Effect of the "door-to-balloon" time on the results of treatment of patients with ST-segment elevation myocardial infarction, depending on the duration of the pre-hospital delay.

Aim    To analyze the effect of the door-to-balloon time on treatment outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) depending on the duration of pre-hospital delay.Material ad methods    The study used data of the hospital registry of percutaneous coronary interventions (PCI) in STEMI from 2006 through 2017. The analysis included 1333 patients. All patients were divided into two groups. The first group included 574 (43.1%) patients with the time from the pain syndrome onset to admission was ≤120 min. The second group consisted of 759 (56.9 %) patients with the time of pre-hospital delay exceeding 120 min. Results of the treatment were analyzed for each group depending on the door-to-balloon time, ≤60 min or >60 min.Results    In the group of patients with the prehospital delay less than 120 min and the door-to-balloon time ≤60 min vs. patients with the door-to-balloon time >60 min, the following was observed: decreased in-hospital mortality (1.3 % vs. 6.8 %, p=0.001), reduced incidence of major adverse cardiac effects (МАСЕ) (3.2 % vs. 8.3 %, p=0.008), and reduced incidence of the no-reflow phenomenon (3.9 % vs. 9.4 %, p=0.007). Also, immediate angiographic success of PCI was more frequently achieved in these patents (94.5 % vs. 87.5 %, p=0.003). In addition, in the group with the prehospital delay ≤120 min and the door-to-balloon time ≤60 min, a higher ejection fraction was noted at discharge from the hospital (48 [43; 51] % vs. 46 [42; 51] %, р=0.038). Comparison of treatment outcomes between the groups with different door-to-balloon time (≤60 min or >60 min) and a prehospital delay >120 min did not show any significant intergroup differences. According to a multivariate analysis, the door-to-balloon time ≤60 min did not predict in-hospital mortality. There was a strong correlation between the time of prehospital delay and the total time of myocardial ischemia (r=0.87; р<0.001) while the correlation between the door-to-balloon time and the total time of myocardial ischemia was moderate (r=0.41; р<0.001). At the same time, there was no correlation between the time of prehospital delay and the door-to-balloon time.Conclusion    In STEMI patients with a prehospital delay less than 120 min from the pain syndrome onset, a decrease in the door-to-balloon time was associated with better outcome of the hospital treatment. When the duration of prehospital delay was more than 120 min, a decrease in door-to-balloon time did not influence the treatment outcome. The time of prehospital delay strongly correlated with the total time of myocardial ischemia.

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction.

Aim    To develop a scale (score system) for predicting the individual risk of in-hospital death in patients with ST segment elevation acute myocardial infarction (STEMI) with an account of results of percutaneous coronary intervention (PCI).Material and methods    The analysis used data of 1 649 sequential patients with STEMI included into the hospital registry of PCI from 2006 through 2017. To test the model predictability, the original sample was divided into two groups: a training group consisting of 1150 (70 %) patients and a test group consisting of 499 (30 %) patients. The training sample was used for computing an individual score. To this purpose, ß-coefficients of each variable obtained at the last stage of the multivariate logistic regression model were subjected to linear transformation. The scale was verified using the test sample.Results    Seven independent predictors of in-hospital death were determined: age ≥65 years, acute heart failure (Killip class III-IV), total myocardial ischemia time ≥180 min, anterior localization of myocardial infarction, failure of PCI, SYNTAX scale score ≥16, glycemia on admission ≥7.78 mmol/l for patients without a history of diabetes mellitus and ≥14.35 mmol/l for patients with a history of diabetes mellitus. The contribution of each value to the risk of in-hospital death was ranked from 0 to 7. A threshold total score of 10 was determined; a score ≥10 corresponded to a high probability of in-hospital death (18.2 %). In the training sample, the sensitivity was 81 %, the specificity was 80.6 %, and the area under the curve (AUC) was 0.902. In the test sample, the sensitivity was 96.2 %, the specificity was 83.3 %, and the AUC was 0.924.Conclusion    The developed scale has a good predictive accuracy in identifying patients with acute STEMI who have a high risk of fatal outcome at the hospital stage.

[Assessment of no-reflow phenomenon in patients with acute ST-elevation myocardial infarction]. / Otsenka fenomena 'no-reflow' u patsientov s ostrym infarktom miokarda s pod''emom segmenta ST.

