The Clinical Evolution of Diffuse Myocardial Fibrosis in Patients With Arterial Hypertension and Heart Failure With Mildly Reduced Ejection Fraction Treated by Olmesartan or Sacubitril / Valsartan.

Aim      A 12-month evaluation of the potentialities of the angiotensin II receptor inhibitor olmesartan (Olme) and the angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan in patients with arterial hypertension (AH) and dyslipidemia in the dynamics of the following indicators of chronic heart failure (CHF): N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), LV global longitudinal strain (LV GLS) in diffuse myocardial fibrosis (MF) previously diagnosed by magnetic resonance imaging (MRI).Material and methods  Olmesartan medoxomil (n=56) and sacubitril/valsartan (n=63) were used for 12 months in patients with hypertension, dyslipidemia and NYHA functional class II-III CHF with mid-range LVEF (CHFmrEF). MF was diagnosed by the following MRI criteria: late gadolinium enhancement and an increased proportion of extracellular matrix (33% or more). The frequency of persisting late gadolinium enhancement and the increased proportion of extracellular matrix (33% or more) was evaluated at 12 months; changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), NT-proBNP, and LV GLS were evaluated after 3, 6, and 12 months of follow-up.Results Baseline parameters did not differ between groups. The late gadolinium enhancement and increased proportion of extracellular matrix were present at baseline in all patients of both groups (100%; p=1.0). Already at 3 months, statistically significant decreases in SBP and DBP were observed in both groups. In addition, the LV GLS monitoring showed LV GLS significantly increased in both groups after 3 months and continued changing after 6 and 12 months. The NT-proBNP concentration significantly decreased in both groups already after 3 months and continued to decrease after 6 and 12 months. At 6 and 12 months, sacubitril/valsartan was superior to olmesartan in reducing SBP and NT-proBNP and in restoring LV GLS. At 12 months, the incidence of persisting, abnormal late gadolinium enhancement and increased proportion of extracellular matrix was significantly less in the ARNI group.Conclusion      Olmesartan was demonstrated effective in the multi-modality therapy of CHFmrEF and MF in patients with AH and dyslipidemia. ARNI was superior to olmesartan in this regard, but further research of this issue is required.

Atherosclerosis of the carotid and coronary arteries in elderly patients with acute coronary syndrome.

Aim    To study the relationship between severities of the carotid artery injury and the atherosclerotic process in coronary arteries of elderly patients with acute coronary syndrome (ACS).Material and methods    The study included 110 patients aged >75 years. Based on the degree of maximal carotid stenosis according to data of duplex scanning (DS), all patients were divided into group I, (>50% stenosis) and group II (<50% stenosis).Results    According to coronary angiographic data, multivessel disease was observed in 63.6 % of patients. Patients of group I more frequently had three-vessel coronary artery disease than patients of group II (35.8 and 5.3 %, р<0.001). Coronary angiography and DS showed that 82.7 % patients (in group II, not all carotid stenoses were hemodynamically significant) had a combined damage of coronary and carotid arteries; carotid artery stenoses of >50% were associated with three-vessel coronary artery disease. A correlation between atherosclerosis of carotid and coronary arteries was found. Considering this correlation, a scale was introduced that suggested the severity of coronary atherosclerosis based on DS of carotid arteries. The score was assigned by assessing the degree of maximal stenoses in carotid arteries. A ROC analysis has determined a threshold score suggestive of the severity of coronary atherosclerosis: score <6, absence of >70% coronary stenosis; score >6, likely presence of >70% coronary stenosis (sensitivity, 70 %; specificity, 89 %).Conclusion    Combined coronary and carotid artery disease was detected in 82.7% of elderly patients with ACS. A correlation between the severity of atherosclerosis in carotid and coronary arteries was found. DS of carotid arteries can be extensively used in evaluation of elderly patients with ACS, which will allow additional stratification of patients at high risk of cerebrovascular and recurrent cardiovascular diseases.

Chronic obstructive pulmonary disease in patients with coronary heart disease worsens long-term prognosis after percutaneous coronary interventions.

