Aim. To estimate long-terms results of incomplete revascularization with the internal thoracic artery to the left anterior descending anastomosis performed during mammary-coronary bypass grafting (MCBG) in 228 patients with stable coronary artery disease using the single-center registry database.

Methods. All patients were enrolled into 2 groups. Group 1 consisted of patients with residual SYNTAX score ≤8 (group SYNTAX ≤8, n = 75), Group 2 with residual SYNTAX score >8 (group SYNTAX ≥9, n = 153).

Results. The reasons for the incomplete revascularization were: (1) small diameter of the distal segment of the coronary arteries in 52 (23%) patients, (2) calcification and transmural scar of the myocardium in 18 (8%) patients, (3) severe concomitant pathology in 33 (14%) patients, (4) danger and / or inability to place proximal anastomosis on the ascending aorta in 35 (16%) cases, (5) coronary artery hypoplasia in 11 (5%) patients, (6) unfit grafts for shunting in 6 (2%) patients, (7) technical difficulties in visualization of coronary arteries on the posterior and lateral walls due to Dressler's syndrome in 9 (4%) patients. (8) Incomplete revascularization was considered reasonable in 64 (28%) cases due to the number of causes. The three-year all-cause mortality was 4% in the group of SYNTAX ≤8 versus 3.9% in the SYNTAX group ≥9, P = 0.7, similarly to the cardiac death – 2.7% in the group of SYNTAX ≤8 versus 3.3% in the group SYNTAX ≥9, P = 0.9. The need for repeat coronary revascularization was the same in both groups (P = 0.4). The groups did not differ in the number of the combined endpoint (8% in the group of SYNTAX ≤8 versus 6.5% in the group SYNTAX ≥9, (P = 0.9).

Conclusion. The study demonstrated that the results of incomplete revascularization with LIMA to LAD do not depend on the residual SYNTAX score. 

Aim. To assess risk factors for arterial hypertension in pregnant women.

Methods. The prevalence of risk factors for arterial hypertension (AH) was estimated in 240 pregnant women with arterial hypertension (AH) and 126 healthy pregnant women. Women with symptomatic or gestational hypertension or diabetes mellitus were excluded from the study. The following AH risk factors were assessed: age, family history, smoking, overweight/obesity, and excessive salt intake. Odds ratios were calculated utilizing stepwise logistic regression.

Results. Pregnant women ≥32 years of age had 1.33-fold higher risk of AH in comparison with those <32 years of age. Hypertensive status of both parents or one of them was associated with 1.8- and 1.67-fold higher risk of AH as compared to patients without family history of AH. Smoking, overweight, and obesity increased risk of AH by a factor of 1.83, 1.74, and 2.24, respectively. Combination of age ≥32 years with obesity, family history of AH or smoking status further augmented risk of AH (2.46-, 2.18 or 2.14-fold, respectively) as compared to healthy pregnant women. Likewise, combination of AH family history with overweight or obesity resulted in 2.9- and 3.0-fold higher risk of AH. Combination of smoking with family history of AH, overweight, and obesity increased risk of AH by a factor of 2.95, 3.61, and 4.65, respectively. Amount of salt intake did not differ in pregnant women with and without AH.

Conclusion. The estimated risk factors for AH are significant in pregnant women. Age over 32 years was associated with 1.33 OR for AH, family history with 1.8 OR, smoking with 1.83 OR, overweight with 1.7 OR, whereas obesity increased 2.24-fold odds for AH. Obesity and family history increased 2.9-fold odds for AH, whereas smoking and family history were associated with 3-fold increased odds for AH and combined with obesity up to 4.6-fold increased odds. 

Background. Non-ST elevation acute coronary syndrome (NSTE-ACS) is a common cause of hospital admissions of coronary artery disease patients.

Aim. To assess clinical and epidemiological patterns and hospital outcomes of treatment of NSTE-ACS in Kemerovo in period from 2015 to 2017.

Methods. 4884 patients with NSTE-ACS admitted to the Kemerovo healthcare facilities in the period from 2015 to 2017 were included in a retrospective observational study. In-hospital period was subjected to the analysis.

Results. The morbidity of NSTE-ACS increased by 16.92% (from 267.78 cases in 2015 to 302.13 cases per 100 thousand population in 2017). The rate of invasive treatment strategies in patients with NSTE-ACS did not change significantly within the study period (about 33%). In-hospital mortality from NSTE-ACS slightly decreased (from 3.74% in 2015 to 3.21% in 2017, p = 0.681).

