[An experience of the use of stents with drug coating in patients with long and diffuse coronary artery lesions].

Treatment of long and diffuse lesions of coronary arteries remains one of most complicated sections of endovascular treatment. From 2003 to 2005 treatment with the use of stents with drug coating was conducted in 198 patients with long and diffuse coronary artery lesions. This made up 26% of total number of patients subjected to percutaneous coronary intervention during this time. Mean age of patients was 58 +/- 11 years, 164 (83%) of them were men, 37 (19%) had chronic occlusions of coronary arteries, in 91 (46%) side branches went out from the damaged segment. Patients were divided in two groups: 1st (n=136) comprised patients with lesion length from 22 to 33 mm, 2nd consisted of patients in whom lesion length exceeded 33 mm. Control group comprised 54 patients with lesion length less than 23 mm subjected to endovascular treatment with the use of stents with drug coating during same period of time. Average length of stented segment was 27.3 +/- 3.6 mm in the first group, 44.5 +/- 9.8 mm in the second group and 14 +/- 3.6 in the control group. Immediate success of the procedure was somewhat lower in group II compared with group I (87 and 91%, respectively). Hemopericardium and cardiac tamponade requiring urgent surgery developed in 2 group II patients (3.2%) during first 2 hours after attempt of recanalization of long chronic occlusions of the anterior descending artery. One patient (1.6%) had small-focal myocardial infarction after procedure, in another patient (1.6%) subacute occlusion developed after stenting of venous graft to the right coronary artery which we failed to eliminate. In the first group in 2 patients (1.4%) small-focal myocardial infarction developed. There were no complications in the control group. In 8 months after procedure angiographic restenosis developed in 6 patients (5%) in the 1st group, in 4 (8%) in the second and in 1 (2%) in the control group, however differences were not significant. Rates of repeat revascularizations of the target stenosis were 3, 5 and 0%, respectively. Of 10 cases of restenosis in patients with long stenoses in 5 cases restenosis was located inside stent and was focal (length less than 10 mm), in 3 cases it was located proximal or distal to stent, and in 2 patients manifested as complete occlusion of the stented segment. Treatment of long and diffuse lesions with the use of stents with drug coating appears safe and effective. Overall rate of development of perioperative complications is higher in treatment of stenoses longer than 33 mm compared with stenoses with length 23-33 cm (6.4 vs. 1.4%). Probability of restenosis and repeat revascularization of target stenosis after 8 months is not high.

[Assessment of antianginal and antiischemic effect of trimetazidine and its effects on myocardial perfusion in patients with ischemic heart disease and stable angina.]. / Otsenka antianginal'nogo i antiishemicheskogo éffekta trimetazidina iego vliianiia na perfuziiu miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei napriazheniia.

AIM: To assess antianginal and antiischemic effects of trimetazidine and its action on myocardial perfusion in patients with ischemic heart disease and stable angina. MATERIAL: Open trimetazidine was given for 3 months to 53 nitroglycerine and beta-blocker treated men aged 47-69 (mean age 60.2+/-0.85) years with ischemic heart disease and stable angina. Stenoses of 1-3 main coronary arteries were found at angiography in 37 of these patients. METHODS: Registration of frequency of anginal attacks and nitroglycerine consumption, treadmill exercise tests and 24-hour ECG monitoring, assessment of severity of myocardial perfusion defects by scintigraphy with (99m)Tc MIBI were used for elucidation of treatment efficacy. RESULTS: After 3 months number of anginal attacks per week decreased from 9.3+/-0.6 to 4.8+/-05% (-48%, p<0.001), weekly nitroglycerine consumption fell from 9.9+/-0.8 to 4.6+/-0.6 pills (-53%, p<0.001), time to ST-segment depression during exercise on treadmill increased from 6.4+/-0.4 to 7.7+/-0.5 min (+16.9%, p<0.001) and total work performed increased from 7.8+/-0.4 to 9.2+/-0.5 METS (+15.2%, p<0.001). According to 24-hour ECG monitoring numbers of episodes of painful and painless ischemia decreased from 4.1+/-0.9 to 1.9+/-0.7 (-56.3%, p<0.002) and their overall duration shortened from 24.3+/-7.0 to 10.6+/-3.9 min (+56.3%, p<0.02). Analysis of heart rate variability revealed significant augmentation of SDNN in 77.8% of patients (from 130.0+/-6.9 to 145+/-8.1, p<0.05). Severity and extent of myocardial perfusion defects decreased in 87.5% of patients by 24,2% (from 476.1+/-78.5, p<0.01) and 20.3% (from 19.7+/-2.4 to 15.7+/-2.0, p<0.01), respectively. CONCLUSION: The use of trimetazidine as complimentary therapy to nitrates and beta-blockers in patients was associated with additional antianginal and antiischemic effects and improvement of myocardial perfusion.

