The aim of this study was to investigate the prognostic role of initial and residual severity of coronary atherosclerosis by SYNTAX SCORE among ST segment elevation myocardial infarction patients (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Materials and methods. The study included 327 STEMI patients with multivessel coronary atherosclerosis who underwent primary PCI. Two groups were formed to study the prognostic value of initial coronary atherosclerosis severity: SYNTAX ≤22 points (n=213) and SYNTAX ≥23 points (n=114). 317 patients included in the second sub-analysis (the study of the prognostic role of residual severity of coronary atherosclerosis). The patients were divided into two groups, depending on the residual SYNTAX SCORE after primary PCI: ≤8 points (n=243) and ≥9 points (n=74). The endpoints of the study were adverse cardiovascular events over 12 months.

Results. The initial value of SYNTAX ≥23 points led to a significant increase in the rate of death, myocardial infarction (MI) and stent thrombosis (ST) as well as the combined endpoint. The most significant adverse events during the 12 months of observation, associated with the severity of coronary lesions on the SYNTAX ≥23 are: 1) death from any cause – OR 4.9 (95 % CI, p=0.004); 2) cardiac death – OR 5.6 (95 % CI, p=0.004); 3) MI – OR 3.5 (95 % CI, p=0.01); 4) The combined endpoint – OR 2.4 (95 % CI, p=0.05); 5) ST – 5 OR (95 % CI, p=0.007). The group of residual SYNTAX ≥9 in comparison with the group SYNTAX ≤8 characterized by less favorable prognosis, which was reflected in a higher frequency of death from all causes – 13.5 % vs. 2.9 % (p=0.001), OR 3.4 (1,5–7,9 95 % CI) (p=0.004), MI – 10.8 % versus 4.1 % (p=0.05), OR 2.7 (1.2–6.1; 95 % CI) (p=0.01), non-target vessel revascularization – 9.5 % versus 2.5 % (p=0.02), OR 2.6 (1.2–5.5; 95 % CI) (p=0.01).

Conclusions. It was demonstrated the high predictive value of initial and residual severity of coronary lesions by SYNTAX SCORE to influence the risk of adverse cardiovascular events in patients undergoing primary PCI. The results obtained may find application in the development of predictive models aimed at determining the optimal strategies revascularization for patients with STEMI in multiple coronary atherosclerosis.

Purpose. To estimate hospital outcomes of different strategies of surgical treatment of patients with concomitant coronary disease and internal carotid artery (ICA) stenoses.

Methods. In a single-center prospective study included 391 patients with hemodynamically significant coronary artery and internal carotid artery stenoses. All patients were divided into four groups depending on the revascularization strategy: 1) staged surgery – coronary bypass grafting (CABG) followed carotid endarterectomy (CE) (CABG – CE, n=151, 38.6 %); 2) simultaneous surgery CABG and CE (CABG + CE, n=141, 36 %); 3) hybrid revascularization – percutaneous coronary intervention (PCI) and CE (PCI – CE, n=28, 7.2 %); 4) staged surgery – CE followed CABG (CE – CABG, n=71, 18.2 %).

Results. The average age of the patients was 63,4±6,9 (36–83) years. The average EuroScore II in the general study sample – 4,5±2,4 %, while the severity of coronary atherosclerosis on a SYNTAX Score – 22,5±9,4 points. The majority of patients had multiple coronary lesions (n=361, 92.3 %). Every fourth patient had a significant stenosis of the left main coronary artery (n=92, 23.5 %). Bilateral ICA stenosis diagnosed in 60.1 % of patients; 28.1 % of patients had a history of stroke or TIA. Almost one in three patients (29.7 %) had diabetes. Mortality rates in the overall study sample was 2 % (n=8), the majority of cases were reported in CE – CABG group. Perioperative myocardial infarction was recorded in CABG – CE (n=2, 1.3 %) and CABG + CE (n=2, 1.4 %) group, while the other two groups missing this complication (p>0.05). The least favorable for stroke / TIA rate was CE – CABG group, while patients of CABG – CE group had minimal level of this complications. CABG + CE and PCI – CE groups took an intermediate position. The maximum amount of bleeding that required re- mediastinotomy noted in CABG – CE group (n=10, 7.1 %).