Conclusion. The observational study reported a tendency towards increasing prevalence of NSTE-ACS in a large industrial center within the 3-year period by 16.92%. Nevertheless, the availability of invasive treatment in Kemerovo within the study period remained high (33%). However, relatively high in-hospital mortality rate (3.36%) in NSTEMI has been determined and requires additional studies. 

Aim. To compare the safety and efficacy of stenting of the left main coronary artery (LMCA) in patients with moderate to high risks estimated with the SYNTAX score.

Methods. 112 patients with multivessel coronary disease and LMCA disease (SYNTAX score ≥23) and severe comorbidities were included in the study. All patients were deemed ineligible for CABG by the Heart Team. Patients were assigned to two groups according to the Syntax scores: Group 1 – patients with the SYNTAX scores of 23–32 (n = 66), and Group 2 patients with the SYNTAX scores of >32 (n = 46).

Results. 107 patients completed the 12-months follow-up. 5 patients in Group 1 and 2 patients in Group 2 were lost to follow up. Myocardial infarction (MI) (8.06% versus 13.33%, p = 0.37757) and heart mortality (6.45% versus 6.67%, p = 0.9646) cumulative rates were similar within the 12-month follow-up. There were no strokes or noncardiac deaths in both groups. The 12-month confirmed rate of stent thrombosis in Groups 1 and 2 did not differ statistically (3.23% vs. 6.67%, p = 0.4051). The unadjusted model (effects of variables on survival) reported that age (OR 1.15 (95% CI 1.05– 1.26), p = 0.0032), pulmonary hypertension (OR 1.05 (95% CI 1.01–1.09), p = 0.0111) and mitral insufficiency (OR 2.65 (95% CI 1.13–6.21), p = 0.0252) affected the composite endpoint. The adjusted model determined that only age affected the prognosis (OR 1.17 (95% CI 1.05–1.29), p = 0.0038).

Conclusion. The first results of our study showed that stenting of LMCA in patients with moderate to high SYNTAX scores is a possible option and comparable with the 12-month follow-up. Age is as an independent predictor of future adverse events. Further evaluation of this complex patient cohort is required. 

Aim. To determine factors associated with percutaneous coronary intervention (PCI) and/ or coronary artery bypass grafting (CABG) in patients with stable coronary artery disease (CAD), who have no indications for myocardial revascularization.

Methods. The data were collected using the Federal CAD Registry. Medical data of 1522 patients with CAD were reviewed. Of them, 326 patients (median age – 54.7±8.7 years; 73.0% – males) who had no indications for PCI and CABG according to 2013 ESC guidelines on stable CAD (ESC 2014) were analyzed.

Results. 216 patients out of 326 (66%) patients received medical treatment. The rest 110 patients (34%) without any recommended indications underwent myocardial revascularization. Discriminate analysis determined coronary artery stenosis of >70% was the only factor reliably associated with the decision to perform myocardial revascularization in the absence of any indications (р<0.001). Almost 93% of the interventions were performed in asymptomatic patients or patients with mild angina.

Conclusion. Patients with stable CAD without any objective indications for coronary intervention may be unreasonably referred to myocardial revascularization (commonly PCI) due to coronary artery stenosis >70% regardless of whether they have or do not have angina symptoms. 

Aim. To determine seasonal patterns in the incidence of acute myocardial infarction (AMI) and sudden cardiac death (SCD) among the population of Tomsk city in the period from 2006 to 2015.

Methods. Data were obtained from the WHO project “Acute Myocardial Infarction Register”. 9060 cases, including 8383 (92.5%) – AMI and 677 (7.5%) – SCD, were registered within the 10-year follow-up among the inhabitants of Tomsk aged over 20 years old. The weather data were taken from the Tomsk branch of the West Siberian Federal Service for Hydrometeorology and Environmental Monitoring. V.I. Rusanov`s classification was used to identify the days with the contrast weather change.

Results. The highest incidence of acute coronary accidents was registered in January with the 11.7% increase the annual average, the lowest incidence - in November with the 7.8% decrease the annual average. Similarly, the highest incidence of MI was registered in January (+10.5%), and the lowest in November (-7.7%). The highest incidence of SCD was registered in January (+ 28.6%), while the lowest - in October (-6.1%). The months associated with increase in the rate of acute coronary accidents in general and MI and SCD have been selected. In 2006 it was October, in 2009 – April, in 2011 – March and in 2012 – January. These months had a large number of days with contrasting weather changes.

