Purpose. To investigate the prevalence of polyvascular disease (PolyVD) depending on the diagnosis criteria.

Materials and methods. Seven hundred and thirty-two consecutive patients (586 men and 146 women), undergone CABG, were divided according to the number of affected arterial beds. The first definition of PolyVD was ≥ 30 % stenoses while the second one considered the lesions of ≥ 50 %. History, risk factors, laboratory and instrumental data were analyzed. Logistic regression was performed to reveal the influence of risk factors on the prevalence of PolyVD.

Results. In the first definition of PolyVD (≥ 30 %) one-bed lesions were found in 385 (52,6 %) and two or more in 347 patients (47,4 %). In the second definition of PolyVD (≥ 50 %) one-bed lesions were found in 531 (72,5 %) and two or more in 201 patients (27,5 %). In the first definition of PolyVD the probability of its detection declined with the increase in BMI (p = 0,022) and GFR (p = 0,025), and rose with the history of hypertension (p < 0,001) and smoking (p = 0,005), older age (p < 0,001) and intima-media thickness (IMT) (p < 0,001). In the second definition of PolyVD the probability of its detection was higher with smoking (p = 0,001), the history of hypertension (p = 0,001) and older age (p = 0,001). This probability is reduced with the increase in BMI (p = 0,007). In a multivariate analysis, regardless of PolyVD definition, age (p = 0,001), IMT (p < 0,001), smoking (p = 0,002) and hypertension (p = 0,008) retained their influence on the probability of PolyVD detection.

Conclusions. Before CABG PolyVD was diagnosed in 27,5 % of patients with ≥ 50 % stenoses and in 47,4 % of patients with ≥ 30 % stenoses. Risk factors associated with the prevalence of atherosclerosis are age, smoking, hypertension, IMT.

Purpose. To study the incidence of carotid artery stenotic lesions of different severity and the associated factors in ischemic stroke patients.

Materials and methods. 694 patients with different subtypes of ischemic stroke treated in the neurology department were enrolled. Color duplex imaging was used as a diagnostic technique. According to the degree of carotid artery disease patients were divided into the following groups: Group I included individuals with no or mild stenoses (up to 30 %), Group II included those with moderate stenotic lesions (30–49 %) and Group III, patients with carotid artery setnoses of 50 % and more. The NIHSS was used to assess the severity of neurologic deficit and ischemic stroke subtype was determined according to the TOAST classification.

Results. Patients with carotid stenoses of 50 % and more had atherothrombotic strokes, risk factors for stroke and severe neurologic deficit unlike those who had no or mild or moderate lesions. Patients with moderate carotid lesions more often had cardioembolic strokes and moderate neurologic deficit while the group with no carotid lesions had hemodynamic strokes and mild or moderate neurologic deficit.

Conclusions. Detecting carotid artery stenotic lesions of different severity allows to find ischemic stroke patients with poor prognosis and a high risk for concomitant coronary artery disease.

Purpose. To compare preoperative risk assessment strategies prior to vascular surgeries and evaluate their impact on long-term survival.

Materials and methods. Clinical records of the two patient groups, who underwent preoperative assessment prior to surgeries on abdominal aorta and lower extremity arteries, were retrospectively reviewed. 202 patients, who received surgical treatment in Kemerovo Cardiology Center were included in Group 1 (59,9 ± 7,4 years) and 121 patients operated in City Clinical Hospital № 29, Novokuznetsk, were enrolled in Group 2 (56,8 ± 7,7 years). The majority of patients in Group I underwent coronary angiography prior to surgery, and preventive myocardial revascularization was done in case general indications were found. Long-term outcomes were evaluated for an average of 4,5 years.

Results. Preventive myocardial revascularization was performed in 57 Group I patients (28 %) and coronary angiography in 162 (80 %) Group I patients. Follow-up mortality rates were 3,5 % for Group 1 and 32,2 % for Group II (p < 0,001). Univariate analysis was performed to identify factors increasing mortality rates in both groups: no prior preventive revascularization and age. Factors reducing mortality rates were β-blockers, ACE inhibitors and aspirin. Multivariate analysis was performed to identify independent risk factors increasing mortality rates: no prior preventive myocardial revascularization (RR 5,97; 95 % CI 0,79–44,77; p = 0,08) and patients’ age (RR 1,13; 95 % CI 1,07–1,19; p = 0,001).

Conclusions. Preventive myocardial revascularization improved the long-term survival in those patients who underwent high risk vascular surgeries. Preoperative assessment and cardiac complications risk reduction strategy as well as patients’ age produced an independent effect on long-term mortality after surgery.

Purpose. To perform a comparative assessment of diagnostic tools and strategies of myocardial revascularization in patients with and without polyvascular disease (PolyVD) based on the findings of perioperative analysis.