Conclusion. Patients with concomitant coronary disease and ICA stenoses have high clinical and instrumental concentration of negative factors, associated with a poor prognosis and require the implementation of various surgical revascularization strategies. Maximum severity of complications was recorded in patients with CE – CABG and CABG + CE revascularization strategy. Despite this, the results of simultaneous surgery are very promising.

Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) occurring in left-to-right shunt. The progression of PAH is associated with delayed diagnosis and surgical treatment of congenital heart disease. An uncorrected left-to-right shunt in patients with CHD lead to histological changes of pulmonary vessels and reversal of the shunt may arise, with the development of Eisenmenger’s syndrome. Until recently, the surgical treatment of patients thought to be impossible, and few attempts to perform radical correction were associated with high in-hospital mortality. The main causes of the in-hospital mortality included acute right ventricular failure, pulmonary hypertension crisis and cardiac arrhythmias. The long-term survival of these patients was low, directly associated with the progression of residual pulmonary hypertension. The novel technique of a fenestrated double patch has been widely used abroad, but very rarely in Russia. Moreover, there is no standardized algorithm for selecting surgical approach in these patients as well as common approaches to the preoperative management and anesthetic protocol. The efficiency of specific therapies for residual pulmonary hypertension is poorly understood. Lack of research and experience in applying the fenestrated double patch in Russia for a population of children and adolescents who require combined treatment (surgical and specific therapy for pulmonary arterial hypertension) proved our research to be pivotal.

Purpose. Examine the clinical and cost-effectiveness of the use of methods of measurement of fractional flow reserve in the treatment of coronary heart disease patients with multivessel coronary.

Materials and Methods. The study included 62 patients with coronary heart disease and multivessel coronary disease who underwent multi-stage endovascular revascularization.

Results. Conducting clinical and economic analysis showed that the use of additional methods of measurement of fractional flow reserve in patients with multivessel coronary disease increases the cost of percutaneous coronary interventions during the first phase of myocardial revascularization. But at the same time, it reduces the cost of treatment of the patient in general, reducing the «cost of disease.» This is achieved by reducing the need for patient readmission rates for the second phase of myocardial revascularization.

There is a current view on the problem of clinical importance of the treatment of patients with atrial fibrillation, pathophysiological basis and selection of the optimal catheter or surgical ablation method, based on review of current guidelines and expert consensus is in this review.

The most efficient method of restitution of a blood-groove at a myocardial infarction is implantation of a stent in a heart attack the bound artery. Restitution of a blood-groove in a heart attack of the bound artery starts processes of reperfusion damage, thereby increasing a hibernation zone with the subsequent nekrosis of a myocardium. Now several techniques helping to resist efficiently to reperfusion damage of cardiomyocyts are considered. Mechanisms of a pre-conditioning and post-conditioning of a myocardium are actively investigated the last decades, at the same time the common concept of protection of a myocardium is not created. In our opinion pharmacological protection of a myocardium can be considered as the modern technique restoring fabric respirations at the level of mitochondrions.

Purpose. To analyze levels of insulin-like growth factor-1 (IGF-I) in plasma in patients with acute coronary syndrome.

Materials and methods. The identification of concentrations of IGF-I in 71 patients with acute coronary syndrome, comparison groups and control.

Results. IGF-I in myocardial infarction is lower than in the comparison group. Increased IGF-I in unstable angina pectoris has no significant differences with control groups and comparisons. The highest IGF-I levels in the comparison group, the lowest in cases of mortality. Patients older age group have lower concentrations of IGF-I and lower regenerative capabilities to repair damaged vascular wall and myocardium. In the aspect of the «cardiovascular continuum» reparative role of IGF-I is also defined for acute kidney injury in patients with ACS. Correlation of IGF-I with the basic laboratory parameters of renal system reflect the nature of the protein impact, an opportunity for an expanded range of applications. IGF-I in patients with ACS within the first 24 hours acts as a vector of mortality.

Conclusions. IGF-I is a new highly sensitive biochemical marker of vascular inflammation and damage, can be used in the laboratory diagnosis of acute coronary syndrome. IGF-I levels decline with increasing age of patients with ACS. In the aspect of the «cardiovascular continuum» reparative role of IGF-I is systemic in nature, exerting its beneficial effects on the kidneys.

Purpose. To evaluate the association between polymorphisms APOE rs7412+rs429358 and traditional risk factors for CHD in patients with myocardial infarction with ST-segment elevation.