Conclusion. The most unfavorable months in the period from 2006 to 2015 associated with the development of acute coronary accidents were January and May. Days with contrasting weather changes contributed to the increase in the incidence of acute coronary accidents. The determined patterns should be taken into account when planning the delivery of care to patients with acute coronary pathology. 

Aim. To compare morphological properties, mineral, and organic profile of spherical calcium phosphate bions (SCPB) and needle calcium phosphate bions (NCPB) for the assessment of the CPB-specific endothelial toxicity in models of mild or severe hypercalcemia/hyperphosphatemia in the further studies.

Methods. Both SCPB and NCPB were artificially synthesized employing blood-mimetic medium either moderately or significantly supersaturated of calcium and phosphorus salts. Size and shape of SCPB and NCPB were investigated by scanning and transmission electron microscopy and atomic force microscopy. Elemental analysis was performed utilizing energy-dispersive X-ray spectroscopy, atomic emission spectroscopy, and CHNSO analysis, functional groups were examined using Fourier-transform infrared spectroscopy and Raman spectroscopy while chemical formula was identified by X-ray powder diffraction analysis. Protein profile of SCPB and NCPB was screened employing sodium dodecyl sulfate polyacrylamide gel electrophoresis following silver staining.

Results. SCPB were visualized as crystalline spherical spongeous particles of 80-200 nm diameter and mean diameter of around 120 nm while NCPB represented needle crystals of a similar diameter. Both SCPB and NCPB had similar crystallinity, surface charge and tended to form clusters of several particles. Furthermore, both SCPB and NCPB were composed of carbon, oxygen, hydrogen, nitrogen, calcium, and phosphorus, contained phosphate (PO4 3-), carbonate (CO3 2-), and hydroxyl (OH- ) functional groups, and consisted of hydroxyapatite (Ca10(PO4 )6 (OH)2 ) and carbonate-hydroxyapatite (Ca10(PO4)3 (CO3)3 (OH)2 ). In addition, protein profile of SCPB and NCPB was similar and notable for the abundant albumin and fetuin A levels.

Conclusion. Having similar size, surface charge, extent of crystallinity, and chemical composition, SCPB and NCPB possess a different shape. 

High mortality from cardiovascular diseases, especially coronary artery disease (CAD), represents a major economic burden on healthcare systems. The number of diagnostic coronary angiographies (CAG) is increasing in the Russian Federation. However, routine invasive CAG is not able to determine obstructive coronary artery disease in a considerable number of patients. The rate of intact coronary arteries reaches 42% in the major registries and accounts for 37.9% in our Research Institute. Despite all improvements in the diagnostic algorithms focused on suspected coronary artery disease, stated in the recent international and national guidelines, and the availability of advanced non-invasive diagnostic methods, they do not improve accurate CAG diagnosis of obstructive coronary artery disease. Moreover, the available guidelines contain many contradictions. Therefore, an optimal diagnostic algorithm of significant coronary artery lesions is a subject of discussion. The proposed review discusses all discrepancies concerning the assessment of the pretest probability as well as the proposed non-invasive testing. In addition, the preferred use of non-invasive tests with anatomical assessment (i.e. multispiral computed tomography coronary imaging) rather than functional tests with visualization is stated. This review ensures better understanding of diagnostic strategies for stable coronary artery disease used both in researches and in clinical practice.

The review article updates current data concerning drug therapy in patients with acute coronary syndrome (ACS) of different types. High refusal rate to invasive management among patients with ACS in our country suggests that the need for optimizing drug therapy. Recent epidemiological data are presented in addition to the main target groups of patients who do not receive invasive treatment: elderly patients, patients with multivessel coronary artery disease and distal lesions and those who have chronic kidney disease. The general patient profile who will be prescribed drug therapy is presented. The optimal drug therapy regimens for patients with different ACS types are provided.

Modifiable cardiovascular risk factors commonly include disorders of lipid metabolism, arterial hypertension, smoking, alcohol consumption, physical inactivity, overweight, etc. The number of epidemiological studies have already proved the presence of the associations between them and the risk of developing cardiovascular diseases. However, the analysis of the recent studies showed that despite the negative impact of these factors on cardiovascular health, there are some arguments that prove their positive effects. Such a phenomenon is commonly described in the publications as a “paradox” of a particular risk factor. This review presents data on the smoking paradox – one of the leading risk factors contributing to the development of cardiovascular diseases.