Aim    To evaluate the incidence rate of major adverse cardiovascular events (MACVE) in the long-term following percutaneous coronary interventions (PCCI) in patients with acute and chronic ischemic heart disease (IHD) and the contribution of concurrent chronic obstructive pulmonary disease (COPD) to the long-term prediction.Material and methods    This prospective cohort study included 254 patients with IHD and concurrent COPD and 392 patients with IHD without COPD. PCCI was performed in all patients: for acute coronary syndrome in 295 patients and for chronic IHD in 351 patients. The follow-up period lasted for up to 36 months. The outcome was a composite endpoint, MACVE, that included cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization (MR), and the time to the event.Results    The age-standardized incidence of MACVE in patients with IHD and COPD was 31.5 vs. 23.2 % in patients with IHD without concurrent COPD (p=0.025), primarily due to an increased frequency of repeated unscheduled MR (20.5 vs. 14.0 %, p=0.041), which was associated with earlier occurrence of adverse events (p<0.001). Repeated unscheduled MR was more frequently performed in patients with moderate COPD; the frequency of MR decreased with increasing severity of COPD, whereas the total incidence of cardiovascular death, myocardial infarction, and stroke was the highest in patients with severe and very severe COPD.Conclusion    The presence of concurrent COPD increases the relative risk of MACVE 1.36 times (95 % confidence interval: 1.05-1.75) and facilitates their earlier development. Repeated unscheduled MR makes the major contribution to the increase in the total risk (relative risk, 1.46; 95 % confidence interval: 1.03-2.06). The increase in severity of COPD is associated with the increase in total frequency of MACVE (p=0.005).

[3-years outcome of follow-up of patients with chronic obstructive pulmonary disease successfully treated by percutaneous coronary intervention due to acute coronary syndrome].

Aim To evaluate results of three-year follow-up in patients after acute coronary syndrome (ACS) associated with chronic obstructive pulmonary disease (COPD) and to identify predictors for delayed serious cardiovascular adverse (SCVAE) events.Material and methods This prospective cohort study included 119 patients with verified COPD who had ACS after a successful urgent percutaneous coronary intervention and were discharged from the hospital without in-hospital complications. Incidence of and time to SCVAE (cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization) were recorded. SCVAE predictors were identified with the Cox regression by stepwise inclusion of variables into the model.Results SCVAE occurred in 33.6 % of ACS patients with COPD. The high rate of repeated myocardial revascularization mostly contributed to the development of delayed SCVAEs (19.3 % of patients). Independent predictors of SCVAE included the total number of stenoses in major coronary artery branches; ankle-brachial index; glomerular filtration rate calculated with the CKD-EPI equation; frequent COPD exacerbations; functional residual capacity of the lungs; and 6-min walk distance.Conclusion New independent predictors of SCVAE were identified in COPD patients after ACS with percutaneous coronary intervention and stenting, including distance in the 6-min walk test, frequent COPD exacerbations, and functional residual volume of the lungs as an index of pulmonary hyperinflation.

[Prediction of long-term adverse cardiovascular events after percutaneous coronary interventions in patients with coronary artery disease and concomitant chronic obstructive pulmonary disease].

Aim To identify independent predictors for long-term serious adverse cardiovascular events following percutaneous coronary interventions (PCI) in patients with a combination of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) and to develop a prognostic mathematical model.Materials and methods Design: a prospective cohort study. The study included 254 patients with IHD associated with COPD after PCI (in 119 patients, PCI was performed for acute coronary syndrome and in 135 patients, PCI was elective). Follow-up duration was up to 36 months. Composite endpoint included cardiovascular death, myocardial infarction, stroke or repeated, unscheduled myocardial revascularization. Cox regression with stepwise inclusion of variables was used for identification of predictors for the composite endpoint.Results The following independent predictors of serious adverse cardiovascular events were identified: number of stenoses in major coronary artery branches, ankle-brachial index. glomerular filtration rate, age, distance in 6-min walk test, COPD phenotype with frequent exacerbations (FE), and functional residual capacity (FRC) of lungs. The mathematical model based on the Cox regression for prediction of serious adverse cardiovascular events had a 75% sensitivity and a 81% specificity.Conclusion Incidence of long-term serious adverse cardiovascular events in patients with a combination of IHD and COPD after PCI depends not only on traditional cardiovascular risk factors but also on characteristics of COPD itself, such as the FE phenotype and the FRC indicative of lung hyperinflation. The proposed mathematical model based on the Cox regression can be used for evaluating the odds for adverse cardiovascular events after PCI in patients with a combination of IHD and COPD.

[Lung Hyperinflation in Chronic Obstructive Pulmonary Disease and Long-Term Outcomes of Percutaneous Coronary Intervention].

