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Patients with diabetes mellitus (DM) and coronary heart disease belong to a group with a very high risk of developing cardiovascular disease. In patients with coronary atherosclerosis, DM increases the risk of ischemic events by 2-4 times. Apparently, increased antithrombotic therapy has an advantage in patients with DM who have had myocardial infarction. However, until recently it was not clear there is such an advantage in patients with DM and stable coronary artery disease without prior myocardial infarction. The addition of ticagrelol to monotherapy of acetylsalicylic acid reduces the risk of major cardiovascular events in patients with type 2 DM and stable coronary artery disease undergoing percutaneous coronary intervention, if patients have a high risk of ischemic events.

In 2019, the European Society for Cardiology (ESC) published guidelines with a new term, "chronic coronary syndromes" (CCS). These guidelines presented 6 clinical scenarios, which are most common in outpatient practice. The diagnostic approach described in these guidelines shifts from the standardization to the rationality of individualized solutions on using various diagnostic methods. The diagnostic approach suggested in the ESC guidelines requires extensive medical discussion and consensus because this will definitely entail a) further increase in indexes that reflect the morbidity of ischemic heart disease (IHD) due to unconfirmed diagnoses and b) administration of unreasoned therapy. This article presents statements of the guidelines, which cannot be automatically transmitted to the existing medical practice and should be discussed and adjusted by experts of the Russian Society of Cardiology.

The purpose of the present study was to compare mid-term results of using drug-eluting stents 'NanoMed' and Orsiro. Within the framework of an ongoing randomized prospective study we carried out an intermediate analysis of clinical and angiographic data of 520 patients after coronary artery stenting. The duration of the follow-up period amounted to 6.8±0.2 months. The patients were randomly assigned to the study and control groups each consisting of 260 patients with implanted stents 'NanoMed' and Orsiro, respectively. The obtained findings demonstrated that the main baseline clinical, demographic, and angiographic parameters had no statistically significant differences. The primary endpoint was achieved in 6.1 and 5.3% of cases in the study and control group, respectively (p=0.7). One case of acute in-stent thrombosis was revealed in each group. Cardiac mortality amounted to 0.7% and 0.3% in the study and control group, respectively (p>0.9). Repeat interventions on the target lesion were performed in 2.7 versus 3.4% of cases in the study and control group, respectively (p=0.6). Hence, the comparative analysis of using 'NanoMed' and Orsiro stents in the mid-term period revealed no statistically significant differences.

The purpose of our investigation was to evaluate the immediate and intermediate results of staged operations of carotid endarterectomy and coronary artery bypass grafting in patients with multifocal atherosclerosis. We analysed a total of 475 operations. Of these, 371 (78.1%) patients underwent staged interventions (stage 1 - carotid endarterectomy, stage 2 - coronary artery bypass grafting). No neurological complications were observed after stage 1. Five (1.3%) patients developed cardiac arrhythmia in the form of atrial fibrillation, 7 (1.9%) were found to have transient neuropathy of cranial nerves. There were no lethal outcomes. Stage 2 was carried out 16±13 days after carotid endarterectomy. Of complications encountered, mention should be made of perioperative myocardial infarction in 1 (0.3%) patient, with 2 (0.6%) patients requiring emergency coronary bypass angiography. Newly onset atrial fibrillation was registered in 71 (19.1%) patients, haemorrhage followed by resternotomy in 6 (1.6%), and purulent wound complications in 4 (1.1%) patients. Death occurred in 1 (0.3%) patient. We also analysed the mid-term postoperative results (up to 32 months). The coverage amounted to 151 patients. The incidence rate of major adverse cardiac and cerebrovascular events (MACCE) was 6% (myocardial infarction - 2, acute cerebral ischaemia - 1, repeat myocardial revascularization - 5, lethal outcome - 1). Based on the obtained findings it may be concluded that staged operations on the carotid basin and coronary arteries by the number of complications are comparable to those after isolated coronary artery bypass grafting.

Purpose: to elucidate predictors of cardiorespiratory complications during the early postoperative period after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD)., Material and Methods: We examined 180 patients with IHD (mean age 59.3+/-1.23years). Prior to surgery we assessed their clinical and functional status including state of respiratory function. Predictors of complications were determined by univariate logistic regression analysis., Result and Conclusions: Early postoperative complications in this group of patients were atrial fibrillation, prolonged mechanical ventilation, and cognitive disorders. Main predictors of these complications were preoperative abnormalities of respiratory function (presence of chronic obstructive pulmonary disease, decreased efficiency of pulmonary ventilation), and concomitant diseases such as type 2 diabetes and multifocal atherosclerosis.

