Application of the Appropriate Use Criteria for Coronary Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation: Data from the Federal Registry.

OBJECTIVE: The aim of the study was to apply the appropriate use criteria (AUC) for coronary revascularization on Russian Acute Coronary Syndrome Registry (RusACSR) data to analyze validity of the decision to perform percutaneous coronary interventions (PCIs) among patients with acute coronary syndrome (ACS). MATERIAL AND METHODS: In Russia, the frequency of performing PCI increased almost 7.5 times, and more than half of all interventions were performed in patients with ACS, in the period from 2006 to 2015. AUC 2012 were used to assess PCI appropriateness. Data were exported from RusACSR from a period of January 1, 2016 to December 31, 2016. We analyzed 33 893 cases, but 13 957 patients were excluded owing to absence of data needed. The study group therefore included 19 936 patients with ACS (mean age, 65.3 ± 11.9 years; 40.3% women), and it was divided into 2 subgroups: 13 757 (67.2%) patients who were treated conservatively and 6179 (32.8%) patients who underwent PCI. According to AUC, physicians' choice of strategy was validated. RESULTS: Patients treated conservatively differed significantly (P < .001) from those who underwent PCI. In this group, non-ST segment elevation ACS was significantly more common than in the group of patients who received PCI (84.4% vs. 43.9%, P < .001). They also had more severe clinical status. According to AUC, among patients with ACS treated with PCI, the decision was warranted in 86.3% (valid decision). In 7.6% of cases, there was no need for PCI. Among patients who underwent conservative treatment, 77.7% of patients needed PCI according to AUC. According to our data, only 3.8% of patients who were treated conservatively did not need PCI. Appropriateness of invasive treatment was uncertain in 18.5% and 6.1% in the PCI and non-PCI groups, respectively. All differences were significant (P < .001). CONCLUSION: AUC implementation showed low availability of PCI for patients with non-ST segment elevation ACS accompanied by complicated clinical status. AUC for coronary revascularization could be applied in Russian clinical practice for unbiased PCI candidate selection and for evaluation of decision validity.

Crystal structure of 3-(tri-phenyl-phosphoranyl-idene)-2,5-di-hydro-furan-2,5-dione tetra-hydro-furan monosolvate.

The title pseudo-polymorph of 3-(tri-phenyl-phospho-ranyl-idene)-2,5-di-hydro-furan-2,5-dione crystallizes with a tetra-hydro-furan solvent mol-ecule, viz. C22H17O3P·C4H8O. The succinic anhydride ring is approximately planar (r.m.s. deviation = 0.032 Å). The tetra-hydro-furan mol-ecule is disordered over two orientations about a pseudo-twofold axis with refined occupancy ratio 0.718 (4):0.282 (4). In the crystal, C-H⋯O hydrogen bonds link mol-ecules of the di-hydro-furan-2,5-dione derivative into chains parallel to the b axis and arranged into layers stacked along [100] alternating with hydrogen-bonded tetra-hydro-furan layers.

Novel enantiopure monophospholes: synthesis, spatial and electronic structure, photophysical characteristics and conjugation effects.

A rational and highly efficient method to access lithium 2,3,4,5-tetraphenylphospholide directly from white phosphorus, diphenylacetylene and lithium has been developed. This novel, convenient synthetic route has allowed the incorporation of various chiral substituents into 2,3,4,5-tetraarylphospholes. The spatial and electronic structures of the obtained novel enantiopure phospholes, their oxides and sulfides have been characterized both experimentally (single-crystal X-ray diffraction) and computationally (DFT). The experimental vibrational Raman spectra and electronic absorption and emission spectra of the synthesized compounds have been interpreted using quantum chemical calculations. A moderate impact of the substituent at the P-atom on the photophysical properties of the phospholes was demonstrated both experimentally and theoretically, while the oxidation/thionation of the phosphorus center was shown to influence remarkably both absorption and emission spectral characteristics. The latter effect is ascribed to the increase of conjugation strength of the oxidized/thionated species with exocyclic Ph rings.

Enhancing the reactivity of 1,2-diphospholes in cycloaddition reactions.

Two different approaches have been employed to enhance the reactivity of 1-alkyl-1,2-diphospholes - the introduction of electron-withdrawing groups either at the phosphorus atoms or in the para-position of the arene ring. The alkylation of sodium 1,2-diphospha-3,4,5-triphenylcyclopentadienide with alkyl halides Hal-CH2-R (R = CN, COOEt, OMe, CH2OEt) results in corresponding 1-alkyl-3,4,5-triphenyl-1,2-diphospholes (alkyl = CH2CN (1a), CH2COOEt (1b), CH2OMe (1c), and (CH2)2OEt (1d)), which spontaneously undergo the intermolecular [4 + 2] cycloaddition reactions at room temperature to form the mixture of the cycloadducts, 2a-c, respectively. However the alkylation of sodium 1,2-diphospha-3,4,5-tri(p-fluorophenyl)cyclopentadienide with ethyl iodide leads to stable 1-ethyl-3,4,5-tris(p-fluorophenyl)-1,2-diphosphole (1e), which forms the [4 + 2] cycloadduct 2,3,4,4a,5,6-hexa(p-fluorophenyl)-1-ethyl-1,7,7a-triphospha-4,7-(ethylphosphinidene)indene (2e) only upon heating up to 60 °C. With further heating to 120 °C with N-phenylmaleimide, the cycloadducts 2a-c and 2e undergo the retro-Diels-Alder reaction and form only one product of the [4 + 2] cycloaddition reaction 3a-с, 3e with good yields up to 65%.