Materials and methods. The medical records of 2 828 patients, aged 32–84, consecutively admitted to the clinic of the Research Institute for Complex Issues of Cardiovascular Diseases between January, 2006, and July, 2010, for coronary artery bypass surgery, were retrospectively reviewed. All the patients were divided into two groups: Group 1 included 448 (15,48 %) PolyVD patients with clinically manifested or angiographically confirmed obliterating (≥ 60 %) non-cardiac artery lesions. Group 2 (the control group) included 1691(59,79 %) patients without any clinical symptoms of non-coronary atherosclerosis. The incidence rate, structure and causes of in-hospital mortality and type I neurological disorders (i.e. strokes and transient ischemic attacks) were assessed in both groups.

Results. The incidence rate of significant non-cardiac occlusive stenotic lesions in patients with coronary artery disease (CAD), who had to undergo CABG, was 15,84 %. Simultaneous revascularization of coronary and non-coronary arteries was performed in 2,46 % of patients with CAD and PolyVD and multi-stage surgical procedures were chosen in other cases.

Conclusions. The outcomes of CAD surgical treatment were improved in this group of patients due to the implementation of a multidisciplinary team approach, which ensured a proper diagnosis of polyvascular disease.

Purpose. To investigate the effect of moderate (< 50 %) carotid artery (CA) stenoses on electroencephalogram (EEG) changes associated with on-pump coronary artery bypass surgery (CABG).

Materials and methods. The study involved 39 male patients, 13 of those had moderate CA stenoses. EEG was performed 3–5 days before and 7–10 days after CABG.

Results. It was found that patients with moderate ICA stenoses had higher power values of teta1,2 and beta1-rhythm biopotentials with the eyes closed 7–10 days after CABG compared with patients without the lesions. These changes can be regarded as a manifestation of ischemic neuronal damage during CPB surgery.

Conclusion. Patients with coronary artery disease and moderate CA stenoses are the high risk group of intraoperative neurological complications.

Purpose. To evaluate the impact of polyvascular artery disease (PolyVD) and the timing of the second revascularization phase on the treatment results in patients with ST elevation myocardial infarction (STEMI).

Materials and methods. During the hospital stay 227 patients had screening ultrasound of the aortic arch branches and lower extremity arteries performed. The patients were classified according to the presence or absence of PolyVD, which refers to the presence of extracardiac artery stenosis ≥ 30 % (lower limb arteries and \ or extracranial arteries). The first group consisted of patients with STEMI, multivessel coronary disease and PolyVD, who underwent primary PCI (n = 63) (STEMI + IPA), the second group consisted of similar patients without IPA (n = 164) (STEMI). Each of the groups was further subdivided into two subgroups: the second phase of coronary revascularization ≤ 60 days after primary PCI and > 60 days after primary PCI.

Results. Preventive revascularization was performed in 84 patients from Group 1 by the cardiac catheterization findings. The overall mortality rate was 4,62 % for Group 1 and 34,15 % for Group 2 (p < 0,001). The factors, increasing the overall mortality rate in both groups, were identified by the univariate analysis: disease course without preventive revascularization, age, peripheral artery interventions, perioperative complications (p < 0,05). The factors reducing the mortality rate were preoperative cardiac catheterization, carotid surgery, β-blockers, ACE inhibitors, aspirin (p < 0,05). The independent risk factors increasing the overall mortality rate were disease course without preventive revascularization, age, perioperative complications (p = 0,05).

Conclusion. Screening detection of extracranial artery disease and lower extremity artery disease is a necessary component in the management of patients with STEMI and multivessel disease undergoing primary PCI. In case of peripheral artery stenosis ≥ 30 % detection the second stage of coronary revascularization is required within no more than 60 days after primary PCI.

Purpose. To develop and implement into clinical practice the algorithm of surgical tactics for patients with combined atherosclerotic lesion of coronary and carotid arteries basing on identification of functional reserve of myocardial and cerebral perfusion.

Materials and methods. 68 patients with combined atherosclerotic lesion of coronary and carotid arteries were enrolled into the study. They were examined for reserved capabilities of their myocardium and cerebrum. Basing on the obtained results the patients were allocated into two groups: group 1 (n = 28) the patients who were subjected to simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) and group 2 (n = 40) – those on which the procedure of CEA was performed as the first stage and CABG as the second.