BACKGROUND: The problems concerning assessment of the state of myocardial perfusion in patients with acute ST elevation myocardial infarction after successful revascularization still remain of current importance. Contrast-enhanced echocardiography remains the least studied and most promising ultrasound technology for the diagnosis of the no-reflow phenomenon. AIM: The study was aimed at evaluating echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by means of contrast-enhanced echocardiography in patients with ST-segment elevation myocardial infarction. PATIENTS AND METHODS: The study included a total of forty-three 40-to-82-year-old patients in acute period of myocardial infarction. The patients were divided into two groups: 32 patients with satisfactory myocardial reperfusion after revascularization according to the findings of contrast-enhanced echocardiography and 11 patients with impaired perfusion. RESULTS: The patients in the group with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1±2.2% vs 27.4±8.5%, p<0.001), more frequent LV dilatation (LV end-systolic volume 67.3±20.3 ml vs 51.8±17.2 ml, p=0.015), decreased LV contractility (LV ejection fraction 39.5±3.4% vs 47.2±4.9%, p < 0.001), and significant mitral regurgitation (45.5% vs 3.1%, p=0.011) with a decrease in DP/DT (979.9±363.4 mmHg/s vs 1565.7±502.8 mmHg/s, p<0.001) were more often detected in this group. Coronary angiography showed no perfusion disorders after revascularization in more than a quarter of these patients. In the group with impaired perfusion, more frequently revealed were single-vascular lesions (46.9% vs 9.1%, p=0.033), lesions of the anterior interventricular artery (90.9% vs 40.6%, p=0.004), and acute occlusion (100% vs 68.8%, p=0.043); compliance by the SYNTAX score in this group was higher (18.9±3.7 vs 9.9±5.7, p<0.001). CONCLUSION: In patients with acute myocardial infarction after successfully performed revascularization, perfusion disorders revealed by the findings of contrast-enhanced echocardiography were accompanied by more pronounced echo signs of left-ventricular dysfunction, higher values of the SYNTAX score and significantly more frequently revealed lesions of the anterior interventricular septum as compared with the patients with recovered perfusion.

Influence of Total Ischemic Time on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction.

Aim      To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1-2=0.001; p1-3<0.001; p2-3=0.520). The incidence of major cardiac complications ("adverse cardiac events", MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1-2=0.020; p1-3<0.001; p2-3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1-2=0.539; p1-3=0.001; p2-3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion      The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the "door-to-balloon" time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.

[Percutaneous Coronary Interventions in Patients With ST-Elevation Myocardial Infarction: 10-Years Follow-up].

Aim      To study long-term results and to identify predictors of death in patients with ST-segment elevation acute myocardial infarction (STEMI) who underwent endovascular revascularization.Materials and methods This study included 283 patients registered in the hospital registry of percutaneous coronary interventions (PCI) for STEMI from 2006 through 2009. Analysis of 10-year results included all-cause and cardiovascular death rate, incidence of recurrent myocardial infarction (MI), repeated revascularization, stroke, stent restenosis and thrombosis. Also, a composite endpoint МАССЕ (Major Adverse Cardiovascular and Cerebrovascular Events) was evaluated, which included death, recurrent MI, repeated PCI, stent restenosis and thrombosis, coronary bypass, and stroke.Results Information about the health condition was provided by 204 (72.1 %) patients. Mean follow-up period was 120.1±9.5 months. All-cause mortality was 25.5 % with cardiovascular death determined in 19.1 % of cases. Recurrent MI developed in 21.6 % of patients; in 1.5 % of cases, recurrent MI resulted from thrombosis of previously implanted stents. Repeated PCI was performed for 31.9 % of patients; in 13.7 % of cases, the PCI was performed for stent restenosis. Coronary bypass was performed for 5.4 % of patients. Incidence of stroke was 10.3 %. Major cardiovascular and cerebrovascular complications (МАССЕ) during the follow-up period were determined in 60.3 % patients. According to the Cox proportional hazards regression model, age ≥65 years (odds ratio (OR), 3.75 at 95 % confidence interval (CI) from 1.75 to 8.03; р=0.001) and incomplete coronary revascularization (OR, 3.09 at 95 % CI from 1.52 to 6.30; р=0.002) were independent predictors of death based on data of the 10-year observation.Conclusion      Therefore, at 10 years following endovascular revascularization, STEMI patients showed a moderate death rate with a high incidence of major cardiovascular and cerebrovascular complications. The leading causes for fatal outcomes were recurrent cardiovascular complications. The major predictors of death for the coming 10-year period included age ≥65 years and incomplete myocardial revascularization.

