Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

Aim. To study real-world data on managing patients with coronary artery disease (CAD) and multifocal atherosclerosis (MFA) for 12 months by outpatient cardiologists.Material and methods. KAMMA is a real-world registry organized by the Eurasian Association of Therapists. The main branch included men and women over 18 years of age with confirmed atherosclerosis in two or more arterial systems and one or more risk factors for atherosclerosis. The start date for patient recruitment was February 1, 2022 and the end date was November 27, 2022. The design included 3 following visits: 1 — baseline, 2 — after 6 months, 3 — after 12 months. Twentyeight research centers were located in 7 federal districts of the Russian Federation, as well as in the Republics of Kazakhstan, Uzbekistan and Belarus.Results. A patient population (n=2905) was formed, all of whom had verified CAD. The mean age was 66,0 [59,0; 72,0] years (men — 60,3%). Low-density lipoprotein cholesterol decreased by 20,4% over 12 months, while non-high-density lipoprotein cholesterol — by 12,7%. Over 12 months, lipid-lowering therapy did not undergo significant changes. Statin monotherapy was maintained in 83%, of which only 53,7% of patients received high-dose therapy. Combined statin+ezetimibe therapy was used in 12,4%, while statin+ezetimibe+PCSK9 inhibitor — in 4,6%. During the 1-year follow-up, antithrombotic therapy was not enhanced. Low prescription rate of combination therapy with antiplatelet agents (15,7%) and low-dose rivaroxaban and acetylsalicylic acid (7,9%) remained. By the follow-up end, a high incidence of major adverse cardiovascular events (8,8%) was registered in patients included in the KAMMA registry.Conclusion. Despite the fact that patients with MFA have a very high cardiovascular risk, routine management of these patients is characterized by high clinical inertia. During the 1-year follow-up, lipid-lowering and antithrombotic therapy was not properly strengthened, due to which the target levels of key lipid profile parameters were not achieved and a high rate of major adverse cardiovascular events was observed in patients included in the registry.

Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry. Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%). Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group. Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.

Background:Recurrent ischemic symptoms after coronary artery bypass grafting (CABG) may require repeat percutaneous coronary intervention (PCI). Hypertension is common in coronary artery disease, but its value for predicting repeat revascularization after CABG is uncertain. High residual platelet reactivity (HRPR) may improve risk prediction. Objective: To evaluate the association of arterial hypertension and HRPR with repeat PCI after CABG in patients with recurrent ischemic symptoms. Methods: This retrospective single-center study included 195 patients with prior CABG evaluated for recurrent ischemic symptoms 6-36 months after surgery. Patients were stratified by repeat PCI status. HRPR was assessed using the VerifyNow assay; HRPR was defined as PRU≥208. Clinical and angiographic variables were analyzed using logistic regression. Results:Patients requiring repeat PCI were older and had extensive coronary artery disease and chronic kidney disease. Hypertension prevalence was similar between groups. PRU values were significantly higher in the repeat PCI group (230 vs 145, p<0.001), while HRPR was present in 66.2% of these patients and absent in those without repeat PCI. PRU remained associated with repeat PCI after adjustment. Conclusions: In post-CABG patients with recurrent ischemia, hypertension was not associated with repeat PCI, whereas HRPR showed a strong association with repeat revascularization. Введение:Рецидивирующая ишемия после аортокоронарного шунтирования (АКШ) может потребовать повторного чрескожного коронарного вмешательства (ЧКВ). Роль артериальной гипертензии в прогнозировании повторной реваскуляризации остается неясной, тогда как высокая остаточная реактивность тромбоцитов (ВОРТ) может иметь прогностическое значение. Цель: Оценить ассоциацию артериальной гипертензии и ВОРТ с повторным ЧКВ у пациентов после АКШ с рецидивирующими ишемическими симптомами. Материалы и методы: Ретроспективное одноцентровое исследование включило 195 пациентов после АКШ, обследованных через 6–36 месяцев по поводу рецидивирующей ишемии. Пациенты были разделены по наличию повторного ЧКВ. Реактивность тромбоцитов оценивали методом VerifyNow; HRPRопределяли как PRU ≥208. Данные анализировали с использованием логистической регрессии. Результаты:Пациенты, с повторным ЧКВ, были старше и чаще имели более тяжелое поражение коронарных артерий и хроническую болезнь почек. Частота артериальной гипертензии не различалась между группами. Уровни PRUбыли значительно выше в группе повторного ЧКВ (230 против 145; p<0,001). HRPRвыявлялась у 66,2% пациентов с повторным ЧКВ и отсутствовала в группе без него. PRUсохранял значимую ассоциацию с повторным ЧКВ после корректировки. Выводы: У пациентов после АКШ с рецидивирующей ишемией артериальная гипертензия не связана с повторным ЧКВ, тогда как ВОРТ ассоциируется с повышенным риском повторной реваскуляризации и может иметь прогностическую ценность. Кіріспе: Аортокоронарлық шунттау (АКШ) операциясынан кейін қайталанатын ишемиялық симптомдар қайталама тері арқылы коронарлық араласуды (ТКА) қажет етуі мүмкін. Артериялық гипертензияның қайталама реваскуляризацияны болжаудағы рөлі әлі толық анықталмаған, ал тромбоциттердің жоғары қалдық реактивтілігі (ТЖҚР) болжамдық мәнге ие болуы мүмкін. Мақсаты: АКШ-тан кейін қайталанатын ишемиялық симптомдары бар науқастарда артериялық гипертензия мен ТЖҚР -дың қайталама ТКА-мен байланысын бағалау. Материалдар мен әдістер: Ретроспективті бір орталықты зерттеуге АКШ операциясынан кейін 6–36 ай ішінде қайталанатын ишемияға байланысты тексерілген 195 науқас енгізілді. Науқастар қайталама ТКА-ның болуына қарай топтарға бөлінді. Тромбоциттердің реактивтілігі VerifyNow әдісімен бағаланды; ТЖҚР PRU ≥208 ретінде анықталды. Деректер логистикалық регрессия арқылы талданды. Нәтижелер: Қайталама ЧКВ жасалған науқастар жасы үлкен және коронарлық артериялардың айқын зақымдануы мен созылмалы бүйрек ауруы...

