[Нospital outcomes of coronary artery bypass grafting in patients with coronary heart disease with previous percutaneous coronary intervention].

AIM: Evaluation of the frequency hospital cardiovascular events in groups of patients with stable angina who underwent percutaneous coronary interventions (PCI) with stenting of the arteries before coronary bypass surgery, or who did not have previous myocardial revascularization. MATERIALS AND METHODS: The 120 patients with stable angina who underwent routine coronary artery bypass grafting were examined. Group composition: Men 80.8%, age 587.6, duration of coronary heart disease 65.7 years, history of myocardial infarction (MI) 77.5%. Arterial hypertension was present in 92.5%, diabetes mellitus in 12.5% of patients. Multivessel coronary artery disease in 72.5% of patients. 28 (23.4%) patients had previously undergone PCI with stenting of the coronary arteries. The period from PCI to coronary bypass surgery was 2032.6 months. Coronary bypass surgery on-pump was performed in 88.3%, coronary bypass surgery on off-pump in 11.7%. The number of distal anastomoses ranged from 1 to 4. RESULTS: There were no differences in clinical and angiographic indicators, pharmacotherapy, and operation characteristics between the groups of patients who were subjected to or did not have PCI before coronary bypass surgery. There were no differences between the analyzed groups of patients in the frequency of cardiac death (0 and 1.1%, p=0.58), non-fatal MI (3.6% and 9.8%, p=0.29), stroke (0 and 1.1%, p=0.58), acute heart failure (11.7% and 34.8%, p=0.06), the number of patients with paroxysms of atrial fibrillation (28.6% and 17.4%, p=0.94), the proportion of patients with resternotomies (3.6% and 3.3%, p=0.94) and gastrointestinal bleeding (3.6% and 4.3%, p=0.86). CONCLUSION: PCI with coronary artery stenting, prior to coronary bypass surgery, does not affect the frequency of post-operative hospital cardiovascular and hemorrhagic complications.

Risk Factors and Hospital Outcomes of Acute Kidney Injury in Patients Operated on for an acquired Valvular Heart Disease.

Aim      To determine predictors of acute kidney injury (AKI) related with surgeries for correction of acquired valvular heart disease (HD) and to evaluate the incidence of in-hospital complications in patients with postoperative AKI.Material and methods  This study included 62 patients after surgery for correction of acquired valvular HD (mean age, 61±10.9 years) with a disease duration of 11±5.3 years. NYHA functional class (FC) 1 chronic heart failure (CHF) was observed in 1.6 % of patients, FC 2 in 64.5 %, and FC 3 in 33.9 %.17.7% of patients had chronic kidney disease (CKD). Coronary lesions of ≥50 % of vascular lumen were detected in 27.4 % of patients. Surgical correction of mitral valvular disease was performed in 32 cases, aortic valvular disease in 36 cases, tricuspid valvular disease in 8 cases, and combined operations for correction of valvular disease and coronary bypass in 8 cases. Creatinine concentrations were measured according to the Jaffe method; glomerular filtration rate (GFR) was estimated with the CKD-EPI equation. AKI was diagnosed based on KDIGO (2012) criteria.Results The AKI incidence related with surgeries for correction of valvular HD was 16.1 % (8.1 % of patients had stage 1 AKI, 3.2 % had stage 2 AKI, and 4.8 % had stage 3 AKI), and 3.2% required kidney replacement therapy. AKI was associated with the presence of CKD at baseline (р=0.044), development of hemopericardium requiring drainage (р=0.012), more pronounced coronary lesions (in the AKI group: stenoses from 50 to 70 % in 20% of patients, from 70 to 90 % in 30 % of patients, and ≥90 % in 0 %; without AKI: from 50 to 70 % in 13.4 % of patients, from 70 to 90 % in 3.8 %, and ≥90 % in 5.8 % of patients, respectively; р=0.032). Probability of postoperative AKI significantly increased with the development of hemopericardium requiring drainage. Patients with postoperative AKI compared to persons without AKI had higher mortality (20 % and 0 %; р=0.001), greater incidence of decompensated CHF (40 and 9.6 %; р=0.012) and hemopericardium requiring drainage (30 and 1.9 %; р=0.012).Conclusion      The development of postoperative AKI is associated with CKD at baseline, more pronounced coronary injury, and hemopericardium requiring drainage.

