[Long-term Outcomes of Elective Percutaneous Coronary Interventions].

OBJECTIVE: to analyze long-term outcomes and to develop a model for determining the risk of long-term adverse сardiovascular events after elective percutaneous coronary interventions (PCI). MATERIALS AND METHODS: We included in this study 148 patients, sent from 2009 to 2011 for routine endovascular intervention for chronic ischemic heart disease on the background of stenotic coronary artery atherosclerosis. Outcomes of interventions were assessed over 6 years after the index PCI by analyzing medical records and telephone interviews. The primary composite endpoint of the study was major adverse cardiovascular event (MACE), including cardiovascular death, acute coronary syndrome (ACS), acute cerebrovascular accident (CVA). RESULTS: Cardiovascular death was registered in 10.6 %, acute coronary syndrome occurred in 34.4 %, stroke - in 6.6 % of patients. Overall MAСE occurred in 40.4 % of patients. Patients with MACE were initially significantly more likely to have chronic obstructive pulmonary disease (16.4 vs. 4.4 %, p=0.02), multifocal atherosclerosis (32.8 vs. 17.8 %, p=0.034). They were initially more often diagnosed with atrial fibrillation (AF) (23 vs. 7.8 %, p=0.016) and were more likely to have family history of cardiovascular disease (50.8 vs. 24.4 %, p=0.0009). They had significantly higher levels of CRP before PCI (6 (5-11.5) vs. 5 (4.7) mg/L, p=0.034) and restenosis of previously installed stent (8.2 vs. 1.1 %, p=0.04). Most significant predictors of MACE identified using stepwise logistic regression and included in the developed model were: family history of cardiovascular disease, treatment with statins at time of PCI, initial level of postprandial blood glucose, high risk of contrast induced nephropathy (CIN) (11-15 points on Mehran CIN risk score). AUC values for the found model was 0.852 [95 % CI 0.749-0.956]. CONCLUSION: The use of our model in patients with the upcoming PCI with the aim of stratifying the risk of long-term adverse cardiovascular events allows to identify groups of patients, who require the timely administration of more active follow-up strategies, through the use of simple clinical characteristics.

[Prevention of periprocedural kidney ingury by loading doses of statins in elective percutaneous сoronary interventions].

PURPOSE OF THE STUDY: To compare the effect of loading doses of atorvastatin and rosuvastatin on the value of the acute kidney injury and acute inflammatory response to elective percutaneous coronary interventions. MATERIALS AND METHODS: An open prospective comparative study included 68 patients referred for elective percutaneous coronary intervention (PCI). At baseline, all patients had been taking statins for a long time as a standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of 80 mg of atorvastatin (As) 12 hours before the intervention with saving this dose for 2-6 days. The second group included 35 patients treated with rosuvastatin (Rs) 40 mg / day in the same manner. The levels of creatinine and cystatin C in the blood were determined at baseline and 12, 24, 48 and 72 hours after the intervention. HsCRP level was determined at baseline and 72 hours after PCI. RESULTS: AKI was diagnosed in 5 patients (7.94 %): 4 patients (12.1 %) in group As and 1 patient (3.3 %) in group Rs (p = 0.36). The increase of serum creatinine level in the group As patients was 43.4 % higher than one in the Rs group patients (p = 0.024). The decrease of glomerular filtration rate (GFR) in group As was 15.5 % higher than one in group Rs (p = 0.09). Initially, the level of cystatin C in the groups did not differ (698.9 (560.2-869.6) ng / ml in group As vs 759.5 (673.8-899.9) ng/ml in group Rs, p = 0.75). Significant intergroup differences were found in the level of serum cystatin C 12 hours after PCI (718.3 (555.6-839.6) ng/ml in group As vs 470.6 (378.2-689.4) ng/ml in the Rs group, p = 0.007) that persisted 24 hours after the intervention (732.1 (632.3-887) ng/ml vs 526.4 (357.4-802.7) ng/ml, respectively, p = 0.02). From the second day after PCI, intergroup differences in serum cystatin C disappeared. The level of hsCRP significantly increased 72 hours after the intervention in group As (1.65 (0.9-4) mg/l at baseline vs 4.55 (1.6-8.7) mg/l 72 hours after PCI, p = 0.01). The level of hsCRP did not change significantly at the same time in the Rs group (2.8 (0.8-6.8) mg/l at baseline vs 2.75 (1.5-6.5) mg/l 72 hours after PCI, p = 0.16). CONCLUSION: The loading dose of rosuvastatin better prevents periprocedural kidney injury in PCI and more significantly reduces the overall inflammatory response to intervention compared to the loading dose of atorvastatin.

[Evaluation of long-term adverse cardiovascular events risk after elective percutaneous coronary intervention].

OBJECTIVE: The aim of our study was to analyze long-term outcomes, to identify their predictors and to develop a model for determining the risk of long-term adverse сardiovascular events after elective percutaneous coronary interventions (PCI). MATERIALS AND METHODS: A retrospective study included 151 patients 6 years after the elective PCI. Outcomes were assessed by analyzing medical records and telephone interviews. The primary composite end point of the study was a major adverse cardiovascular event (MACCE), including death from cardiovascular causes, acute coronary syndrome, acute cerebrovascular accident. RESULTS: Death from cardiovascular events was reported in 10.6 % of patients, acute coronary syndrome occurred in 34.4 %, stroke - in 6.6 %. Thus MAСCE occurred in 40.4 % of patients. MACCE predictors in the long-term period were chronic kidney disease, contrast-induced acute kidney injury, baseline C-reactive protein more than 5.5 mg/l. Restenosis of previously installed stents increases the risk of MACCE at 8.09 times, chronic obstructive pulmonary disease - 3.4 times PT - 2.84 times, family history for cardiovascular disease (CVD) - in 2.94 times, a very high risk of contrast-induced nephropathy (CIN) (≥11 points on the R. Mehran scale) - 2.15 times. The most significant MACCE's predictors identified using stepwise logistic regression and included in the developed model are: family history for СVD, statins reception during the procedure of PCI, the initial level of postprandial blood glucose, high risk of CIN (11-15 points on a scale of R. Mehran). AUC values for the found model was 0.852 [95 % CI 0.749-0.956]. CONCLUSION: The use of our model of risk stratification in patients after elective PCI allows, on the basis of simple clinical characteristics, to distinguish groups of patients with a high residual risk of adverse cardiovascular events that require the timely application of more active follow-up strategies.

[Pharmaco-invasive Approach Aimed at Preserved Left Ventricular Function in Patients With Stable Coronary Heart Disease Background Carbohydrate Metabolism Disorders].

Performed an open, prospective, randomized, controlled clinical trial, including 63 patients stable coronary artery disease on the background of carbohydrate metabolism disorders. All patients underwent elective coronary stenting. Patients of the main group (n=32) within 2 weeks before the intervention received trimetazidine 35 mg x 2 times a day in addition to standard therapy. Patients in the control group (n=31) PCI and follow-up was performed with standard therapy and without the use of metabolic drugs. Revealed that long reception of myocardial cytoprotector trimetazidine leads to a significant improvement of the contractile function of the left ventricular myocardium at a distant period according to echocardiography (reducing end diastolic index by 5.5%, decrease in end-systolic index by 4.4%, increase in LVEF of 2.5% in 12 months after endovascular revascularization compared with baseline).