Purpose: to identify the role of factors of inflammation and myocardial ischemia in the development of atrial fibrillation (AF) in the early postoperative period after coronary artery bypass grafting (CABG)., Methods: We enrolled in this study 96 patients with ischemic heart disease who had undergone CABG. Patients were divided into 2 groups: (1) without postoperative AF (n=67, 80.6% men, mean age 57.9+/-7.3 years), (2) with early new-onset AF after CABG (n=29, 86% men, mean age 64.0+/-8.4 years)., Results: AF occurred on average 4.9+/-3.8 days after surgery. Concentrations of interleukin-10, C-reactive protein, fibrinogen, troponin were not significantly different between two groups both before and after CABG. At multivariate analysis the following parameters were related to development of AF in postoperative period: left atrial dimension >41 mm (odds ratio [OR] 3.6 (95% confidence interval [CI] 1.2-5.8, p=0.0002), interleukin-6 level >68 pg/ml (OR 3.2, 95%CI 1.8-4.7, p=0.009), interleukin-8 level >9.5 pg/ml (OR 2.9, 95% CI 1.4-6.7, p=0.009)., Conclusion: Our research shows significant increase of interleukin-6 and interleukin-8 in patients with AF after CABG what confirms the role of inflammation factors in development of this complication.

Aim: to determine risk factors of early cardiovascular complications after beating-heart coronary artery bypass grafting (CABG) in patients with ischemic coronary disease (IHD) and type two diabetes (D2)., Materials and Methods: We included into this study 188 patients (mean age 59 years, 85.1% men) with IHD and D2 who underwent off-pump CABG. The following cardiovascular complications (CVC) registered within 7 days after surgery were analyzed: myocardial infarction (MI), stroke/transient ischemic attack (S/TIA), atrial fibrillation (AF). The control group of patients without CVC was formed by case-control method. In the study groups we compared IHD severity, coronary angiography, brachiocephalic and peripheral arteries duplex ultrasonography data, blood pressure level, glomerular filtration rate, EuroSCORE II risk, preoperative glycemic parameters and hypoglycemic therapy, as well as CABG volume and severity. Factors associated with postoperative CVC were determined by multiple stepwise logistic regression., Results and Conclusions: CVC were registered in 47 patients (MI - in 18, S/TIA - in 2, AF - in 27). As compared with the control group patients with CVC had higher Canadian Cardiovascular Society angina class and EuroSCORE II risk, lower left ventricular ejection fraction and glomerular filtration rate; they more frequently had left main coronary artery involvement, total coronary artery occlusions, carotid and peripheral artery disease. Group of patients with CVC had higher levels of glycosylated hemoglobin, serum glucose and its diurnal variability, as well as higher proportion of patients switched preoperatively from oral hypoglycemic agents to rapid-acting insulin. According to logistic regression most informative predictors of CVC were peripheral artery disease (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-7.1), diurnal serum glucose variability on admission day (OR 13.2, 95% CI 5.9-30.0 per 0.1 mmol/l) and the day before surgery (OR 1.3, 95%CI 1.2-2.4 per 0.1 mmol/l), and switching from oral hypoglycemic agents to insulin (OR 2.5, 95%CI 1.2-5.5).

Purpose: to assess clinical efficacy of early post discharge rehabilitation of patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) in conditions of a polyclinical department of cardiological rehabilitation (stage III of cardiorehabilitation)., Material and Methods: We included in this study 36 men with IHD in 3-8 weeks (mean 7.8+/-1.6 weeks) after CABG. Patients were randomized in 2groups: patients of the main group attended special "School for patients recovering after CABG" [School] (60-80 min sessions once a week for 5 weeks) and participated in a program of monitored (up to 60 min 3 times a week for 4 months) and unmonitored (home based) exercise training. Patients of the control group attended School and were given advice to do physical exercises at home. Follow up duration was 1 year., Results: Main group. Compared with baseline values after 4 months exercise duration increased 32.6% (p<0.05), this effect persisted at 12 month; threshold exercise load increased 35.2% (p<0.05) after 4, 53.9% after 6, and 49.5% after 12 month. After 4 and 12 months of training some increases of left ventricular (LV) ejection fraction and stroke volume, and decrease of LV end systolic volume occurred. Physical training in this group was associated with improvement of parameters of quality of life. During 12 months of follow up there were no significant changes of concentrations of total and low density lipoprotein cholesterol (TC, LDLC). In the control group slight increase of exercise duration was observed only at 12 months (9.8%, p<0.05), and it was not accompanied by dynamics of exercise tolerance. Increases of concentrations of TC (10.2%, p<0.05) and LDLC (15.6%, p<0.05) were registered at 12 months. Serious cardiovascular complications in the main group (physical training + educational School) were three times less frequent than in the control group (attendance of School only) (11.1 vs. 39.2%, respectively.

The paper gives an original algorithm for the management of patients with stable coronary artery disease, preserved/moderately reduced left ventricular systolic function, and high-grade ventricular arrhythmias from the first registration of the latter to the choice of treatment policy. Great attention is paid to the assessment of a private clinical case, by determining the nature of arrhythmias, and to the involvement of autonomic regulation in the genesis of ventricular arrhythmias. The importance of topical diagnosis of ventricular arrhythmias and identification of psychological disorders is emphasized. Diagnostic problems are solved in a step-by-step fashion using up-to-date techniques. The key point of the algorithm proposed is to prevent sudden cardiac death.