Materials and Methods. 358 patients admitted with STEMI and undergoing diagnosis and treatment at the Kemerovo Cardiology Clinic were included in the study. Blood samples were collected at days 2–14 for genotyping. Clinical and demographic data, laboratory and instrumental findings were assessed. Data analysis was performed using the STATISTICA program (version 8.0; StatSoft, Tulsa, Oklahoma) and SPSS Statistics 17.0.

Results. The carriers of the e4 allele of gene APOE was associated with adverse anamnestic characterisics, such as myocardial infarction in anamnesis, severe chronic heart failure and prior angina. The carriers of the e4 allele had a higher level of LDL and severe coronary arterial sclerotic disease (SYNTAX ≥23 score (OR=2.10, 95 % CI=1.26–3.51, p=0.005). The carriers of the e4 allele had signs of multifocal atherosclerosis (OR=2.44, 95 % CI=1.17–5.12, p=0.02) and reduction of left ventricular ejection fraction less 40 % (OR=5.25, 95 % CI=1.06–27.39, p=0.04).

Conclusion. Was demonstrated, that gene APOE associated not only with lipid metabolism disorders, but also to the clinical criteria of severe STEMI and can to be used as a marker adverse clinical progression of STEMI.

Purpose. To study the dynamics of the emergence and clinical course of acute myocardial infarction (AMI) in young patients and to compare the changes in treatment strategies at various time intervals in this age group patients.

Materials and methods. Selection of clinical material was carried out as a continuous sample from the database of the «Acute Myocardial Infarction Registry» (AMIR). Inclusion criteria: young patients (younger than 45 years) suffered from acute myocardial infarction (AMI). All favorable outcomes were studied separately: 69 clinical cases in 2005–2007, and 109 episodes in 2012–2014.

Results. The history of young patients was burdened. AMI was manifested with typical heart attack in more than 90 % of cases in both time intervals. The duration of the period of «pain-hospital» remained the same, despite the significant reduction of time delays at the stage of «pain-call the ambulance». The majority of young patients with AMI were hospitalized in a specialized cardiology departments: in recent years, the proportion of such patients substantially increased (from 85.5 to 95.4 %, p=0.04). Vital medicines were recommended to the majority of young patients at discharge from hospitals, and the frequency of their assignment had increased.

Conclusion. The frequency of AMI in young patients has not significantly changed, as well as the gender composition. AMI was occurred on the background of diabetes mellitus in young patients. The establishment of vascular centres and primary hospitalization of young patients to specialized medical institutions has contributed to a significant intensification of interventions in the acute period of MI.

Purpose. We study of enzyme activity of blood platelets in patients with acute coronary syndrome (ACS) in a combination with anxiety and depressive disorders (ADD ).

Materials and methods. We examined 315 patients of both sexes in the first 24 hours of the ACS. There were 154 ACS patients without ADD and 161 patients with ADD . We researched the activity of the NAD and NADP-dependent dehydrogenases in platelets of the patients using bioluminescence assay methods in the first 24 hours after the patients’ admission and in the disease progress on the 10th day.

Results. A distinctive feature of the platelet metabolism in patients with ACS without ADD is a decreased level of aerobic respiration activity accompanied with the violation of interrelation between the Krebs cycle and reactions of amino acid metabolism while anaerobic respiration intensity is at a normal level. Patients who had ACS with ADD at all the stages of the examination had decreased activity of both anaerobic and aerobic respiration beside the disrupted connection between the products of amino acid metabolism and the Krebs cycle reactions.

Conclusion. ACS patients with ADD had a more pronounced change in the platelet energy metabolism, which may be one of the pathophysiological causes of the violation of the functional platelet activity in the hemostasis.

Subjects with tandem lesions bifurcation lesions, left main disease and acute coronary syndrome are not included in trials supporting fractional flow reserve (FFR)-guided revascularization. Assessment and interpretation of FFR in these clinical scenarios is technically challenging due to the unique changes in flow hemodynamics in each of these situations. The existing literature supports the safety of using FFR to guide revascularization in these situations; however, the evidence is limited and further research is warranted.