OBJECTIVE: to assess the effect of lung hyperinflation (LHI) in patients with chronic obstructive pulmonary disease (COPD) on longterm outcomes of percutaneous coronary intervention (PCI). MATERIALS AND METHODS: Patients with COPD who suffered stable ischemic heart disease and underwent PCI (n=135) were included in a prospective cohort study. LHI was found in 60 patients, while 75 patients had no LHI. Evaluation included comparing the frequency of major adverse cardiac events (MACE) (cardiac death, myocardial infarcпункtion [MI], stroke, repeat revascularization) and Kaplan-Mayer curves between groups of patients with and without LHI. Associations of parameters of pulmonary function and plasma levels of high sensitivity C-reactive protein (hsCRP) with occurrence of MACE were also elucidated. Duration of follow-up was up to 3 years (median 20 months). RESULTS: Study groups did not differ significantly by main factors of cardiovascular risk, except plasma level of hsCRP. MACE occurred in 41.7 and 26.7 % of patients in groups with and without LHI, respectively (p=0.097). However, divergence of the Kaplan-Meier curves was statistically significant (p=0.04). The main contribution was made by cardiac death, MI and stroke (21.7 and 8.0 % among patients with and without LHI; p=0.027). No difference was found regarding repeat revascularization. The correlation between functional residual lung capacity and plasma level of hsCRP was closer than the correlation between forced expiratory volume in 1 second and hsCRP level (r=0.36 and r=0.19; p.

[Radial Approach for Percutaneous Coronary Interventions in Patients With Ischemic Heart Disease: Advantages and Disadvantages, Complications Rate in Comparison With Femoral Approach].

During recent 10-15 years, percutaneous coronary interventions (PCI) have reached a new level of efficacy and safety. Rate of serious coronary complications has decreased. That to a greater degree exposes the problem of peripheral complications at the site of arterial approach. At the same time portion of patients older than 75 years in the total pool of PCI constantly increases. Number of patients with pronounced obesity also grows each year. Radial approach for PCI allows to substantially decrease rate of peripheral complications at the account of lowered rate of bleedings, and to shorten duration of hospitalization. In this literature review we present results of a number of relevant clinical studies including those which contained groups of elderly patients and of patients with obesity. We also have summarized main advantages and disadvantages of radial approach as compared with femoral approach for coronary angiography and PCI.

[The Phenotype of Chronic Obstructive Pulmonary Disease With Frequent Exacerbations in the Aspect of Long-term Percutaneous Coronary Intervention Results].

OBJECTIVE: To evaluate the results of percutaneous coronary interventions (PCI) in patients with coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD), depending on the frequency of exacerbations of COPD. MATERIALS AND METHODS: We enrolled in this prospective study 103 patients with CHD and COPD who underwent PCI (n=103) including 25 who satisfied criteria of COPD phenotype with frequent exacerbations (main group). Analysis included comparison of rates and times to major adverse cardiac events (MACE - myocardial infarction, stroke, cardiac death, repeat revascularization) in the main group and other patients. Clinical and functional features of patients with major adverse cardiac events were also analyzed. RESULTS: Study groups did not differ significantly on demographic characteristics and the presence of comorbidity. MACE frequency was almost 2 times higher in the main group (relative risk 1.87; 95% confidence interval (CI) 1.1-3.3). There was a tendency to higher rate of MACE among patients with history of more or equal 1 COPD exacerbations in a year (40% vs. 24%, p=0.09). The following clinical and functional characteristics of COPD, were associated with MACE in remote period after PCI: frequency of exacerbations, results of the COPD Assessment Test, exercise capacity, forced expiratory volume in 1 sec. Conclusion/ COPD phenotype with frequent exacerbations in patients with CHD undergoing PCI is associated with increased risk and earlier occurrence of MACE.

[Ability to Overcome the Thrombocyte Resistance to Acetylsalicylic Acid in Patients With Coronary Artery Disease After Myocardial Revascularization With Coronary Stenting].

Resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease is a poor predictor for the development of atherothrombotic complications. In 277 patients with coronary artery disease suffered uncomplicated coronary angioplasty with stent implantation, we was estimated arachidon-induced platelet aggregation during treatment with acetylsalicylic acid by bedside VerifyNow Assay test at 28-90 days after the intervention. It was found that 18.9% of the 144 patients receiving a combination of ASA 75 mg with 15.2 mg of magnesium hydroxide had true (laboratory) resistance to ASA. At the same time on the original enteric coated ASA 100 mg, we can found only 0.8% resistance to ASA among 129 patients. We made switch from combination of ASA 75 mg with 15.2 mg of magnesium hydroxide to original enteric coated ASA 100 mg and repeat VerifyNow Assay test at 2-4 days and found lost of resistance in 92% of 28 patients. Thus, resistance to the ASA is not constant, it depends on the form and the applied dose of ASA, and eliminating more than 92% when ASA changes from ineffective to effective form.