[The importance of modern high - sensitivity troponin tests in the diagnosis of myocardial infarction without ST-segment elevation].

The literature review presents the characteristics of modern high - sensitivity tests for detection of Tn (hs - cTn) in the blood and the results of large studies on the diagnosis of non segment elevation myocardial infarction (nonSTEMI) using hs - cTn. The results of these studies served as the basis for the development of three - and one - hour diagnostic algorithms nonSTEMI, presented in the recommendations of the European Society of Cardiology 2012 and 2015 and also in fourth Universal Definition of Myocardial Infarction 2018.

Cardiorenal syndrome in the early stages of coronary bypass surgery.

AIM: Evaluate the frequency and risk factors of postoperative atrial fibrillation (pAF) in patients with chronic coronary artery disease (CHD) with acute kidney injury (AKI) developed in connection with coronary artery bypass grafting (CABG). MATERIALS AND METHODS: The study involved 90 patients (pts) undergoing CABG at age 58±7 years, duration of CHD - 6±6 years. 80% of pts had previous myocardial infarction. Chronic heart failure, functional class II was detected in 53.3% pts, functional class III - in 46.7% pts. Multi-vessel coronary lesions had 75.6% pts. CABG with cardiopulmonary bypass was performed in 88.9% pts, operation on a beating heart was fulfilled in 11.1% pts. Creatinine was determined by Jaffe method, the glomerular filtration rate (GFR) was calculated with the СКD-EPI formula. AKI was diagnosed according to KDIGO criteria, 2012. RESULTS: The frequency of transient AKI after CABG was 33.3%, pAF - 17.8 %, pAF among those with AKI was 20%. The development of AKI was associated with higher levels of troponin T after CABG (Me [25; 75 percentiles] - 0.36 [0.24; 0.99] versus 0.28 [0.11; 0.50] ng/ml; p=0.037), with more frequent use of inotropic drugs (60% and 25%; p=0.002), longer duration of inotropic therapy (2.0 [1.0; 2.5] versus 1.0 [0; 1.0] days; p=0.001). The proportion of patients who had pAF among those with AKI and without it were not significantly different (20% and 16.7%; p=0.7). Decrease in GFR less than 39 [29.8; 45.7] ml/min/1.73 m2 after CABG was the most important risk factor of pAF in pts with CHD and AKI.

Risk factors and in-hospital outcomes of acute kidney injury that developed after coronary artery bypass grafting in patients with stable angina.

AIM: The aim of the study is to assess frequency, risk factors and in-hospital outcomes of acute kidney injury after coronary artery bypass grafting in patients with stable angina. MATERIALS AND METHODS: The study included patients with stable angina pectoris and indications for coronary artery bypass grafting. We examined 93 patients aged 58±7.6 years, with duration of coronary heart disease 6±6.0 years. Previous myocardial infarction had 79.6% of patients. Arterial hypertension was present in 92.5% of patients. Multi-vessel coronary disease was registered in 94.6%, stenosis of the left main coronary artery > 50% was in 16.1% of patients. Coronary artery bypass grafting in conditions of artificial circulation was performed in 89.2% of patients, coronary grafting on working heart was held in 10.8% of patients. At initial stage, on the first and second days after coronary grafting the level of creatinine was determined by the method of Jaffe. The presence, the severity of acute kidney injury after (AKI) coronary artery bypass grafting was evaluated according to the criteria KDIGO (2012). We took into account in-hospital complications: cardiac death, intraoperative myocardial infarction (iMI), stroke, atrial fibrillation (AF), acute heart failure (AHF) according to requirement in intraaortic balloon pump, and the use of adrenaline. RESULTS: The proportion of persons with transient AKI stage 1 after coronary artery bypass grafting was 31.2%, those of 2 stage was 3.2%. The development of AKI was associated with cases of AHF. The increase in the duration of therapy with adrenaline - more than 1±1.8 days (median) - was connected with increase of the relative risk of AKI developing in 1.9 times. The incidence of cardiac death, iMI, strokes, paroxysmal AF did not differ among patients with AKI and without it. CONCLUSION: The frequency of transient AKI after coronary artery bypass grafting was 34.4%. The development of AKI is associated with AHF that occurred during coronary artery bypass grafting. The frequency of hospital complications did not differ among patients with AKI after coronary artery bypass grafting and without it.

