[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.

[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.

[Mitral regurgitation and coronary stenosis in postmyocardial infarction patients].

The results of investigations devoted to relationship of mitral regurgitation (MR) and scars are contradictive, data on relationship of MR and localization of coronary lesions are few. Purpose. To determinate relationship of moderate or severe MR to localization of coronary stenosis in postmyocardial infarction patients. Methods. There were 1167 patients with no MR and 403 patients with moderate or severe MR. Results. Patients with MR had more severe New York Heart Association (NYHA) functional class (III-IV) (35.5 vs. 11.2%). Echocardiographic indices of left atrial dimension (23.5+/-2.9 vs. 20.3+/-2.1 mm/m) and extent of left ventricular (LV) wall motion abnormalities (32.8+/-14.9 vs. 23.6+/-12.7%) were higher in patients with MR as well as reduced LV systolic function (LV ejection fraction <50% - 63.7 vs. 25.6%) and LV dilatation (63.3 vs. 19.9%, all p<0.001). Rates of multivessel coronary artery involvement (three or more arteries) (27.5 vs. 18.3%, p=0.001), lesions in left main coronary artery (7.2 vs. 1.1%), circumflex (36.2 vs. 26.7), and right coronary artery (57.3 vs. 44.9%) were higher in patients with MR (all p<0.001). According to results of multivariate analysis MR was independently associated with LV dilatation, NYHA class of congestive heart failure, index of left atrial size, and extent of LV wall motion abnormalities. Moderate or severe chronic MR was not related to localization of coronary stenosis in these patients.

[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.

[Effect of cardiac resynchronization therapy in the treatment of chronic heart failure].

As a result of cardiac resynchronization therapy in all 10 patients with chronic NYHA class III-IV heart failure at duration of observation from 2 to 20 months was noted positive dynamics: improvement of self feeling, increase of 6 min walking distance, decrease of heart failure class, and improvement of functional parameters of the heart according to echocardiography data. Implantation of biventricular cardiac pacemaker to patients with chronic heart failure is relatively safe and accomplish-able from technical point of view. Cardiac resynchronization in patients with pronounced chronic heart failure appears to be an effective supplementation of drug therapy.