Background and Objective. Epistaxis is a frequent bleeding manifestation in patients receiving antithrombotic therapy, and its management falls between otolaryngology and cardiology guidance. We aimed to translate the evidence into an operational framework for joint decisions. Methods. PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library were searched (January 2015 through August 2026), current ESC, ACC/AHA, EHRA, AAO-HNS, and SFORL guidance were analyzed, and national clinical protocols of different countries were screened; 67 sources were included. Results. Direct oral anticoagulants were consistently associated with fewer clinically relevant epistaxis events than warfarin, and minor epistaxis led to permanent anticoagulant discontinuation more often than minor bleeding at other sites. No guideline defines epistaxis severity, and guidance diverges on protected dual antiplatelet therapy, bleeding-risk assessment, and the sequence of local hemostasis and drug interruption. We propose a three-tier severity classification (minor, clinically relevant non-major, major) informed by ISTH and BARC definitions, a pragmatic thrombotic risk stratification, and an algorithm with agent-specific decisions. Conclusions. In minor and most clinically relevant non-major episodes, antithrombotic therapy can usually be continued while local hemostasis is achieved; interruption, de-escalation, or reversal should be individualized and reserved for uncontrolled or major bleeding. Effective local hemostasis can help avoid unnecessary interruption of antithrombotic therapy, and otolaryngologists should be part of multidisciplinary teams managing such bleeding.

Background: Advanced endovascular procedures are increasingly used for ischemic stroke, but real-world evidence from middle-income settings remains limited, particularly regarding survival, disability, and neurorehabilitation. This study examined mortality, recorded disability, procedure-related differences, and neurorehabilitation exposure among patients receiving high-technology stroke care in Almaty, Kazakhstan. Methods: We conducted a retrospective cohort study of 328 adults with ischemic stroke who underwent endovascular or stent-based procedures between 2014 and 2024. Survival was assessed using Kaplan–Meier analysis and Cox proportional-hazards regression. Binary mortality status and recorded disability were examined using logistic regression. Procedure codes were grouped as mechanical thrombectomy/endovascular removal, intracranial stenting, and embolization/coiling/other procedures. Results: Neurorehabilitation was received by 39% of patients and was associated with better crude survival (1 year survival 93.6% vs. 76.7%; 5-year survival 69.0% vs. 60.7%; log-rank p = 0.001). In the adjusted Cox model, older age (HR = 1.069, 95% CI 1.046–1.092, p < 0.001) and greater total bed-day burden (HR = 1.071, 95% CI 1.029–1.116, p = 0.001) were associated with higher mortality hazard. Binary neurorehabilitation was not independently associated with survival (p = 0.803). Male sex was the only consistent factor associated with recorded disability (fully adjusted OR = 2.662, 95% CI 1.261–5.617, p = 0.010). Conclusions: Older age and bed-day burden were the most stable mortality-related factors. Neurorehabilitation was linked to better crude survival but not adjusted survival or recorded disability. Procedure-related and disability findings should be considered exploratory because baseline stroke severity and validated functional scales were unavailable.