[One-stage PCI of left main stenosis and infarct-related left main major branches in STEMI patients].

AIMS: to determine immediate and long-term results, safety and efficacy of one-stage PCI of LMCA and infarct-related LAD or CxA in STEMI. METHODS: 81 patients with STEMI treated with one-stage PCI of LMCA and infarct-related LAD or CxA were included into the study. LAD was infarct-related in 53 (65.4%) patients, circumflex (CxA) involved in 28 (34.6%) cases. Distal LMCA lesion was in 45 patients (55.6%). RESULTS: All patients were treated with drug-eluting stents. Radial access was used in 66 (81.4%) cases, in 38 (46.9%) patients intra-aortic balloon contrapulsation supported the procedure. IVUS was performed in 19 (23.4%) patients. Mortality during the procedure was 2.5% (2 patients with cardiogenic shock owing to infarct-related LAD). All other cases were technically successful. Two more patients died during the hospitalization, so short-term mortality was 4.9%. Angina symptoms persisted in 27 patients (33.3%) and were due to lesions in other coronary arteries. In these cases, the second PCI was performed. The mean follow-up period was 32-39 months. During follow-up 7 patients (8.6%) died due to various reasons. Target lesion revascularization was performed in 10 (12.3%) patients, including 3 repeated PCI of LMCA. Repeated revascularization due to atherosclerosis progression in other segments was done in 11 (13.5%) patients. MACCE-free survival was 60.7%. CONCLUSIONS: one-stage PCI of LMCA and infarct-related LAD or CxA seems to be effective and safe treatment in patients with STEMI but larger studies with prolonged follow-up are needed.

[Polymorphism C1444T of C-reactive protein gene and C-reactive protein concentration in blood serum of healthy people and patients with myocardial infarction].

UNLABELLED: CRP level is a risk factor of development of ischemic heart disease (IHD) and acute myocardial infarction (MI) in healthy people, while in patients with cardiovascular diseases it is a marker of unfavorable prognosis. It has been shown in recent investigations that individual variations of plasma CRP levels to a great extent are genetically determined. These data constitute a basis for the study of associations of polymorphic variants of the CRP gene with risk of MI in healthy people as well as with unfavorable prognosis in IHD patients. MATERIAL AND METHODS: We included into the study 232 Russian patients aged 52.3 +/- 10.3 years, 175 men (50.1 +/- 10.6 years) and 57 women (55.2 +/- 10.1 years). Control group comprised 159 Russians without history of cardiovascular diseases and other serious severe concomitant diseases (age 60.5 +/- 14 years), 76 men (age 57.3 +/- 13.9 years ) and 83 women (age 63.1 +/- 14 years). CRP concentration was measured initially (at the moment of hospitalization), on days 3, at discharge, in 1 and 6 months, 1 year after onset of infarction. For genomic typing of C1444T polymorphism of CRP gene we used restriction fragment length analysis of products of polymerase chain reaction (PCR). RESULTS: Distribution of genotypes of C1444T polymorphism of CRP gene: C/C 51.8%, C/T 35.8%, T/T 12.4% in patients with MI; C/C 55.2%, C/T 40.2%, T/T 4.6% in control group. We found significant difference (p = 0.006, relative risk [RR] 0.3, 95% confidence interval [CI] 0.15-0.74) in frequency of carriers of C1444 allele (sum of C/C and C/T genotypes), which was higher in control group. Correspondingly in the group of patients with MI T/T genotype was met significantly more frequently than in control (p = 0.006, RR 3.0, 95% CI 1.3-6.5), and can be looked upon as risk factor of MI. We found no relation between carriage of CRP alleles/genotypes of CRP and one year prognosis in patients with MI. Analysis of association of the C1444T polymorphism with CRP concentration revealed significant relationship between T/T genotype and higher CRP level.

[The clinical value of determination of natriuretic peptides in acute coronary syndrome].

The production and release of natriuretic peptides (NPs) into the bloodstream are stimulated by increased left ventricular wall tension during volume overload. In ischemia, NPs are secreted by myocardial cells in response to stress or overload, particularly in the development of myocardial systolic dysfunction. The review details the time course of changes in amino acid N-terminal proBNP in acute coronary syndrome (ACS) with and without ST-segment elevation and discusses the role of the index in defining the tactics of treatment and prognosis in patients with ACS.

[Peculiarities of dynamics and prognostic value of NT-proBNP level in different variants of treatment of patients with acute coronary syndrome].

UNLABELLED: Aim of the study was to assess dynamics of NT proBNP in ACS as well as to analyze effect of different methods of treatment on the level of the parameter and its prognostic value. MATERIAL AND METHODS: Patients aged 30-70 years were included into the study: 52 patients with ST segment elevation ACS (STEACS), 61 patients with non ST-segment elevation ACS (NSTEACS). Control group comprised 20 people of the same age without ischemic heart disease. In all patients serum was taken for subsequent measurement of NT proBNP at admission, on day 3 of hospitalization, and before discharge (days 7-10). RESULTS: In ACS baseline NT proBNP concentration was significantly higher than in stable angina and in control group. During period of hospitalization NT proBNP level rose in the group of patients with STEACS and fell in the group of patients with NSTEACS. After early restoration of coronary blood flow (less than 4 hours after onset on the pain syndrome) in patients with STEACS dysfunction of the left ventricular myocardium was less pronounced (NT proBNP level was lower). High level of NT proBNP was an unfavorable prognostic factor in ACS irrespective of the selected tactics of treatment.

[Comparative dynamics of markers of inflammation and NT-proBNP in different variants of treatment of patients with ACS].

STUDY AIM - assessment of dynamics of markers of inflammation (CRP, Il-6, Il-10, TNFa, CD40L, fibrinogen) and N - N in acute coronary syndrome (ACS) as well as analysis of effect of various methods of treatment on level of these parameters. Patient aged 30 - 70 years were included in the study: 52 patients with ACS with ST-segment elevation (STEACS) and 61 - without ST-segment elevation (NSTEACS). Initial level of markers of inflammation (Il-6, CRP) in STEACS was lower than in NSTEACS. Initial level of antiinflammatory Il-10 was significantly higher in patients in the STEACS group (72.6 +/- 39.1 and 6.6+4.2 pg/ml, < 0.01). At admission the highest values of N - N were noted in the group of NSTEACS (761.5 pg/ml compared with 451.1 pg/ml in STEACS, =0.04). During period of hospitalization elevation of N - N occurred in the group of STEACS while its lowering occurred in the group of NSTEACS. In STEACS patients with early restored coronary blood flow dysfunction of the myocardium was less pronounced (lower level of N - N ). In patients with NSTEACS during period of hospitalization levels of CRP, Il-6 fibrinogen lowered. In invasively treated patients with NSTEACS levels of CRP and fibrinogen lowered to a greater extent than in conservatively treated.