Quality of life (QL) of patients with ischemic heart disease (IHD) is a combination symptoms of the disease, physical state, emotional status, and social-laboring functioning. Until recently there were no universal questionnaire allowing to perform comparative analysis of QL of patients with effort angina (EF), survivors of myocardial infarction (MI) and chronic heart failure (CHF). Therefore, European Association of Cardiovascular Prevention and Rehabilitation conducted a study with the aim of developing universal questionnaire for assessment of QL in patients with IHD - HeartQol. The study enrolled 6384 patients with angina, MI, or CHF across 22 countries (315 in Russia). Patients completed a battery of questionnaires and Mokken scaling analysis was used to identify most important guestions for assessment of QL questions to be included into the HeartQoL questionnaire.

Aim: of the study was to examine relationship between behavioral type D and adherence to therapy in cardiological patients., Material and Methods: Patients (n=308, 63 [20.5%] women and 245 [79.5%] men, mean age 59+/-4 years) with stable ischemic heart disease and arterial hypertension were divided into 2 groups: with (n=84) and without (n=224) type D. Psychological status was assessed using type D scale-14 (DS-14) questionnaire, adherence to treatment - with the help of S.V. Davydov method and the Morisky-Green test., Results: Patients with compared with those without type D personality more often had indicators of lower adherence to treatment (48 vs 39%, <0.05). Indicators of higher adherence were found more often in the group without type D personality (11 vs 19%, p<0.003). Indicators of lower compliance were independently associated with type D personality (odds ratio 3.21, p=0.02)., Conclusion: Patients with type D personality have lower adherence to therapy. This can be a link between type D behavior and unfavorable prognosis in patients with cardiovascular diseases.

The authors present immediate and long term results of the first in Russia implantation in coronary artery of Palmaz-Shatz metal stent. Indications for stenting were urgent after complicated dissection as a result of balloon dilation of discrete bifurcational stenosis of anterior interventricular artery (IVA). Immediate angiographic and clinical result was good. At control angiography after 13 years their was no restenosis in stented IVA. However novel narrowing was found in left main coronary artery (LMCA) in which drug eluting stent was implanted. Coronary angiography carried out after 7.5 years after stenting of LMCA and in 20 years after stent implantation in IVA revealed good patency of both stented segments without signs of restenosis. This case report demonstrates possibility of long term preservation of angiographic and clinical effect of staged endovascular treatment of coronary atherosclerosis.

The data of publications regarding the influence of experimental atherosclerosis on the infarct-limiting effect of ischaemic postconditioning (IPost) are controversial. The presented information is suggestive that ageing removes or attenuates the infarct-limiting effect of postconditioning but does not influence the antiarrhythmic effect of IPost. The majority of experimental data report that streptozotocin-induced diabetes removes the infarct-limiting effect of IPost. The data concerning type 2 diabetes mellitus are controversial: some authors state that such diabetes completely levels the cardioprotecting effect of IPost; others tell that it only attenuates but does not remove the infarct-limiting effect of IPost. Postconditioning in rats with elevated arterial pressure prevents the appearance of reperfusion cardiac contractility dysfunction and exerts an infarct-limiting effect. Cardiac hypertrophy, postinfarction remodelling and dilatation cardiomyopathy do not influence the infarct-limiting and inotropic effect of postconditioning. According to the majority of publications, IPost enhances the inotropic and cardioprotecting effect of cardioplegia. The data of literature sources regarding the effect of gender on efficacy of IPost are limited.

Sudden cardiac death (SCD) persists as one of challenging problems in cardiology and cardiac surgery, only in Russia costing more than 350,000 deaths annually. Arrhythmias and ischemic heart disease (IHD) prevail as SCD immediate direct mechanisms. Unfortunately, timely diagnostics of heart diseases is far below the satisfactory level. On the other hand, the number of patients to be followed up is increasing faster than the healthcare capacity. To close the gap, new approaches to diagnostics and prophylaxis of cardiovascular diseases are needed, involving innovative medical technologies. Implantable and external devices for heart arrhythmia and CAD early diagnostics are extensively used in modern cardiologic praxis. Impetuous development of this technique in combination with information and telecommunication technologies during last decade led to origination of completely new medical service based on mobile remote monitoring of patients. Relying on the experience in remote patient monitoring with implantable devices for recording heart electrical activity, Russian Scientific Society.

While complicated acute cholecystitis (ACH) course the focus of infection constitutes one of the main causes of the endogenic intoxication (EI) occurrence, what leads to ischemic and hypoxic myocardial damage. There were presented the treatment results analysis in 213 patients, ageing 60 years old and older, managed for an ACH, complicated by peritonitis, paravesical abscess, with concurrent cardiac insufficiency of ischemic genesis, to whom laparoscopic cholecytectomy (LCHE) was conducted. Microflora of the abdominal cavity exudates in the patients, suffering an ACH of various severity, was studied. More rapid regression of inflammatory process, the EI severity and the ischemic-hypoxic myocardial affection reduction, positive impact on hemodynamics, reduction of myocardial ischemia severity were noted while local affection, when bacteriophages for treatment were applied.

Increasingly, there are patients with concomitant coronary artery disease and aortic valve, especially in elderly patients, who often have severe comorbidities and high surgical risk, which is undoubtedly a certain effect on the choice of method and tactics of treatment. Today, there are several approaches to the treatment of patients in this category, and all of them have certain advantages and disadvantages.

