationИнститут вычислительной математики и математической геофизики Сибирского отделения Российской академии наукРоссияInstitute of Computational Mathematics and Mathematical Geophysics, Siberian Branch of the Russian Academy of SciencesRussian Federation2025300620251028295Copyright © Деришева Д.А., Яхонтов Д.А., Лукинов В.Л., 20252025Деришева Д.А., Яхонтов Д.А., Лукинов В.Л.Derisheva D.A., Yakhontov D.A., Lukinov V.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/1022

Цель. Оценить особенности течения стабильной ишемической болезни сердца (ИБС) в зависимости от времени ее дебюта в контексте перенесенной COVID-19 и определить предикторы прогрессирования заболевания в постковидном периоде. Материалы и методы. В исследование включен 431 пациент со стабильной ИБС, перенесший подтвержденную COVID-19 инфекцию с 2020 по 2023 гг., за 3 месяца и более до исследования. Пациенты были разделены на 2 группы в зависимости от времени дебюта ИБС: в 1-ю группу вошли 198 больных, у которых ИБС была впервые диагностирована в постковидном периоде, во 2-ю группу – 233 больных с ИБС, диагностированной до перенесенной COVID-19 инфекции. В исследовании использовались клинико-лабораторные методы диагностики, включая показатели липидного профиля (уровень аполипопротеинов А1 (апо А1), В (апо В), липопротеина (а) (Лп(а)), N-терминального фрагмента мозгового натрийуретического пептида (Nt-proBNP), стимулирующего фактора роста (ST2), а также коронароангиография. Для выявления предикторов прогрессирования ИБС на основании комплексного анализа клинических данных использован метод логистической регрессии. Результаты. Пациенты 2-й группы были старше (медиана возраста 62 vs 61 лет, p = 0,009), имели больший индекс массы тела (ИМТ) (31,02 vs. 28,73 кг/м², p < 0,001) и более длительный анамнез артериальной гипертензии (15 vs. 9,5 лет, p < 0,001). Течение COVID-19 во 2-й группе характеризовалось большей тяжестью: статистически чаще требовалась госпитализация (50,2% vs. 37,8%, p = 0,012) и преобладала среднетяжелая степень SARS CоV-2 в остром периоде (58,7% vs. 45,9%, p <0,009). Также во 2-й группе преобладали пациенты с перенесенным инфарктом миокарда (51,0% vs. 26,7%, p <0,001) и гемодинамически значимым поражением коронарных артерий (86,2% vs. 67,6%, p <0,001). В то же время неизмененные коронарные артерии чаще встречались у пациентов 1-й группы (8,5% vs. 7,2%, p = 0,003), что может указывать на роль микрососудистого повреждения в патогенезе ИБС в постковидном периоде. Распространенность мультифокального атеросклероза была высокой в обеих группах (75,7% vs. 79,8%, p = 0,351). ХСН с умеренно сниженной ФВ значимо чаще выявлялась во 2-й группе больных (10,7% vs. 5,0%, p = 0,034), тогда как ХСН с сохраненной ФВ преобладала в 1-й группе (94,9% vs. 89,2%, p = 0,034). ФВ ЛЖ и скорость клубочковой фильтрации (СКФ) были статистически ниже во 2-й группе (60% vs. 62%, p = 0,007) и (63,0 мл/мин/1,73 м² vs. 67,5 мл/мин/1,73 м², p <0,001) соответственно. Лабораторные показатели также демонстрировали различия: показатели триглицеридов, Лп(а), апоВ, мочевой кислоты и цистатина С были значимо выше во 2-й группе (p <0,05). Многофакторный анализ выявил значимые предикторы прогрессирования ИБС в постковидном периоде, к которым отнесены длительность стенокардии > 2,5 лет, ИМТ > 29,66 кг/м², перенесенный COVID-19 среднетяжелой степени, Лп(а) > 317.6 мг/дл и NT-proBNP > 161.04 пг/мл. Заключение. Результаты исследования подчеркивают значимость временного фактора дебюта ИБС у пациентов, перенесших COVID-19 инфекцию, что требует дифференцированного подхода к стратегии их ведения для прогнозирования течения заболевания.

Aim. To evaluate the clinical course of stable coronary artery disease (CAD) depending on the timing of disease onset in relation to COVID-19 infection, and to identify predictors of disease progression during the post-COVID period. Materials and Methods. This study included 431 patients with stable CAD who had a confirmed history of COVID-19 between 2020 and 2023, with a minimum of 3 months between infection and enrollment. Patients were divided into two groups based on the timing of CAD diagnosis: patients diagnosed with CAD in the post-COVID period (n = 198, post-COVID-CAD) and patients diagnosed with CAD before their COVID-19 infection (n = 233, pre- COVID-CAD). We further evaluated clinical and laboratory parameters, including lipid profile (apolipoprotein A1, apolipoprotein B, lipoprotein( a)), N-terminal pro-brain natriuretic peptide (NT-proBNP), ST2, and coronary angiography. Logistic regression analysis was used to identify predictors of CAD progression. Results. Patients with pre- COVID-CAD were older (median age 62 vs. 61 years, p = 0.009), had a higher body mass index (BMI: 31.02 vs. 28.73 kg/m², p < 0.001), and a longer history of arterial hypertension (15 vs. 9.5 years, p < 0.001). COVID-19 was more severe in patients with pre-COVID-CAD, with a higher hospitalization rate (50.2% vs. 37.8%, p = 0.012) and more frequent moderate cases during the acute phase (58.7% vs. 45.9%, p < 0.009). Patients with pre-COVID-CAD also had a higher prevalence of prior myocardial infarction (51.0% vs. 26.7%, p < 0.001) and hemodynamically significant coronary artery lesions (86.2% vs. 67.6%, p < 0.001). Conversely, normal coronary arteries were more often observed in patients with post-COVID-CAD (8.5% vs. 7.2%, p = 0.003), possibly indicating microvascular involvement in post-COVID-CAD pathogenesis. Multifocal atherosclerosis was prevalent in both groups (75.7% vs. 79.8%, p = 0.351). Heart failure with mildly reduced ejection fraction (HFmrEF) was more common in patients with pre-COVID-CAD (10.7% vs. 5.0%, p = 0.034), whereas heart failure with preserved ejection fraction (HFpEF) predominated in patients with post-COVIDCAD (94.9% vs. 89.2%, p = 0.034). Left ventricular ejection fraction and glomerular filtration rate were significantly lower in patients with pre-COVID-CAD (60% vs. 62%, p = 0.007; 63.0 vs. 67.5 mL/min/1.73 m², p < 0.001, respectively). Laboratory indicators such as triglycerides, Lp(a), apoB, uric acid, and cystatin C were significantly elevated in patients with pre-COVID-CAD (p < 0.05). Multivariate analysis identified the following significant predictors of CAD progression in the post-COVID period: angina duration > 2.5 years, BMI > 29.66 kg/m², a history of moderate COVID-19, Lp(a) > 317.6 mg/dL, and NT-proBNP > 161.04 pg/mL. Conclusion. The timing of CAD onset in relation to COVID-19 significantly influences the disease course, emphasizing the need for a differentiated management strategy in post-COVID patients to predict CAD progression

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