[Changing Clinical Presentation of Acute Coronary Syndrome in Patients With Chronic Obstructive Pulmonary Disease].

OBJECTIVE: to determine clinical features of acute coronary syndrome (ACS) in patients with chronic obstructive pulmonary disease (COPD). METHODS: We included into this study 272 patients with ACS, 110 with and 162 without concomitant COPD. In both groups we registered prevalence of atypical forms of ACS debut, severity of acute heart failure (Killip class), time from symptoms onset prior to percutaneous coronary intervention (PCI), as well as the prevalence of cardiac arrhythmias. RESULTS: Demographic characteristics and presence.

[The differences between the guidelines of the European Society of Cardiology and the American College of Cardiology/ American Heart Association for oral P2Y12 inhibitor therapy in the management of patients with acute coronary syndromes].

The analysis of the evidence that formed the basis for the current guidelines of the European Society of Cardiology (ESC) on oral therapy by antithrombotic drugs for acute coronary syndromes (ACS), and a comparison with the U.S. guidelines. The ESC guidelines, published during 2011-2012, declared the superiority of prasugrel and ticagrelor over clopidogrel in patients with ACS without ST elevation and myocardial infarction (MI) with ST elevation. These guidelines are based in each case on a subgroup analysis of a single study using either prasugrel (TRITON), or ticagrelor (PLATO). In contrast, the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, published in 2012-2013, are more balanced, conservative and present evidence-based outlook, suggesting no proven extra benefit of one P2Y12 antagonist over the other(s). The ESC guidelines regarding the findings of the superiority of prasugrel or ticagrelor over clopidogrel are overly optimistic and not always evidence-based. A small frequency of clinical use of prasugrel and ticagrelor in the world in general and Europe in particular, suggests a discrepancy between the traditionally appointed treatment and published ESC guidelines.

[Two years experience of the use of a penetration catheter (Tornus) recanalization during percutaneous coronary interventions on chronic total occlusions].

We included in this study 43 patients chronic total occlusions (CTO) subjected percutaneous coronary interventions (PCI) with the use of penetration catheter (Tornus) in 2009-2010. Penetration catheter was applied only in those cases when it was not possible to introduce low profile coronary dilatation catheter into the site of occlusion. After penetration of CTO by a guide wire a channel was formed by a manually rotated penetration catheter. The Tornus catheter was successfully passed into distal part of an artery in 81.4% of cases. In other.

[Possibilities of recanalization of chronic coronary occlusions with penetration catheter <>].

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain one of most difficult parts of interventional cardiology. Introduction of novel devices and methods of recanalization of CTO have facilitated fulfillment of these interventions and increased number of successful procedures. Howere a number of cases it is impossible to position a balloon in the site of occlusion even after its successful crossing with a guidewere. Penetration catheter Tornus was specifically created for such cases. It allows to form a channel in CTO for subsequent dilation and stent implantation. We present a review of available clinical studies assessing efficacy of the use of Tornus catheter during PCI for CTO, as well as results of its comparison with efficacy of rotational atherectomy. Authors of these studies concluded that Tornus catheter was highly effective in cases when it was not possible to pass a catheter for changing usual "RotaWire" guide with the aim of conducting rotational atherectomy, or in cases of impossibility to pass a balloon along a guidewere for predilation of the occlusion site. At the same time the use of penetration catheter had no advantages over rotational atherectomy.

[Salt sensitivity in patients with arterial hypertension].

We present literature review on the role of excessive sodium consumption with food in pathogenesis of salt sensitive arterial hypertension (AH) as well as scientific data allowing to consider sensitivity to salt as independent factor of development and unfavorable course of AH associated with insulin resistance, high activity of sympathetic nervous system, and risk of cardiovascular complications. We present data on differential antihypertensive activity of drugs used for therapy of AH depending on sensitivity of patients to salt.

[Comparative eficacy of antihypertensive therapy in patients with arterial hypertension and various sensitivity to salt].