Aim: To investigate a balance between circulating regulatory T lymphocytes (Treg) exerting antiatherogenic activity and T helper type 1 (Th1) and T helper type 17 (Th1 7) cells having proatherogenic activity in patients with stable coronary artery disease (CAD) and different degrees of coronary atherosclerosis., Subjects and Methods: According to coronary angiography findings, 80 patients were allocated to 4 groups: 1) 18 patients with intact coronary arteries; 2) 21 with no progressive coronary atherosclerosis; 3) 16 with progressive coronary atherosclerosis (more than 50% stenosis) in the native coronary arteries; 4) 25 patients with three-vessel lesions. Groups 2 and 3 patients had undergone coronary stenting 23.8 ± 8.4 and 22.4 ± 8.7 months before their enrollment, respectively. Lymphocytes were typed by direct immunocytofluorometry: Treg was defined as CD4+CD25highCD127low and CD4+FoxP3+ lymphocytes. For CD4+IL-17a+ Th17 and CD4+INFgamma Th1 analysis, mononuclear cells were preactivated by culture. The serum levels of high-sensitivity C-reactive protein, IL-10, sCD25, and IL-17a were determined by nephelometry, chemiluminescence (Immulite) and ELISA, respectively., Results: Group 4 was found to have lower Treg levels and higher Th17 levels than Group 1. The ratio of Th17/Treg proved to be higher in Groups 3 and 4 than in Group 1 and that of (Th1+Th17)/Treg was higher in Group 3 than in Group 2. The female patients had higher Tregs levels than the male ones. The Th17/Treg index turned out to be increased in patients with a history of myocardial infarction., Conclusion: The imbalance of pro- and anti-atherogenic lymphocyte subpopulations plays a role in the pathogenesis of CAD and is associated with progressive atherosclerosis.

No-reflow phenomenon is a complication of percutaneous coronary intervention and is the absence of distal coronary bed filling. The main cause of this phenomenon is distal embolism of the coronary artery by atheromatous and thrombotic masses. The paper gives different classifications for evaluation of myocardial and coronary reperfusion. The use of aspiration catheters, glycoprotein IIb/IIIa receptor inhibitors and other drugs that affect prognosis in patients with this phenomenon is also touched upon.

Aim: To study the role of eosinophil granulocytes in the development of restenosis after drug-eluting stent (DES) implantation., Materials and Methods: The blood levels of eosinophils, eosinophil cationic protein (ECP), immunoglobulin E (IgE), and C-reactive protein (CRP) were compared in 170 patients with coronary heart disease (CHD) and stable angina who had undergone recoronarography within the first year after endovascular myocardial revascularization using DES. The blood level of eosinophils was determined by the results obtained employing the FACS Calibur flow cytofluorometer (Becton Dickinson, USA). That of ECP, IgE, and CRP was estimated by enzyme immunoassay by means of an Immulite-100 analyzer (Siemens, Germany). The data were presented as median (25th percentile and 75th percentile)., Results: The blood eosinophil level was 272 (234; 292) cells/μl in patients with restenosis while that was 134 (85; 156) cells/μl in those without restenosis (p = 0.002). The plasma ECP level proved to be greater in the patients who had developed restenosis after DES implantation than in those who had not [17.7 (11.2; 24) and 9 (6.4; 12.9) ng/ml, respectively (p = 0.017). At 6 months after DES implantation, the level of ECP was significantly higher (8.6 (7.3; 9.7) ng/ml) than the baseline level (p = 0.04). Later on, there was an even greater increase in ECP levels. No significant changes were noted in blood ECP levels after bare stent implantation., Conclusion: The findings suggest that there is a relationship between the occurrence of restenosis and the enhanced activity of eosinophil granulocytes in CHD patents after DES implantation.

Intervention in bifurcation coronary arteries disease is complicated kind of endovascular treatment of coronary heart disease, especially in patients of elderly and senile age. Recently, in the practice of the operating surgeon there is a large choice of bifurcation coronary artery stents. This report contains the views, features and shortcomings of the presented bifurcation structures. Despite the fact that in the Russian Federation bifurcation stents are rarely implanted, their use can greatly simplify and accelerate interventional procedures, along with the decrease of peri- and postoperative complications.

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.