[Rate of in-hospital cardiovascular complications in patients with postoperative renal dysfunction after surgical myocardial revascularization]. / Chastota gospital'nykh serdechno-sosudistykh oslozhnenii u bol'nykh s posleoperatsionnoi disfunktsiei pochek posle khirurgicheskoi revaskulyarizatsii miokarda.

The study was aimed at revealing the factors associated with renal dysfunction having developed after coronary artery bypass grafting (CABG) and assessing the in-hospital cardiovascular complications rate amongst patients with postoperative renal dysfunction. The study included a total of 99 patients presenting with stable angina pectoris and having indications for CABG. The mean age of the patients amounted to 57±7 years, with the average duration of coronary artery disease (CAD) of 6±5.7 years. A multi-vessel lesion of coronary arteries was revealed in 69.7% of patients, ≥ 50% stenosis of the trunk of the left coronary artery was diagnosed in a further 15.1%. CABG was performed in conditions of assisted circulation (AC) in 88.9% of patients and on the functioning heart in 11.1%. We implanted from 1 to 4 grafts to each patient. At admission, and then on the first and second postoperative days after CABG we determined blood serum creatinine and calculated the creatinine clearance (CrCl) according to the Cockcroft-Gault equation. A decrease in the CrCl < 60 ml/min was regarded as renal dysfunction. Assessing the cardiovascular complications rate we took into consideration cases of cardiac death, perioperative myocardial infarctions (POMI), severe acute cardiac insufficiency having required placement of a counterpulsator, and as well as the proportion of patients with paroxysmal atrial fibrillation. We also evaluated the frequency of repeat sternotomy. The incidence rate of transitory renal dysfunction following CABG amounted to 18.2%. The factors associated with a decrease in the CrCl < 60 ml/min after CABG were found to be as follows: age above - Me 62.5 (range 59-68) years, increased duration of AC above - Me 103 (range 88-133) min and prolonged time of aortic occlusion (AO) above - Me 53 (range 44-60) min, severe postoperative acute cardiac insufficiency, and re-sternotomy. The cumulative rate of in-hospital cardiovascular complications turned out to be significantly higher (55.6 versus 18.5%, p=0.001) amongst patients with postoperative renal dysfunction. We also revealed a substantially higher incidence rate of re-sternotomies in the cohort of patients with a CrCl < 60 ml/min after CABG (11.1 vs.1.2%, p=0.027). Hence, moderate transitory renal dysfunction appears to develop nearly in every fifth patient in the early period after CABG. The risk factors for the development of postoperative renal dysfunction include: age, increased duration of the period of artificial circulation (AC) and time of aortic occlusion (AO), severe acute postoperative cardiac insufficiency, and re-sternotomy. Even moderately pronounced transitory renal dysfunction after CABG is associated with an unfavourable prognosis of in-hospital cardiovascular complications.

[Acute coronary syndrome in patients with carbohydrate metabolic disturbances (a review)].

The review gives the results of large clinical studies of the prognostic value of hyperglycemia in patients with acute coronary syndrome and discusses the basic mechanisms determining the increased cardiovascular risk. The advantages of invasive treatment policy are also described in diabetic patients with an exacerbation of coronary heart disease.

[Albumin cobalt binding ability in assessment of myocardial ischemia in patients with acute coronary syndrome].