[X-ray morphology of coronary arteries in patients with arterial hypertension in late periods after endovascular treatment]. / Rentgenomorfologiia koronarnykh arterii u bol'nykh arterial'noi gipertoniei v otdalennye sroki posle éndovaskuliarnogo lecheniia.

An association of arterial hypertension (AH) and late angiographic outcomes of endovascular interventions was studied in coronary heart disease. Forty two patients with or without AH underwent repeated coronary angiography within 2 months after the procedure. The total number of restenoses was found to be significantly greater in patients with AH than in those without it. The diameter of restenoses was significantly smaller (70.2 +/- 24.7 vs 48.2 +/- 29.2%) and their area is significantly larger (82.6 +/- 19.6 vs 66.9 +/- 28.8). Absence probability of restenosis was significantly smaller in patients with AH (7 vs 27%); at the same time there was the greatest reduction in this probability in the first 8 months following the intervention.

[Immediate and Remote Results of Endovascular Recanalization of Chronic Coronary Artery Occlusions] / Neposredstvennye i otdalennye rezul'taty éndovaskuliarnoi rekanalizatsii pri khronicheskoi okkliuzii koronarnoi arterii.

We compared early and long-term follow-up results of balloon angioplasty and stenting of chronic coronary occlusions. The initial success rate was 75% (82 of 109 patients). Proportion of patients free of angina was 57 and 69% after successful balloon angioplasty and stenting, respectively. Stenting of coronary occlusions yielded better immediate angiographic results than did balloon angioplasty: residual stenosis and minimal diameter of artery after stenting were 13.5-12.4% and 2.7-0.2 mm, respectively; those after balloon angioplasty were 23.2-15.6% and 2.3-0.2 mm, p<0,05, respectively. Four-year clinical outcome was better in stenting than in angioplasty group: free of angina were 52 and 22% of patients in stenting and angioplasty group, respectively (p<0,05). There was no difference at follow-up between two groups in the rate of myocardial infarction, death, repeat revascularization. Repeat coronary angiography was performed after 38-24 months in 44% of patients. The rate of 'late' restenosis was 32% in stenting and 73% in balloon angioplasty group (p<0,05); mean stenosis and minimal diameter of artery after stenting were 43.5-12.4% and 1.7-0.6 mm, respectively; those after balloon angioplasty were 67.5-15.6% and 0.72+0.5 mm, respectively (p<0,05).

[Long-term assessment of clinical parameters in patients with coronary heart disease after balloon angioplasty and stenting balloon angioplasty]. / Otsenka klinicheskikh pokazatelei bol'nykh IBS v otdalennom periode posle ballonnoi angioplastiki i ballonnoi angioplastiki so stentirovaniem.

The aim of this study was to assess clinical parameters in patients with coronary heart disease (CHD) in the late period after balloon coronary angioplasty (BCA) and intracoronary stenting (ICS). The study included 104 patients who underwent repeated coronary angiography (CA) 2-10 months after successful coronary angioplasty. Clinical parameters were analyzed in 2 groups comparable at the moment of its performance in terms of major clinical characteristics. Group 1 comprised 51 patients following BCA and group 2 included 53 patients after ICS. Six months after the first procedure, repeated coronary angioplasty was performed in 19 (37.2%) and 6 (9.4%) patients after BCA and ICS, respectively (p < 0.05). Recurrent angina pectoris was observed in 42 patients from group 1 and in 25 ones from group 2, which was 82.3 and 47.2%, respectively (p < 0.05). Control CA revealed restenosis of the dilated artery in 22 (43.1%) of the 51 patients of group 1 and in 12 (22.6%) of the 53 patients of group 2. There were no differences between the groups in late postoperative bicycle ergometric and 24-hour ECG monitoring findings. The findings have led to the conclusion that implantation of a stent into the coronary artery greatly prolongs the antiischemic effect of coronary angioplasty and reduces a need for repeated endovascular intervention, which appears as lower incidence rates of restenosis and recurrent angina as compared to routine balloon angioplasty.