[State of microcirculation in patients with atherosclerosis and diabetes mellitus after limb revascularization]. / Sostoianie mikrotsirkuliatsii u bol'nykh aterosklerozom i sakharnym diabetom posle revaskuliarizatsii konechnosti.

AIM: The study was aimed at comparatively assessing the dynamics of the parameters of the microcirculatory bed of the skin after endovascular revascularization of the lower limb in patients suffering from intermittent claudication (IC) with and without type 2 diabetes mellitus (DM). PATIENTS AND METHODS: Microcirculation (MC) of the skin of lower extremities was examined in 88 male patients presenting with IC and without DM (Group One) and in 28 male patients with IC and DM (Group Two). 30 patients from Group One and 21 patients from Group Two were subjected to endovascular revascularization of lower limbs. MC was examined on the 2nd day after restoration of blood flow in the extremity by means of laser Doppler flowmetry with the assessment of the amplitude parameters of blood flow fluctuations, reflecting active and passive mechanisms of regulation of microcirculation, the intensity of blood flow through the arteriole-venule shunts and the nutritive blood flow. RESULTS: At baseline, the main parameters of MC had no differences in the groups and were characterized by intensification of the blood shunted bypassing the nutritive bed, venous plethora, constriction of precapillaries and restriction of capillary blood flow. After endovascular angioplasty of the affected artery and restoration of blood flow therein the patients of the examined subgroups demonstrated an equal increase in the ankle-brachial index, thus approaching the normal values; the patients of both subgroups reported disappearance of pain in the legs during usual daily activities. In patients without DM, endovascular intervention was accompanied by a decrease in the intensity of the arteriole-venule shunts, venous plethora, and enhancement of capillary blood flow. The patients with DM at the early stage after restoration of blood flow in the limb were found to have no statistically significant shifts of the functional parameters of the microvascular bed. CONCLUSION: From the point of view of microcirculatory transformations in patients with IC and DM, the effect of limb revascularization at early stages of follow-up turned out to be incomplete, which, probably, was due to irremovable events of latent diabetic microangiopathy and neuropathy.

[Association of Strategy of Direct Stenting of Infarct-Related Artery with Reduction of Mortality in Woman with ST-Elevation Myocardial Infarction].

Aim of this study was to evaluate the impact of direct stenting (DS) strategy on the results of treatment of female patients with STelevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). MATERIALS AND METHODS: Among 1297 patients with STEMI admitted to the coronary care unit and subjected to PCIs from 2006 to 2015 there were 330 women (25.4 %). Data from 161 women (48.8 %) who underwent DS were compared with those from 169 women who underwent indirect stenting (IS). Among patients of IS group in 148 (87.6 %) stenting was performed after predilation, in 7 (4.1 %) after manual thrombus aspiration, and in 14 (8.3 %) after combination of predilation and thrombus aspiration. RESULTS: The rate of angiographic success was higher in the DS group (97.5 vs. 87.6 %, р<0.001). Rates of deaths (4.3 vs. 11.8 %; p=0.013), major adverse cardiac events (MACE)(4.3 vs. 13 %; p=0.005), and no-reflow (1.9 % vs. 11.2 %; p=0.013) were significantly lower in the DS group. There were no differences in rates of recurrent myocardial infarction and access site complications. Following propensity score matching, each group contained 78 patients. Rates of MACE (2.6 vs. 14.1 %; p=0.009) and deaths (2.6 vs. 12.8 %; p=0.016) remained significantly lower in the DS group. After multivariate adjustment, DS strategy was independently associated with lower mortality (odds ratio [OR] 0.29; 95 % confidence interval [CI] 0.09-0.97; p=0.04) and MACE (OR=0.28; 95 %CI 0.09-0.087; p=0.03). CONCLUSION: DS strategy in STEMI female patients turned out to be safe and effective technique.

[Impact of Diabetes Mellitus and blood glucose levels on the results of treatment of patients with ST-elevation myocardial infarction undergoing percutaneous coronary interventions].