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are diseases, diagnosed at a late stage with functional class III or IV according to World health organization (WHO). PAH and CTEPH leads to severe right heart failure
and ultimately, death. The modern researches aim at exploring the potential therapeutic targets, as at developing new drugs that can affect the previously set target. Riociguat is the first in a new class of soluble guanylatecyclase stimulators. The analysis of main researches, which reflect the evidence of riociguat efficiacy and safety in patients with PAH and inoperable, persistent/recurrent CTEPH, is presented in this rewiew.

The increasing life expectancy of patients after complex therapy for breast cancer is accompanied by the growth of remote postradiation pathology of the heart. Late diagnosis and correction of these complications leads to deterioration in the quality of life of patients and increases the risk of cardiac mortality. Presents a clinical case of development of aortic valve disease in the late period after radiotherapy in the patient with left-sided localization of breast cancer.

The review describes an up-to-date status and development prospects of a minimally invasive method of arterial hypertension treatment, the renal denervation.

Purpose. Of the study was to estimate the genesis of unexplained syncope in adolescents using implantable ECG recorders.

Materials and methods. Twenty adolescents 16.4±1.1 years of age with syncope were included in the study. Cardiological and neurological pathology in them was ruled out according to international guidelines. All of them underwent implantation of Reveal XT subcutaneous ECG monitors. The mean follow-up duration was 3.2±0.6 months

Results. All 20 (100 %) patients have manually recorded 43 ECG episodes (the mean was 2.1±0.3 per patient). From these 43 manually activated events only 13 (30.2 %) were associated with syncope, 8 (18.6 %) with weakness, 10 (23.3 %) with vertigo, and 12 (27.9 %) with palpitations. The sensitivity of prolonged ECG monitoring in arrhythmogenic mechanism reveal was 46.3 %, the positive predictive value was 59.5 %.

Conclusion. In young subjects, suffering from syncope, the aggressive strategy with subcutaneous ECG recorded implantation should be chosen.

Purpose. To identify factors influencing compliance with treatment for arterial hypertension (AH) among the aboriginal and nonaboriginal inhabitants of Gornaya Shoria.

Materials and methods. We performed a clinical epidemiological study in the population of Gornaya Shoria (with a sample of 453 people). Arterial blood pressure (AP) was measured using a mercury sphygmomanometer after a 10-minute rest in both arms according to the WHO recommendations (1980) and the measurement was repeated after a 5-minute interval. The diagnosis of AH was made irrespective of the AP levels and was based on the use of hypotensive drugs. We applied a questionnaire in those subjects who were willing to fill it in (including data on age, marital status, education, alimentary behaviour, presence of AH, current therapy, presence of a permanent income and previous diseases). The subjects were divided into three age groups including the young group aged 19 to 39 years, the middle group aged 40 to 59 and the older group aged 60 and above. Also, the subjects were classified into those with higher education, those with secondary education and those with primary education.

Results. The prevalence of AH in the population of Gornaya Shoria was higher than the average Russian level. The aboriginal inhabitants showed lower levels of awareness than the non-aboriginal and they were less likely to reach target levels of AP. Treatment compliance correlated with social status in both ethnic groups. Old age pensioners were found to be more committed to therapy, irrespective of their ethnicity. In the aboriginal population, those employed were more committed to therapy than the unemployed. The level of education did not influence treatment compliance.

Purpose. To evaluate the outcomes of the treatment of acute myocarditis by mechanical circulatory support and heart transplantation (HT).

Materials and Methods. We studied the medical records of 5 patients (3 women, men – 2). They suffered acute myocarditis complicated with cardiogenic shock, which required extracorporeal membrane oxygenation (ECMO) and / or the HT. The age of patients ranged from 22 to 59 years.

Results. In four patients ECMO was used, considering the growing multi-organ failure. At the same time in two patients ECMO served as a «bridge to the HT», in 1 patient there was a complete recovery of left ventricular systolic function, one woman died on the fifth day of hospital stay. One patient made the HT without prior treatment of mechanical circulatory support. The residence time in the hospital before the HT ranged from 10 to 96 days. 2 recipients died during the observation in the postoperative period: one for 1 month after surgery (purulent complications), one recipient on the 8th month after the HT ( rejection of heart transplant to the damage of immunosuppressive therapy). The duration of follow-up was 5 days to 3.5 years (depending on the outcome of the disease).

Conclusion. According to the domestic and foreign literature, based on our own experience, we can say that the mechanical circulatory support, including ECMO, and / or heart transplantation may increase the chances of a favorable outcome the acute myocarditis.