Objective: To assess the effect of hypoxic preconditioning (HPC) on the level of s-NGAL (lipocalin-2) in myocardial revascularization under conditions of extracorporeal haemocirculation (EH)., Patients and Methods: We examined a total of 40 patients presenting with CAD (mean age 57.62±1.20 years) and subjected to coronary artery bypass grafting (CABG) under conditions of EH. All patients were subdivided into 2 groups. The study group comprised 20 patients who during CABG were subjected to HPC, and 20 patients made up the comparison group. Preconditioning was carried out in the mode of one cycle of 10-minute hypoxemia followed by a 5-minute period of reoxygenation. All patients were subjected to measuring the concentration of lipocalin in blood serum prior to CABG and 5 hours after the beginning of the operative intervention with the help of the test system Human Lipocain-2 NGAL, ELISA., Results: Prior to operative treatment the average levels of lipocalin in blood serum of the patients of the compared groups significantly did not differ, with the inverse correlation between the levels of s-NGAL and the ejection fraction of the left ventricle (r=-0.37, p=0.02), as well as the glomerular filtration rate (according to the findings of radionuclide renoscintigraphy) and the level of lipocalin (r=-0.28, p=0.046). Five hours after the CABG, there was a statistically significant increase in the s-NGAL concentration as compared with the preoperative value both in the HPC group patients and the comparison group (from 70.65±10.72 to 127.58±22.59 ng/ml and from 65.01±8.64 to 171.65±20.10 ng/ml, respectively). There was a direct relationship between the duration of EH and the dynamics of the s-NGAL level in patients of the both groups. However, an increase in the NGAL concentration in the comparison group patients was considerably more manifested vs the study group patients (p=0.02). The median value of the difference between the pre- and postoperative values of the lipocalin level in Group I amounted to 56.94±19.76 ng/ml, being in Group II 106.64±18.94 ng/ml (p=0.004)., Conclusion: Hypoxic preconditioning during myocardial revascularization under the conditions of extracorporeal haemocirculation prevents a critical elevation of the lipocalin-2 level, thus suggesting a decrease in the degree of the lesion of the renal parenchyma in cardiosurgical patients.

Physical rehabilitation is an important component of cardiorehabilitation and secondary prophylaxis programs for patients with coronary heart disease (CHD) especially after endovascular interventions. Of special importance among a variety of rehabilitative technologies under current conditions of financial crisis are those ensuring high-quality and cost-effective medical aid The clinico-economic analysis of the programs of long-term physical training is presented with reference to their application for rehabilitation of patients with CHD after endovascular intervention. The use of this approach on an individual basis is believed to promote the introduction of physical training methods into clinical practice, rational planning of secondary prophylaxis programs and reduction of financial burden on public health services.

Objective: To study the results after stenting extensive stenoses, the incidence of restenosis according to angiographic findings, as well as changes in endothelization and other morphological parameters in accordance with the data of intravascular ultrasound study (IVUSS)., Subjects and Methods: The study included 220 coronary heart disease patients with extensive stenoses of the coronary bed. Double antiaggregant therapy was used in 90% of the patients during the first year and in 9.5% during the second year. Contrast-enhanced coronarography was performed in 174 and 82 patients within the first and second years following stent implantation, respectively. IVUSS was made in 26 patents by the end of the first year and in 24 patients by the end of the second year of a followup. Quantitative and qualitative analyses were done in terms of the following indicators: the mean minimal diameter of a stented segment; its mean minimal area; the number of stents with complete endothelization. RESULTS; In the first year, 1 (0.5%) patient had a fatal outcome; the development of Q-wave and non-Q-wave myocardial infarction (MI) was observed in 2 (1%) and 3 (1.5%) patients, respectively. The appearance of angina symptoms during a year was noted in 10 (4.5%) patients; coronary artery bypass grafting (CABG) was performed in 7 (3.2%) patients; 3 (1.5%) cases had endovascular reintervention. At 2-year follow-up, 6 (2.7%) patients died; 7 (3.2%) and 7 (3.2%) patients developed Q-wave and non-Q-wave MI, respectively; recurrent angina pectoris was noted in 22 (10%) patients. CABG was made in 5 (2.3%) patients; endovascular reintervention was done in 15 (6.9%) patients. The total rate of coronary events was significantly higher at 2-year follow-up (19.2% versus 7.3% at 1-year follow-up). According to coronary angiography, stented segment restenosis was 3.8 and 4.9% after one and two years, respectively. IVUSS showed that the morphological indicators characterizing late vessel luminal loss did not differ between different periods of the follow-up. Complete endothelization was observed only in 40% of endoprostheses a year after stent implantation and in 92% of endoprostheses by the end of the second year (p < 0.05)., Conclusion: Complete endothelization was shown by 40 and 91% of the drug-eluting stents by the end of the first and second years of the follow-up, respectively. Within the first year of the follow-up, the total number of coronary events (death + MI + recurrent angina or repeat revascularization) was significantly smaller than that within the second year.

In article, analysis has been carried out on the influence of recanalization of chronic total occlusion of left anterior descending artery on the course of heart failure in elderly patients who had damage to a single artery and viable myocardium. Recanalization of chronic occlusion of left anterior descending artery together with conservative therapy in elderly patients improves the clinical course of heart failure. A more significant improvement seen in patients with chronic occlusion of left anterior descending artery without history of myocardial infarction.