The aim of this study was to evaluate the impact of diabetes mellitus (DM) and glucose levels on the results of treatment of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). MATERIALS AND METHODS: Data were collected from all patients (n=1280) with STEMI who were admitted to the coronary care unit and underwent PCIs from 2006 to 2015. 212 (16.6%) patients with DM were compared with 1068 (83.4%) patients without DM (non-DM group). To investigate the influence of the blood glucose levels, all patients were divided into two groups above and below the median of blood glycemia (7.52 mmol/l). RESULTS: Thus, 634 patients with high level of blood glycemia (>7.52 mmol/l) were compared with 635 patients with low level of blood glycemia (≤7.52 mmol/l). In comparing of DM and non-DM groups there were no differences in the rate of death (5.2% vs 4.2%, р=0.526), stent thrombosis (1.4% vs 1.0%, р=0.622), recurrent myocardial infarction (MI) (1.4% vs 1.2%, р=0.813) and major adverse cardiac events (MACE) (7.5% vs 5.4%, р=0.228), which included in-hospital death, recurrent MI and stent thrombosis. The rates of angiographic success (92.9% vs 93.8%, р=0.625) and no-reflow (6.6% vs 5%, р=0.327) also were comparable between groups. The rates of death (6.3% vs 2.5%, р=0.001), MACEs (7.6% vs 4.1%, р=0.008), and no-reflow (6.9% vs 3.6%, р=0,009) were significantly higher in patients with high level of blood glycemia (>7.52 mmol/l). Angiographic success rate (95.1% vs 92.1%, р=0.029) was higher in patients with low level of glycemia (≤7.52 mmol/l). After multivariate adjustment, high level of blood glycemia (>7.52 mmol/l) remained an independent predictor of death (OR=2.28; 95% CI 1.18-4.40, р=0.014), MACE (OR=2.08; 95% CI 1.16-3.75, р=0.014) and no-reflow (OR=2.07; 95% CI 1.15-3.74, р=0.015). At the same time DM wasn't associated with death, MACE or no-reflow. CONCLUSION: High level of blood glycemia was an independent predictor of death, MACE and no-reflow in patients with STEMI, undergoing PCI. The presence of DM was not associated with worse in-hospital outcomes.

[Comparison of Direct Stenting Versus Stending After Pre-Dilation in ST-Elevation Myocardial Infarction].

AIM: To study was to assess in-hospital outcomes of direct coronary stenting (DS) compared with stenting after predilation (PD) in patients with ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Data were collected from all patients (n=1103) with STEMI subjected to primary PCI in Tyumen cardiology center from 2006 to 2014. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of no-reflow phenomenon were analyzed. The composite of in-hospital death, myocardial infarction (MI) and stent thrombosis were defined as major adverse cardiac events (MACE). RESULTS: Altogether 563 patients (51 %) underwent DS, and in 540 (49 %) stents were implanted after PD. Patients in DS group compared with those in PD group were younger (57.9±10.9 vs 60±11.5 years; p=0.001), less often had chronic kidney disease (5.2 vs 8.4 %; р=0.034), more often recieved prehospital thrombolysis (25 vs 11.9 %; p.

[Impact of hyperglycemia on the results of percutaneous coronary interventions in patients with acute ST-segment elevation myocardial infarction]. / Vliianie giperglikemii na rezul'taty chreskozhnykh koronarnykh vmeshatel'stv u bol'nykh ostrym infarktom miokarda s pod''emom segmenta ST.