Results. In the 1st group patients mean time of carotid artery clamping was 30,7 ± 6,1 min. Mean cardio pulmonary bypass (CBP) time during CABG comprised 50 ± 12,6 min. In 4 of the patients (14,2 %) clinical signs of encephalopathy were noticed. In one case (3,6 %) from this group acute cerebral blood flow disturbance was registered on a collateral side of CEA. Mean hospital stay for the group with simultaneous surgical treatment was 28,2 ± 4,7 days. Mean CA clamping time in the 2nd patient group was 30,2 ± 5,2 min and mean time on CPB during CABG was 57 ± 15,6 min. Acute myocardial infarction (MI) was verified in one patient (2,5 %) in the early postoperative period after CABG as the 2nd stage. Clinical signs of encephalopathy were registered in 3 (7,5 %) patients. Mean hospital stay for the 2nd group patients comprised 42,3 ± 5,1 days.

Conclusion. Simultaneous surgeries are beneficial for the patients with lowered reserve of both coronary and cerebral blood flows. Risk of cerebral and cardiac postoperative complications is comparable with the outcomes after stage by stage surgeries, thus shortening patients’ hospital stay. Hypoxic test results are another criterion for making decision about placement of an intraarterial shunt. This makes the time for the main stage of CEA shorter and lets avoid extra possible complications in the early postoperative period.

Purpose. The results of primary percutaneous coronary interventions (PPCI) in the treatment of ST elevation myocardial infarction (STEMI) patients with coronary artery disease (CAD) and peripheral arterial disease (PAD) remain little known.

Materials and methods. We analyzed 12-month outcomes of 259 consecutive patients who underwent PPCI with STEMI. The outcomes of 48 patients (18,5 %) with CAD and PAD (CAD + PAD group), who underwent PPCI, were compared with the outcomes of 211 patients (81,5 %) with isolated CAD and without PAD (CAD group), who underwent PPCI. The groups were comparable regarding the incidence of diabetes mellitus, arterial hypertension, smoking and left ventricular ejection fraction. The endpoints at 12 months included all deaths, myocardial infarction (MI), target lesion/vessel revascularization (TLR/TVR) and non target vessel revascularization (non-TVR).

Results. Angiographic success (TIMI III flow and residual stenosis < 20 % by QCA) was 93,8 % for CAD + PAD group (n = 45) and 97,2 % for CAD group (n = 205) (р = 0,486). At 12 months CAD + PAD group and CAD group did not differ in the incidence of death (8,3 vs 6,2 % respectively, p = 0,821), TLR/TVR (6,3 vs 2,8 % respectively, p = 0,468), while there were differences in the rates of nonfatal MI (20,8 vs 9 % respectively, p = 0,036) and non-TVR (37,5 vs 16,6 % respectively, p = 0,002).

Conclusion. ST-elevation myocardial infarction patients with peripheral arterial disease are a special category of patients having significantly more severe coronary artery stenoses, higher incidence of non-fatal myocardial infarctions and higher incidence of non-target vessel revascularizations during 12 months.

The state of the art in antiplatelet therapy in ST elevation myocardial infarction patients was reviewed. The possibility of clopidogrel substitution for the newer and more potent antiplatelet drugs such as ticagrelor and prasugrel was discussed. The rationale for the use of each medication was presented. The results of clinical trials comparing clopidogrel with ticagrelor and prasugrel were analyzed. It was highlighted that only ticagrelor can substitute clopidogrel and only in primary coronary intervention setting. In other settings including thrombolytic therapy, pharmacoinvasive approach or no reperfusion, clopidogrel has no alternatives as a part of dual antiplatelet therapy in ST elevation myocardial infarction. It was observed that with dual antiplatelet therapy the rationale for GPIIb/IIIa inhibitors use during percutaneous coronary interventions became significantly different in the category of patients under discussion.

Purpose. Examine the functional state of cell membranes in pregnant patients with arterial hypertension.

Materials and methods. 110 pregnant patients, aged 19–40 years (mean age 29,1 ± 0,49) were monitored in the second trimester of gestation, of those 41 patients (Group 1) were diagnosed with grade II arterial hypertension, 25 patients (Group 2) had symptomatic and 24 women (Group 3) had gestational hypertension. 20 apparently healthy pregnant women were the control group.

Results. Pregnant women with different clinical forms of arterial hypertension have lower osmotic and mechanical resistance of red blood cells compared to the controls. Impaired functional state of cell membranes, with red blood cells as a model, was the most pronounced in patients with gestational arterial hypertension and high beta adrenoreactivity, reflecting the process of adrenoreceptors desensitization induced by endogenous catecholamines in the conditions of hypersympathicotonia.

Conclusions. Pregnant patients with different clinical forms of arterial hypertension have impaired functional state of red blood cell membranes, i.e., the decrease in their osmotic and mechanical resistance. These changes are the most pronounced when there is a specific syndrome of gestational arterial hypertension during pregnancy. Apparently healthy pregnant women and those with arterial hypertension have hypersympathicotonia, i.e., high beta adrenoreactivity parameters, especially if there is gestational arterial hypertension.