Objective: comparative assessment of the informative value of the methods of perfusion and metabolic single-photon emission computed tomography (SPECT) in detecting the hibernated myocardium., Materials and Methods: the study included a total of twenty six patients diagnosed with coronary artery disease (CAD). Of these, there were 24 men and 2 women, mean age 52.0±7.0 years. All the patients in order to detect the viable myocardium were subjected to perfusion scintigraphy of the myocardium with (99)mTc-technitrile («Diamed», Russia) at rest and in a combination with the nitroglycerine test, as well as metabolic scintigraphy of the myocardium with (123)I-labelled beta-methyl-ρ-iodophenyl pentadecanic acid (BMIPP)., Results: the studies showed that sensitivity of myocardial scintigraphy with (99)mTc-technitrile on the background of the nitroglycerine test amounted to 89%, with specificity of 85% and diagnostic accuracy of 86%. While calculating the diagnostic significance of SPECT with (123)I-BMIPP, in turned out that the method's sensitivity amounted to 94%, specificity to 87%, and diagnostic accuracy to 91%., Conclusion: perfusion scintigraphy of the myocardium on the background of the nitroglycerine test and scintigraphic assessment of metabolism of fatty acids are highly informative tests for revealing viable portions of the ischemic myocardium, with the diagnostic parameters of SPECT with (123)I-BMIPP being slightly superior to those of perfusion scintigraphy with (99)mTc-technitrile on the background of sublingual administration of nitroglycerine.

Aim: To study the prognostic significance of the SYNTAX score in the evaluation of outcomes of primary percutaneous coronary interventions (PCIs) and revascularization strategy choice in patients with ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease., Material and Methods: The long-term outcomes of primary PCIs were analyzed in 163 patients with STEMI in terms of the objective assessment of the severity of the coronary bed lesion according to SYNTAX scores., Results: In a cohort of STEMI patients who had undergone primary PCI, the SYNTAX score of > or = 23 (a severe lesion) was associated with the higher incidence of acute heart failure (Killip class II) and three-vessel coronary artery disease (odds ratio (OR) 2.8), with the higher risk of death (OR 7.5) and the higher rate of the combined endpoint of death, myocardial infarction, and target vessel revascularization (OR 2.8) as compared with patients with a SYNTAX score of < or = 22 (a moderate lesion)., Conclusion: The SYNTAX score has a prognostic value in assessing the outcomes of primary PCIs in the cohort of STEMI patients with multivessel disease, which can find use in the differential choice of the optimal revascularization strategy and improve treatment results. In the group of patients with a SYNTAX score of > or = 23, the incomplete revascularization strategy shows the least favorable results as compared to multivessel stenting and staged revascularization.

In a review of the literature describes the risks and benefits of surgical interventions, in particular, coronary artery bypass grafting in patients with coronary artery disease receiving antiplatelet therapy with no cancellation or late withdrawal of acetylsalicylic acid (ASA). The data supporting a moderate - without increasing the frequency of reoperation and blood transfusion - an increased risk of perioperative bleeding in cases where operations are conducted against a background of aspirin therapy. At the same time showed a significant reduction in the risk of perioperative cardiovascular complications and improve survival after intervention, which did not occur before the removal of the drug ASA.

Despite obvious progress in management of diabetes mellitus, the DM-related complications rate remains inadmissibly high. Macroangiopathy is known to rank first amongst complications of diabetes mellitus, and coronary artery disease remains to be the major cause of death. Analysed herein are peculiarities of the clinical course in diabetic patients presenting with coronary artery disease and lower limb critical ischaemia, followed by discussing the issues concerning drug therapy, preoperative examination, and methods of diagnosis in this cohort of patients prior to vascular operations, assessment of the preoperative risk, indications for coronarography and myocardial revascularization. Also presented are the results of the main clinical trials dedicated to preoperative myocardial revascularization, including those in diabetic patients with limb critical ischaemia, and finally highlighting current importance of optimizing approaches to managing and working out algorithms of treatment policy for diabetic patients with a combination of coronary artery disease, diabetes mellitus, and critical limb ischaemia.

Since 2003 intracoronary administration of autologous bone marrow mononuclear cells has been performed in 119 patients with inoperable coronary artery disease, 53 of which had reduced ejection function that was gradually increased after injection of mononuclear bone marrow cells. By the 6th year the difference between the median of systolic and diastolic sizes of the left ventricle decreased by 12 and 14 mm respectively. In the control group the dynamics of changes of these indices at the same period was of negative character. The introduction of intracoronary bone marrow mononuclear cells is a safe and effective method of invasive therapy in patients with coronary artery disease to whom surgery is contraindicated.

Proof of clinical equivalence of generic and original dugs - the way to lessen cost of therapy of patients while providing comparable clinical effects. We present in this paper results of 1 year follow-up of 115 patients receiving Egithromb or Plavics after coronary artery stenting. Comparable clinical efficacy and safety of Egithromb and Plavics has been established.

We report an observation of one of the rarest coronary arteries anomaly, type IV dual left arterior descending artery in 43-year-old man. The patient arrived with angina pectoris and underwent multispiral computed tomography of coronary arteries, having revealed abnormal anatomy as well as atherosclerotic lesion of coronary arteries. Hemodynamically signification stenoses were successfully eliminated by the way of coronary stending.

The intermittent normabaric hypoxic training (IHT) is a non-pharmacological method, which due to several positive effects, has been used successfully in treating patients with cardiovascular diseases (CVD). However, the application of this method in the elderly has its own peculiarities because of age-related changes of organism. The article presents the indications and limitations of IHT in elderly people with coronary artery disease, the method of the mode of training in the elderly, as well as displaying the results of our clinical study of the safety and efficacy of IHT in 45 elderly patients with stable angina of I and II functional classes. It is shown that IHT is a safe method, leading to reduction in clinical symptoms of angina and duration of daily myocardial ischemia, normalization of lipid metabolism and increase exercise tolerance. Mechanisms of positive effects of IHT in patients with stable angina of I and II functional classes are an economical functioning of the cardiovascular system, optimization of oxygen consumption, improvement of vasomotor endothelial function due to increased formation of nitric oxide, normalization of microcirculation.