In 102 patients with high risk (52 patients with history of myocardial infarction, 50 patients with history of cerebral stroke within previous 6-48 months) arterial hypertension (AH) we studied clinical efficacy on angiotensin converting enzyme inhibitor (ACEI) lisinopril, calcium antagonist felodipine, and nonselective - -blocker carvedilol in dependence on salt sensitivity of AH. Efficacy of treatment was assessed with the help of office pressure measurement and 24 hour arterial pressure monitoring before and after 12 weeks of therapy. Patients who showed 10 or more mm Hg lowering of AP at transition from high salt (15 g/day) to low salt ( 3 g/day) diet were considered salt sensitive. On the basis of obtained results optimal for the treatment of AH in salt resistant patients are ACEI while in the treatment of salt sensitive patients it is expedient to administer calcium antagonists. The use of -adrenoblockers is equally effective in AH with various salt sensitivity.

[In-hospital and long-term (to 3 years) results of using bare-metal stents in patients with coronary artery disease and chronic kidney disease].

Patients (n=727) who had been subjected to implantation of one or several standard stents in 2004 were included into this study. These patients were divided into 3 groups according to initial level of glomerular filtration rate (GFR, MDRD equation): group 1 - 466 patients with GFR >60 ml/min/1,73 m(2), group 2 - 233 patients with GFR 30 - 60 ml/min/1,73 m(2), group 3 - 38 patients with GFR <30 ml/min/1,73 m(2). In all group 2 and 3 patients prevention of contrast induced nephropathy (CIN) was implemented: hydration before and after angiography, limitation of intake of nephrotoxic drugs, N acetylcysteine 600 mg/day orally. In all group 2 and 3 patients only contrast preparation iodixanol was used. Total amount of contrast did not exceed 350 ml in patients with GFR 45-59 ml/min/1.73 m(2) and 250 ml - with GFR <45 ml/min/1.73 m(2). In all patients with GFR 60 ml/min/1.73 m(2) low osmolar contrast preparations were used (total amount - less then 600 ml per patient). Immediate success of PCI was similar in all groups (99.4%, 98.2% 97.4%, respectively). Rate of CIN rose significantly in groups 2 and 3 (0.4%, 4.9%, 13.2%, respectively, <0.001). Before 6 months after PCI restenosis developed more frequently with lowering of GFR (group 1 - 11%, group 2 - 22%, group 3 - 34%, <0.001). Myocardial infarction developed by 3 years in 6, 10, and 26% of patients in groups 1, 2, and 3, respectively. Lethality during 3 years was 5, 10, and 24% in groups 1, 2, and 3, respectively. Regression analysis showed that as a whole 3 years rate of myocardial infarction rose 1.57 times in group 2 compared with group 1, and 3.91 times in group 3 compared with group 1. Mortality by 3 years rose 1.93 times in group 2 compared with group 1, and 4.52 times in group 3 compared with group 1. Thus, presence of initially lowered GFR increases risk of CIN after elective implantations of standard stents, leads to rise of restenosis rate by 6 months and increase of mortality and rate of nonfatal myocardial infarction by 3 years.

[The role of reduction of glomerular filtration rate in outcomes of drug-eluting stents implantation in patients with ischemic heart disease and chronic kidney disease].

Patients (n=432) subjected to percutaneous coronary interventions (PCI) with implantation of one or more drug eluting stents (DES) in 2005 were included in this study. These patients were divided into 3 groups according to baseline glomerular filtration rate (GFR): group 1 - GFR 60 ml/min/1.73 m2, n=271, group 2 - GFR 30-60 ml/min/1.73 m2, n=132, group 3 - GFR <30 ml/min/1.73 m2, n=29. In all patients only contrast preparation iodixanol was used and prevention of contrast induced nephropathy (CIN) was implemented. Immediate success of PCI was higher and comparable between groups. Rate of development of CIN turned out significantly higher in groups 2 and 3 (6.8 and 17.2% compared with 0.7% in group 1, <0.001). During 12 months of follow up restenosis rate was higher in groups 2 and 3 (15.9 and 27.6% compared with 6.6% in group 1, <0.001). Lowered GFR became predictor of long term (up to 3 years) mortality in patients with CKD as for group 2 compared with group 1 relative risk (RR) of death was 1.77 (95%CI 1.19-3.74, =0.001), and for group 3 compared with group 1 - 3.69 (95%CI 1.58-6.87), =0.001. In addition lowered GFR was predictor of nonfatal myocardial infarction (MI) up to 3 years: for group 2 compared with group 1 RR 1.69 95%CI 1.12-3.07, =0.009, for group 3 compared with group 1 RR 3.44 95%CI 1.37-6.19, =0.001. The conducted study showed that initially lowered GFR after stenting increased risk of development of CIN, led to rise of restenosis rate and repeat revascularizations up to 12 months, and also appears to be predictor of death and nonfatal MI in remote period up to 3 years.