[Evaluation of antianginal effectiveness of nicardipine in patients with angina pectoris]. / Otsenka antianginal'noi éffektivnosti nikardipina u bol'nykh so stenokardiei.

The new calcium antagonist nicardipine was studied for its potency in 73 patients with coronary heart disease concurrent with angina pectoris, including 16 with vasospastic angina. Nicardipine given in a mean daily dose of 70.1 +/- 12.4 mg induced an increase in exercise test duration by 1-2 min in 71.9% of the patients as compared with placebo. The agent was slightly less potent than nifedipine. In vasospastic angina, nicardipine was effective in 81.3% of the patients.

[Importance of transesophageal pacing of the atrium in the diagnosis of ischemic heart disease]. / Znachenie chrespishchevodnoi élektricheskoi stimuliatsii predserdii v diagnostike ishemicheskoi bolezni serdtsa.

The diagnostic importance of transesophageal pacing of the atria (TPA) in revealing coronary heart disease was determined by means of comparing the pacing data with the clinical picture of the disease and coronarography readings in 231 patients. It is shown that the sensitivity of TPA in CHD diagnosis is equal to 80%, specificity to 70%, the predicting value of the positive result amounts to 86%, of the negative result to 59%. The greatest diagnostic importance belongs to the positive result of TRA in patients with typical angina pectoris and to the negative result in patients with cardialgia. The sensitivity and predicting value of TRA do not significantly differ from the corresponding indicators of bicycle ergometry. However, TPA is less specific.

[Comparative evaluation of the anti-anginal effects of dilzem and corinfar in patients with ischemic heart disease and exertion-induced stenocardia]. / Sravnitel'naia otsenka antianginal'nogo deistviia dil'zema i korinfara u bol'nykh ishemicheskoi bolezn'iu serdtsa so stenokardiei napriazheniia.

Antianginal efficiency of dilzem, as compared to placebo, was assessed in 53 patients with angina of effort, functional class II-IV. Repeated bicycle ergometry and 24-hour ECG monitoring were used as objective methods for the assessment of treatment efficiency. Antianginal effect of dilzem (180-300 mg/daily) was compared to that of corinfar (30-60 mg/daily) in 16 patients by a simple blind cross procedure, using placebo. The duration of continuous bicycle ergometric exercise increased by 163 sec. In the presence of dilzem, and by 152 sec. in the presence of corinfar, as compared to the placebo, while the performance volume increased by 1296 and 1188 kgm, respectively (p less than 0.001). Unlike corinfar, dilzem produced a significant drop in heart rate and double product both at rest and during exercise. Both dilzem and corinfar considerably reduced average rate and total duration of painless episodes of myocardial ischemia (p less than 0.05), as evidenced by Holter's monitoring.

[Evaluation of the effectiveness of corinfar in patients with ischemic heart disease using a method of repeated transesophageal electric stimulation of the left atrium]. / Otsenka éffektivnosti korinfara u bol'nykh ishemicheskoi bolezn'iu serdtsa metodom povtornoi chrespishchevodnoi elektricheskoi stimuliatsii levogo predserdiia.

The efficiency of 20 mg corinfar, administered sublingually, was assessed by means of esophageal left-atrial electrostimulation (EES) in 49 coronary patients with angina of functional classes 1 through 4. The antiischemic effect of corinfar was evaluated within 30 min after the administration in 27 patients and within 1 hour after the administration in 22 patients. To assess the reproducibility of the results, repeated EES was performed in 11 patients, treated with placebo this time. Corinfar was shown to have a good antiischemic effect 1 hour after sublingual administration, with the maximum induced heart rate rising from 130 to 147 beats per minute and the total duration of the stimulation increasing from 232 to 308 seconds. It is demonstrated that paired EES may be used for the assessment of corinfar efficiency in coronary patients.

[Use of transesophageal electrical stimulation of the left atrium for assessing the anti-ischemic effect of nitrosorbide]. / Primenenie chrespishchevodnoi élektricheskoi stimuliatsii levogo predserdiia dlia otsenki antiishemicheskogo éffekta nitrosorbida.

Anti-ischemic effect of sorbide nitrate was assessed by means of esophageal left-atrial electric stimulation in 26 coronary patients. This method is shown to be useful for objective assessment of the efficiency of antianginal drugs by acute tests in coronary patients. Repeated stimulation in the presence of sorbide nitrate treatment showed smaller ischemic ECG changes.