Despite the rapid evolution in the development of endovascular surgery, the mortality of patients undergoing percutaneous coronary interventions (PCI) with high risk of severe cardiac complications and critical conditions (cardiogenic shock, cardiac arrest) remains extremely high. The success of PCI directly depends on the ability of the Heart Team to prevent and timely eliminate severe cardiac disorders. Despite the rapid evolution in the development of endovascular surgery, the mortality of patients undergoing percutaneous coronary interventions (PCI) with high risk of severe cardiac complications and critical conditions (cardiogenic shock, cardiac arrest) remains extremely high. The success of PCI directly depends on the ability of the Heart Team to prevent and timely eliminate severe cardiac disorders. Pharmacological therapy is not able to completely resist the development of severe cardiac events during PCI. In such situations the usage of devices for percutaneous mechanical circulation support (PMCS) can make an invaluable help in the treatment of this group of patients. Despite the fact that the PMCS devices are used to stabilize patients with cardiogenic shock and to provide hemodynamic support for high-risk PCI for several decades, the results of their application remain ambiguous. The purpose of this article is to review all existing literature on modern PMCS devices, available data and research results, indications for their use, and operational considerations that can ensure the decision-making process in selecting optimal PMCS devices.

The review describes current state of myocardial revascularization using both venous and arterial grafts in terms of their morphology and function. A new framework of the graft-artery junction as a separate morphological and functional system has been proposed. Taking into account numerous data and separate evidences, this system may be separated into a single unit characterized by mutual relations. On the one hand, the graft produces favorable effects on the coronary artery protecting from atherosclerosis, on the other, the coronary artery itself may provoke specific changes in the graft. The proposed graft-artery junction provides new insight into the decision-making process for the graft selection in coronary artery bypass grafting.

Significant progress in the diagnosis and treatment of cancer resulted in a marked improvement in the survival of these patients. Declining mortality in acute cardiovascular diseases is accompanied by an increase in the proportion of patients with chronic cardiovascular pathology. Both trends resulted in a growing cohort of patients with concomitant oncology and cardiovascular disease, given rise to cardiooncology, a rapidly growing field. Cardio-oncology incudes a variety of clinical issues, particularly preoperative assessment of patients for cancer surgery. However, this section has been recently neglected in the recent guidelines. This review focuses on the preoperative management of patients with cardiovascular diseases for elective cancer surgeries. It reports the existing algorithm of assessing the risk of cardiac events in non-cardiac surgeries relatively to cancer patients. Current international and national guidelines were published in 2014 and, therefore, do not contain the latest evidences. Thus, this review summarizes all recent data and provides a modified and simplified preoperative management strategy for cancer patients. In particular, surgical risk assessment should be comprehensive, taking into account the complexity of the surgical procedures and the severity of comorbidity. The review discusses specific risk assessment scales proposed for different groups of cancer patients (for example, the ThRCRI scale in surgeries for non-small cell lung cancer). In addition, it contains various options for assessing the functional status of patients (stress tests, including spiroergometry, DASI index, assessment tables). Current recommendations on additional screening and preventive treatment of patients are summarized and addressed to the healthcare specialists and researchers studying perioperative risk assessment in cancer surgery.

Acute coronary syndrome in young women is of particular interest for today’s research. There are some data on the different effects of major risk factors among the sex groups, driven by the presence of specific risk factors in the female population. The clinical case reports different clinical course of atherosclerosis in men and women, presented with non-stenotic coronary atherosclerosis with hormonal imbalance and classical risk factors of complicated CAD.

The report describes the case of electrophysiological study and catheter ablation of seven types of supraventricular tachycardia in one patient. During radiofrequency ablation for WPW-syndrome three functionated discrete retrograde conductive accessory atrioventricular pathways were documented and were successfully ablated. Further incessant activity of two ectopic atrial focuses was revealed. First localized in upper part of crista terminalis and another – in left superior pulmonary vein ostium. Five months after patient had a recurrence of supraventricular tachycardia. EPI-study demonstrated evidence for retrograde ventriculoatrial dissociation with induction of atypical fast/slow and typical slow/fast atrioventricular nodal reentry tachycardia, wich were successfully ablated. With further observation, rhythm disturbances did not recur.