Verification of the diagnosis of coronary artery disease (CAD) is based mostly on instrumental diagnostic techniques. Presently, there are no laboratory tests officially recommended for the diagnostics of myocardial ischemia (MI). Biochemical methods that would be able to verify MI in patients with suspected CAD have been under development since the 1990s. Ischemically modified albumin--IMA (Albumin Cobalt Binding test), glycogen phosphorylase BB, and free fatty acid-binding protein have been proposed as laboratory markers of MI. The article discusses advantages and disadvantages of IMA for diagnostics of MI in patients with acute coronary syndrome.

[Efficacy of multifactorial preventive interventions in achievement of target levels of low density lipoprotein cholesterol in survivors of myocardial infarction]. / Effektivnost' mnogofaktornykh profilakticheskikh vmeshatel'stv v dostizhenii tselevogo urovnia kholesterina lipoproteidov nizkoi plotnosti u bol'nykh, perenesshikh infarkt miokarda.

AIM: To assess Efficacy of multifactorial preventive Interventions in achievement of target levels of low density lipoprotein cholesterol in survivors of myocardial infarction. METHODS: Design of the study was open randomized comparative prospective. Two groups of patients with history of myocardial infarction were formed ("active intervention", n=88, "observation", n=48) and followed for 12 months. All interventions consisted in recommendatory and expository measures. Achievement of target low density lipoprotein cholesterol (LDLCH) levels, modifiable risk factors, blood lipids spectrum were assessed in 2-3, 5-6 and 12 months of observation. RESULTS: Overall effect of undertaken multifactorial intervention on modifiable risk factors was positive. By the end of the period of observation number of risk factors per patient decreased from 3.8+/-0.99 to 2.8+/-1.29 (p<0.05). However target levels parameters in many cases were not reached. About half of patients could not decrease consumption of saturated fats and cholesterol, nearly 25% continued to smoke. More than 55% maintained excessive weight and 64% had abdominal obesity. Among patients of "observation" group only 5 (4.2%) began to take lipid lowering drugs. In active intervention group average LDLCH lowering was 23%, 38% of patients received lipid lowering drugs and 44% (of those who completed the study) achieved target LDLCH levels.

[Molecular and cellular mechanisms of myocardial remodeling in heart failure]. / Molekuliarno-kletochnye mekhanizmy remodelirovaniia miokarda pri serdechnoi nedostatochnosti.

The apoptosis of smooth muscle cells, the translocation, structural and functional impairments of remaining cardiomyocytes, ventricular dilatation, and the altered extracellular matrix underlie myocardial remodeling in chronic heart failure (CHF). Among the above factors, apoptosis, which is a membrane-dependent process of programmed cell death, and cytokine derangement are of primary importance. To recognize the cytokine concept of the pathogenesis of CHF permits the clinical application of cytokine synthesis inhibitors and their functional activity.

[A comparative study of the membrane-protector efficacy of anaprilin and korinfar in hypertension patients]. / Sravnitel'noe issledovanie membranoprotektornoi éffektivnosti anaprilina i korinfara u bol'nykh gipertonicheskoi bolezn'iu.

Beta-blocker anapriline and calcium antagonist corinfar are highly effective hypotensive agents. Drop in diastolic arterial pressure with anapriline therapy amounted to 15.9 and 15.6%, with corinfar therapy-to 15.0 and 15.6% in hypertensive disease stage I and II respectively. Hypotensive action of corinfar might result from correction of impaired cation-transport function of cellular membranes, electrolyte homeostasis of cells, phospholipid composition of membranes. No dynamics has been revealed of the membrane tests under study during administration of anapriline therapy treatments.

[Intracellular homeostasis and membrane permeability for calcium in essential hypertension]. / Vnutrikletochnyi gomeostaz i pronitsaemost' membran dlia kal'tsiia pri éssentsial'noi gipertonii.

Intracellular homeostasis of calcium was studied in patients with essential hypertension by two methods: calcium measurements using Lachema kits and study of the kinetics of interaction between chlortetracycline fluorescent probe and cellular membranes. Both the methods are highly sensitive, but they reflect different aspects of calcium homeostasis of the cells and supplement each other, and therefore should be used together to assess the severity of essential hypertension and monitor the therapy administered. The method of interaction of chlortetracycline with cellular membranes should be preferred as a more up-to-date and informative.