The study included retrospective analysis of the results of treatment in 529 patients with CHD and multiple coronary lesions divided into 2 groups. Group 1 included 280 patients who underwent surgical myocardial revascularization, group 2 comprised 249 patients after coronary stenting. The groups did not significantly differ in the occurrence of serious clinical complications (death, acute myocardial infarction) in both early and mid-late postoperative periods. Patients in group 2 more frequently suffered anginal attacks and required repeat myocardial revascularization. The main factor limiting clinical efficiency of endovascular procedures was coronary restenosis in roughly 34% of the patients.

The aim of our investigation was to assess the efficacy of enhanced external counterpulsation (EECP) in ischemic heart disease (IHD) patients depending on previous by-pass surgery. 30 IHD patients (pts) were treated with EECP using standard protocol (35 hours, 1 hour each procedure). All patients were divided into 2 groups. 1-st group (n=15) - pts after by-pass surgery, 2-nd group (n=15) - pts without previous coronary revascularisation. Pts were examined by ECG, echocardiography, bicycle test, radionuclide perfusion scintigraphy (SPECT) before and after EECP treatment. There was significant decreasing of perfusion defect severity for rest SPECT after EECP treatment (64.93+/-13.21 std and 58.53+/-17.28 std, respectively, p<0.01) and decreasing of size of perfusion defects - 26.10+/-15.76% before and 22.63+/-18.54% after EECP (p<0.05). Size and severity of perfusion defects estimated by SPECT at stress conditions didn't change. After EECP treatment the decreasing of perfusion defect severity (p<0.01) was registered in both groups, the decreasing of size of perfusion (p<0.05) - only in the 1-st group. In the 1-st group decreasing of perfusion defect severity and size of perfusion was more intensive. The efficacy of EECP depends on previous coronary revascularization.

Relatively little time has passed since elaboration and introduction of coronary angioplasty however interventional cardiology in these years has made a swift leap in its development. Initially coronary interventions were carried out only on isolated proximal stenoses but later interventions became to be performed on more complex lesions of coronary arteries and then on multivessel disease intruding into area which previously had belonged exclusively to coronary bypass surgery. Although both methods of revascularization rapidly developed the researchers were interested in assessment and comparison of results of two strategies. Thus studies appeared in which patients were randomized for coronary bypass surgery or percutaneous coronary angioplasty. Below we present data of the largest and most interesting studies in which these strategies of revascularization in patients with multivessel involvement have been compared. We also separately consider results of revascularization in a subgroup of patients with diabetes mellitus.

The authors present a review of clinical studies conducted and completed in 2001-2005. The review contains data on clinical trials of sirolimus- and paclitaxel-eluting stents in patients with diabetes mellitus and coronary artery disease. The authors analyze experimental data on mechanism of neointima formation in animals with experimental diabetes as well as clinical data on coronary angioplasty in patients with diabetes mellitus. In addition, they discuss data on the use of sirolimus-eluting stents in the treatment of in-stent restenosis in diabetic patients.

Myocardial revascularization in a standard method of treatment of patients with severe stenocardia and hemodynamically significant lesions of coronary vessels. Nowadays, endovascular correction techniques are more and more wide-spread in patients with multi-vascular lesions. Earlier comparative studies demonstrated absence of differences according to lethal outcome and acute myocardial infarction frequencies, but a higher requirement for repeated interventions and a higher rate of stenocardia recurrence after endovascular technique application vs. surgical treatment. However, nowadays stents with antiproliferative coating allowing for significant reduction in restenosis rate are widely used. This article is dedicated to analysis of the results of surgical and endovascular treatment of patients with multi-vascular coronary lesions.

The state of microcirculation was studied in 35 patients with obliterating atherosclerosis of the lower extremity vessels (1st group) and 36 patients with extensive atherosclerosis having a combined impairment of the peripheral basin: arteries of lower extremities and coronary arteries (2nd group) treated using the method of plasmapheresis (PPh) and PPh combined with intravascular laser irradiation of blood (IVLIB). The isolated use of PPh in patients of the 1st group was established to be effective, while combination of PPh and IVLIB was necessary for the patients of the 2nd group.

The author presented a review of clinical research works conducted and completed in 2001 - 2005. The review contains data on clinical trials of sirolimus-eluting stents in patients with coronary artery disease. The author analyzed experimental data on the mechanism of action of rapamycin on the cell and also analyzed data of clinical trials of sirolimus-containing stents in the treatment of coronary artery stenosis and chronic occlusion. Results of clinical trials of coated stents in diabetic patients with coronary artery stenosis, as well as data on the use sirolimus-containing stents in the treatment in stent restenosis were also discussed.