AIM: To investigate the impact of hyperglycemia on the results of percutaneous coronary interventions (PCIs) in patients with acute ST-segment elevation myocardial infarction (ASTEMI). SUBJECTS AND METHODS: A study group consisted of 511 patients with hyperglycemia (blood glucose level (BGL) ≥7.77 mmol/L) who underwent primary PCIs in the period from 2005 to 2015. A comparison group included 579 patients (BGL ≥7.77 mmol/L). RESULTS: Assessment of the results of hospital interventions revealed that the mortality rates in patients with hyperglycemia proved to be higher than in those with normal BGL (6.5 and 2.6%, respectively; p=0.002). No differences were found in the rates of stent thrombosis (1 and 1.4%; p=0.541) and recurrent myocardial infarction (1.2 and 1.6%; p=0.591). Major adverse cardiac events, including death, recurrent infarction, and stent thrombosis, were more frequently determined in the hyperglycemic patients (7.6 and 4.3%; p=0.020). No-reflow phenomenon statistically significantly more frequently developed in the patients with hyperglycemia (6.8 and 3.3%; p=0.007). Binary logistic regression analysis showed that the presence of hyperglycemia served as an independent predictor of hospital mortality (odds ratio (OR) 2.6; 95% confidence interval (CI), 1.4 to 4.8; p=0.002). The application of a random probability sampling technique revealed that mortality remained statistically significantly higher in the hyperglycemic patients than in the normoglycemic individuals at admission (6.7 and 2.6%; р=0.011). CONCLUSION: PCIs in patients with ASTEMI and hyperglycemia are characterized by higher mortality rates and the risk of major adverse cardiac events. Admission hyperglycemia is an independent predictor of hospital mortality.

[Primary percutaneous interventions into the coronary arteries in patients with diabetes mellitus]. / Pervichnye chreskozhnye vmeshatel'stva na koronarnykh arteriyakh u patsientov s sakharnym diabetom.

AIM: to investigate the specific features and results of percutaneous interventions (PCI) into the coronary arteries in patients with acute ST-segment elevation myocardial infarction (MI) and diabetes mellitus (DM) in clinical practice. SUBJECTS AND METHODS: A study group consisted of 120 patients with a history of type 2 DM, who had undergone primary PCI in 2008 to 2013. A comparison group included 601 patients without a history of DM. RESULTS: Assessment of the results of hospital interventions revealed no differences between the study and comparison groups in mortality rates (4.1 and 3.2%, respectively; p=0.376), stent thromboses (0.8 and 1.2%, respectively; p=0.601), and recurrent MI (0 and 1.5%, respectively; p=0.189). No differences were determined in the combined index including death, recurrent MI, and stent thrombosis (5 and 5%; p=0.985). At the same time, the no-reflow phenomenon developed statistically significantly more frequently in the patients with DM (7.4 and 2.8%; p=0.019). Binary logistic regression established independent associations between the presence of DM and patient age (odds ratio (OR) 1.04; 95% confidence interval (CI) 1.02 to 1.07; p<0.001), female sex (OR 0.36; 95% CI 0.23 to 0.56; p<0.001), and higher body mass index (OR 1.1; 95% CI 1.06 to 1.16; p<0.04). CONCLUSION: Primary PCIs in patients with DM are an effective and safe method for revascularization in acute ST-segment elevation MI and these are not followed by increases in mortality and frequency of major poor cardiac complications at the hospital stage despite the more common development of the no-reflow phenomenon.

[The Results of the Method Percutaneous Intracoronary Intervention in Patients of Both Male and Female].

OBJECTIVE: To assess gender differences among patients subjected to percutaneous coronary intervention (PCI) according to data of the "Register of performed operations of percutaneous transluminal coronary angioplasty (PTCA)". MATERIALS AND METHODS: The Register was conducted from 1996 to 2012 years and comprised 4890 patients (4121 men and 769 women). RESULTS: Women compared to men were older (58.2+/-8.6 vs 53.4+/-8.3 years; <0.001), had higher body mass index (31.4+/-5.3 vs 29.0+/-4.4 kg/m2; <0.001), level of total cholesterol (5.6+/-1.5 vs 5.3+/-1.3 mmol/l%; <0.001), systolic (141.1+/-22.2 vs 135.1+/-20.8 mmHg, <0.001) and diastolic blood pressure (86.5+/-11.8 vs 85.4+/-12.0 mmHg; =0.014). Compared to male cohort females more often had diabetes mellitus (22.5% vs 10.0%; <0.001), arterial hypertension (92.1 vs 75.6%; <0.001), family history of ischemic heart disease (IHD) (31.3 vs 23.4%; <0.001). Moreover, severe functional classes of effort angina (class III-IV 62.8 vs 50.0%; <0.001) and heart failure (NYHA class III-IV 28.1 vs 13.4%; <0.001) were more often detected in women. In men more frequent were smoking (45.4 vs 9.9%; <0.001), alcohol consumption (26.6 vs 9.0%; <0.001) and history of myocardial infarction (51.8 vs 40.2%; <0.001). Linear heart dimensions were larger in men. Men had more severe left ventricular (LV) asynergy (15.9+/-15.1 vs 13.7+/-14.7%; <0.001) and lower LV ejection fraction (54.5+/-8.7 vs 55.4+/-8.6 %; =0.03). As compared with men, portion of women subjected to primary PTCA was higher (14.3 vs 9.2%; <0.001), likewise coronary stenting was more often performed in women (93.6 vs 88.5%; <0.001). Optimal angiographic results were more frequently achieved in women (97.9 vs 96.4%; =0.04). Incidence of post-punctional hematoma was higher in female cohort (15.0 vs 4.6%; <0.001). There were no significant differences between men and women in post-operative mortality and rate of major adverse noncardiac events after primary and planned PTCA. CONCLUSION: Despite the detected clinical, functional, and echocardiographic gender differences both for men and women PCI was safe and highly efficient method of IHD treatment.

[Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction With ST-Segment Elevation After Prehospital Thrombolysis].

PURPOSE: to analyze results of percutaneous coronary intervention (PCI) in patients with acute ST- elevation myocardial infarction performed after prehospital thrombolysis in real clinical practice. MATERIAL: In the period from 2008 to 2013 144 and 577 patients were subjected to PCI after prehospital thrombolysis with tenecteplase (pharmacoinvasive group - PhG) and primary PCI (PPCIG), respectively. RESULTS: PhG compared with PPCIG contained younger patients (mean age 56.9+/-0.2 and 59.6+/-1.2 years, respectively; p=0.01), and higher portion of men (84.7 and 72.6%, respectively; p=0.003). Frequency of complete occlusion of infarct-related artery in PhG was lower (41.7 and 71.4%, respectively; p< 0.001). Time from onset of pain to administration of a thrombolytic drug was 80 (55; 172) min, PCI was performed in 270 (120; 540) min after thrombolysis. In PPCIG time from onset of symptoms to hospital admission was 120 (60; 230) min, "door-to-balloon" time - 86 (67; 115) min. There was no difference between groups in the composite outcome comprising death, recurrent infarction and stent thrombosis, as well as in frequency of bleeding complications at the puncture site. Rate of major cardiac complications during hospital stay was independently associated with elderly age (odds ratio [OR 1.05; 95% confidence interval [CI] 1.02 to 1.08), previous myocardial infarction (OR 2.21, 95% CI 1.18 to 4.18), and total occlusion of infarct-related artery (OR 4.08, 95%Cl 1.86 to 8.94). Pharmacoinvasive strategy was not associated with reduction of the incidence of major cardiac events (OR 1.25, 95%CI 0.60 to 2.60). CONCLUSION: In settlements with PCI capable hospital primary PCI is clinically and economically justified.Key words: myocardial infarction; pharmacoinvasive strategy; primary percutaneous coronary intervention; prehospital thrombolysis.

[Right ventricular dilatation in patients with coronary heart disease without myocardial infarction: According to the data of the Coronary Angiography Surgery Registry].

AIM: To identify factors associated with right ventricular (RV) dilatation in patients with coronary heart disease (CHD) without prior myocardial infarction (Ml). SUBJECTS AND METHODS: Out of 16 839 patents from the Coronary Angiography Surgery Registry, the investigators selected patients with >75% stenosis in at least one coronary artery without acute or prior MI: 75 patients with echocardiographically detected RV dilatation and 1134 without RV dilatation. RESULTS: Among the patients with RV dilatation, there were more men (92% versus 80.2%; p=0.01 2). In this group, the mean body mass index (BMI) was higher (31.7±5.2 kg/m2 versus 30.1±4.7 kg/m2; p=0.01 9); there was more commonly higher NYHA functional class (FC) (III) chronic heart failure (CHF) (22.2% versus 12.5%; p=0.002), clinically relevant mitral regurgitation (29.4% versus 4.0%; all ps<0.001), and cardiac rhythm and conduction disturbances (45.5% versus 17.8%; p<0.001) in rarer severe FC (III-IV) exertional angina (30.3% versus 52.8%; p=0.007). The groups were different as evidenced by coronarography and major blood biochemical indicators. Decreased myocardial contractility (odds ratio (OR), 4.22; p=0.002), male sex (OR, 4.03;p=0.007), cardiac rhythm and conduction disturbances (OR, 2.98; p<0.001), clinically relevant mitral regurgitation (OR, 2.34; p=0.001); higher FC CHF (OR, 1.87; p=0.034), BMI (OR, 1.08; p=0.01 0), and lower FC exertional angina (OR, 0.42; p=0.001) demonstrated an independent relationship to RV dilatation, as evidenced by a multivariateanalysis. CONCLUSION: In the patients with CHD without MI, RV dilatation is independently related to male sex, left ventricular functional characteristics, and higher BMI.