[Optimal method of revascularization in patients with multivessel coronary artery involvement for application of drug eluting stents: percutaneous coronary interventions in comparison with coronary bypassing].

Drug eluting stents (DES) which appeared in the beginning of 21-st century allowed to elevated percutaneous coronary interventions (PCI) to a novel level. High efficacy of DES has been proven in a row of conducted clinical studies: after their implantation low percentage of in stent restenosis and low rate of repetitive target vessel revascularizations have been obtained. At the same time there occurred definite improvements in the technique of coronary bypass surgery. Therefore a question of choice of optimal method of revascularization in patients with multivessel lesions remains open. In this review we present results of a row of large studies in which coronary bypassing and PCI with implantation of DES has been compared in patients with multivessel lesions.

[Safety and efficacy of the use of glycoprotein IIb/IIIa inhibitors in the invasive treatment of patients with ST-elevation acute coronary syndrome].

UNLABELLED: The purpose of the study was to estimate the safety and the efficacy of the use of tirofiban, its influence on the function of the left ventricle of the heart and the clinical outcome of the patients with ST elevation acute coronary syndrome (ACS) during the rescue coronary angioplasty after the unsuccessful thrombolysis. The study included 112 patients who were randomized into two groups: in group I rescue percutaneous coronary intervention (PCI) with stenting was carried out, the patients in group 2 were administered tirofiban and rescue PCI was conducted. Analysis of the immediate events (0-30 days) showed that in the frequency (group I - 13.7%, group II - 19.2%) and intensity of bleeding there were no distinct differences between groups (p>0.05). In the tirofiban group the distinct growth in the ejection fraction LV (6+/-3% versus 3+/-5% in group I, p=0.005) was recorded. Late events (31-180 days) occurred significantly more rarely in group II (5.8% versus 21.6% in group I, p<0.05). Multivariate analysis showed that the development of cardiogenic shock (OR=6.8, 95%CI: 1.8-26, p=0.005) was an independent risk factor of prominent cardiovascular complications and events during 6 months after PCI. Thus only the use of tirofiban during PCI had a significant effect of the decrease of significant cardiovascular complications and events during 6 months after PCI (OR=0.15, 95%CI: 0.04-0.53, p=0.003). CONCLUSION: the performance of rescue PCI in combination with glycoprotein IIb/IIIa inhibitors allows to reach optimal results of the treatment of patients with ST elevation ACS after failed thrombolysis. The remote prognosis of patients after rescue PCI improves if during the intervention a patient receives IIb/IIIa inhibitors of glycoprotein receptors but at the same time considerably worsens in case of cardiogenic shock development.

[The use of tirofiban in invasive treatment of patients with non-ST-elevation acute coronary syndrome].

The study assessed 123 patients with non-ST-elevation acute coronary syndrome who were randomized into two groups: percutaneous coronary intervention (PCI) (62 patients) and PCI against background of tirofiban injection (61 patients). The results of the study were estimated during the early (up to 30 days) and the late (up to 180 days) follow-up. It was stated that the use of tirofiban has led to the increase of minor bleedings (11% versus 4.8%, p<0.05), but the total amount of bleedings between the groups did not differ: 19.7% in the tirofiban group versus 14.5% in group I. The use of tirofiban has led to the significant growth of the LV ejection fraction (5+/-4% versus 2+/-3%, p<0.05) and increment of the LV wall motion index (0.28+/-0.18 versus 0.12+/-0.21, p<0.001). There was no difference in the frequency of the early events: 9.6% versus 8.2% in the groups without and with the use of tirofiban accordingly (p<0.05). The use of tirofiban was associated with the decrease in the frequency of all events during the first 180 days after PCI: 30.7% in group I and 13.1% in the tirofiban group (p<0.005). Absence the main cardiovascular complications according to Kaplan-Meier method for all patients amounted to 77+/-6%, in the group of the patients who received tirofiban 88+/-6%, and 64+/-8% in the group of the patients who did not receive tirofiban (p=0.009). Thereby, the use of tirofiban in the treatment of the patients with non-ST-elevation acute coronary syndrome does not lead to the increase in the frequency and severity of bleedings. At the same time, the use of tirofiban in the treatment of the patients with acute coronary syndrome has a significant influence on the growth of the LV wall motion index and the LV ejection fraction by increasing them. Under these conditions when using tirofiban in the late period the frequency of all events during PCI is 2.3 times lower compared to the patients who did not receive tirofiban.