Data of 5-year prospective follow-up were used for assessment of clinical course, prognosis and effectiveness of drug and nondrug treatment of 202 patients with ischemic heart disease, occlusive coronary artery atherosclerosis and preserved left ventricular function. It was found that 5-year cardiovascular mortality and rate of nonfatal myocardial infarction did not differ significantly between groups of patients subjected to drug treatment only, transluminal balloon angioplasty, and coronary artery bypass grafting.

One of the main difficulties in cardiology is how to correctly choose the volume and method of treatment in elderly patients with ischemic heart disease. 165 elderly patients with IHD were included into the study. 83 patients received partial myocardial revascularization by PTCA and stenting and 82 patients were on the conservative medical treatment. The state of coronary flow was estimated by means of the Holter-monitoring and treadmill-test results. Contraction ability of the heart was evaluated by echocardiography. The Quality of life level in patients was measured by SF-36 questionnaire. The results prove that elderly patients with IHD can benefit from the early partial myocardial revascularization which increases coronary circulation, quality of life level and preserves left ventricular function.

Coronary artery disease (CAD) is one of the most frequent diseases of geriatric patients, which substantially deteriorates the quality of life and leads to lethal outcomes. Coronary angioplasty (CA) is an effective method of CAD treatment in this group of patients. CA is the method of choice for geriatric patients with contraindications for surgical revascularization. No consensus about revascularization volume in multivessel disease has been reached in the worldwide practice. Peculiarities of myocardial blood supply in elderly patients allow partial revascularization with good periprocedural and long-term results.

Aim: To study a short-term clinical effect of balloon coronary angioplasty (BCA) in patients with affection of three coronary arteries regarding an anginal form and completeness of myocardial revascularization., Material and Methods: The study included 80 patients with coronary heart disease (CHD) having three affected major coronary arteries after BCA among them 48 patients with stable and 32 patients with unstable angina. The procedures were made using "Polydiagnost C" angiographic complex (Philips, Holland)., Results: Overall clinical efficacy of BCA in affection of three coronary arteries was 88.75% (in 71 of 80 patients), no response was observed in 9 of 80 patients (11.25%). The response to BCA was independent of the anginal form. In stable angina there were no differences in clinical efficacy in complete and incomplete functionally-adequate anatomic BCA (91 and 89.6%, respectively). In incomplete anatomic revascularization clinical effect was less (62.5%). In unstable angina a clinical effect of BCA did not depend on the degree of myocardial revascularization. Stenting raised clinical response to BCA in all the patients., Conclusion: The findings demonstrate high clinical efficacy of BCA in affection of three coronary arteries irrespective of an angina form. Incomplete anatomic revascularization in stable effort angina is less effective but can be used if other operations are impossible. If definition of the symptom-causing artery is possible, the intervention should be limited to BCA of this artery to decide on dilation of other arteries later.

Data from about 50 consecutive patients with acute coronary syndromes aged > or =18 years admitted to 59 hospitals in different Russian cities were collected between November 2000 and July 2001. In addition to presumably ischemic symptoms within previous 24 hours they were to have ischemic ECG changes, documented coronary heart disease or positive markers of myocardial necrosis. Of 2806 patients included into registry 1394 (49.7%) had non-ST elevation acute coronary syndrome. Markers of myocardial necrosis (mainly CK activity) were evaluated in 59.5% of them. Frequency of interventions known to improve outcome was rather low: aspirin in acute phase was used in 73% (contraindications were reported just in 6%), thyenopyridines - in few cases, unfractionated heparin intravenously only with APTT control - in 11.8%, low-molecular weight heparins - in 7.4% of patients. Beta-blockers were prescribed in 55.6% of cases (with fist dose intravenously in 2.9%). Lipid lowering drugs were recommended on discharge to 15% of patients (to 20% with known hypercholesterolemia). Coronary angiography and revascularization procedures were performed in 25 (1.8%) and 11 (0.8%) patients, respectively. However hospital mortality appeared to be relatively low (3.8%). Meanwhile rates of (re)infactions and angina recurrences during hospitalization were high - 16.5 and 25.1% of cases, respectively.

Aim: To assess immediate and long-term outcomes after BioDiamond-stent implantation in patients with native coronary artery disease., Materials and Methods: The BioDiamond stent was implanted in 112 patients with 132 de novo lesions. Most patients (54%) had unstable angina, 33% of the lesions were of type B2-C., Results: No stent deployment failure occurred as well as acute or subacute stent thrombosis. The 6-month angiographic follow-up was obtained in 108 patients (98%) (125 lesions). The loss index was 0.40 +/- 0.27. Angiographic restenosis rate occurred in 14%. Repeat target lesion revascularization was successful in 16 patients with restenosis., Conclusion: The results of this study indicate a potential benefit of BioDiamond for prevention of stent thrombosis and restenosis in these relatively high-risk patients.

The authors analyze results of coronary angioplasty and stenting in patients with ischemic heart disease with a lesion of the left main coronary artery. Injuries of the left main coronary artery took place in 14 (0.74%) out of 1900 patients after coronary angioplasty. A detailed analysis of the operation technique, indications and contraindications for endovascular intervention is given. The results of balloon angioplasty with and without the following stenting are compared.