[Clinical profile and treatment of left main coronary artery disease in a real-world practice].

Aim of this study was to assess clinical profile, treatment and long-term results in patients with left main coronary artery disease in a real-world practice. 225 cases were analyzed. Long-term results were evaluated from 213 (97.7%) patients. Median follow-up period was 49 months. Fifty two (23.9%) patients received nonsurgical treatment, coronary artery bypass grafting (CABG) was performed in 106 (48.6%) patients, percutaneous coronary interventions (PCI) in 60 (27.5%) patients. Patients of nonsurgical group had more severe clinical profile compared with PCI group. There was no differences between nonsurgical and CABG groups as well as between CABG and PCI groups in clinical profile. Major adverse cardiac and cerebrovascular event rate was higher in nonsurgical group. There was no difference between CABG and PCI groups. Survival in CABG and PCI groups was higher compared with nonsurgical group. Survival effect of revascularization was observed immediately (before 6 months) and continued long-term (more than 60 months). Revascularization was independent predictor of improved long-term survival. After diagnosis of left main coronary artery stenosis PCI was performed more quickly than CABG.

[Specific features of left ventricular remodeling in patients with diabetes mellitus and coronary heart disease residing in the Far North].

This study enrolled 202 patients with diabetes mellitus and coronary heart disease residing in the Far North. They were selected from 8753 subjects included in the Registry of performed coronary angiographies. The control group contained 196 patients with CHD and DM2 residing in the south of Tyumen region. 76 (19%) patients had normal structural and functional characteristics of LV (LVMM = < N and LVRWT < 0.45), in 322 (81%) these characteristics were pathologically changed (eccentric and concentric LV hypertrophy, concentric LV remodeling). Groups 1 and 2 included 79.2 and 68.4% men respectively p = 0.014) of mean age 53.9 +/- 0.45 and 58.1 +/- 0.51 p < 0.001) having LV diameter 26.2 +/- 0.2 mm and 25.5 +/- 0.2 mm (p = 0.012). Other echocardiographic parameters, occurrence of asymmetric myocardial hypertrophy, and distribution of the patients by the types of LV geometric models were not significantly different. Odd ratios for the patients with pathological LV morphology revealed no dependence of LV remodeling on the site of residence. The structural and functional changes in myocardium of the patients residing in the North and South of Tyumen region were comparable in terms of severity. It is concluded that DM is a powerful factor influencing myocardial remodeling to the extent that masks even the effects of extreme ("northern") environmental conditions.

[Clinical features of coronary heart disease with concomitant diabetes mellitus at high latitudes].

Joint effect of diabetes mellitus (DM) and extreme natural conditions of the Far North on the clinical course of coronary heart disease (CHD) remains poorly known. Specific features of DM2 concomitant with CHD were studied in 243 of the 8573 subjects living in Far North areas of the Tyumen region and examined by coronarography (mean age 53.4 +/- 0.4 years). The control group comprised 139 patients (56.9 +/- 0.58 years) with CHD and DM2 living in the south of Tyumen region. Clinical and ECG observations were supplemented by measurement of total cholesterol and selective coronarography. Patients of the study group were younger (p < 0.001), more frequently consumed tobacco (p < 0.001) and alcohol (p = 0.001) and had obesity (p = 0.008). Most patients in both groups had a history of myocardial infarction, suffered functional class II or higher angina and circulatory insufficiency (according to NYHA), high cholesterolemia, and arterial hypertension further deteriorating effects of CHD and DM2. However, the two groups were not significantly different in terms of these characteristics. It is concluded that combination of CDH and DM2 has unfavourable effect in patients living in the Far North although severity of clinical and functional manifestations of CDH in DM2 patients is not significantly different between residents of northern and southern areas of Tyumen region.