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Tyrimo tikslas. Apžvelgus literatūrą, išanalizuoti žarnyno mikrobiotos svarbą širdies ir kraujagyslių ligoms, būsimiems tyrimams bei galimoms intervencijoms. Metodai. Mokslinių tyrimų darbų paieška atlikta naudojant kompiuterinę bibliografinę mokslinių darbų duomenų bazę „PubMed“. Analizuoti publikuoti moksliniai tyrimai, straipsniai, elektroninės knygos. Paieškoje buvo vartojami reikšminiai žodžiai ir jų deriniai: gut microbiota, cardiovascular disease, dysbiosis. Rezultatai. Išanalizavus žarnyno mikrobiotos įtaką širdies ir kraujagyslių ligoms, pastebėti egzogeniniai ir endogeniniai veiksniai, dėl kurių žarnyno mikrobiomos pokyčiai gali tapti potencialiu terapiniu taikiniu kovoje su šiomis ligomis.

Krūtinės angina, dar kitaip žinoma kaip krūtinės skausmas, yra geriausiai atpažįstamas miokardo išemijos simptomas. Daliai stabilia angina sergančiųjų yra atliekama diagnostinė vainikinių arterijų angiografija, o iš jų – 10–15proc. nenustatoma reikšmingų pokyčių. Moksliniuose tyrimuose plačiai aprašoma mikrovaskulinė angina, klinikinėje praktikoje įtariama pacientams, kurie skundžiasi būdingais krūtinės anginos simptomais, tačiau jiems atmesta vainikinių arterijų obstrukcija ir vazospazmas, remiantis EKG, krūvio mėginio ir diagnostinės vainikinių arterijų angiografijos tyrimais. Mikrovaskulinę funkciją galima vertinti invaziniu (CFR matavimo) ir neinvazinais (PET, SPECT, šMRT, streso echokardiografija, TTDE) metodais. Pagrindinis vainikinių mikrovaskulinių arterijų disfunkcijos mechanizmas nėra visiškai išaiškintas, tačiau rizikos veiksniais laikomi tie patys kaip ir makrovakulinę anginą sukeliantys veiksniai. Dėl sudėtingos klinikos kilmės, pagrindinis tikslas yra sumažinti krūtinės anginos simptomus MVA sergantiems pacientams. MVA gydymas apima visišką kardiovaskulinių rizikos veiksnių ir gretutinių ligų (būklių), bloginančių klinikines baigtis, kontrolę.

Background Coronary physiology-guided PCIs are recommended worldwide. However, invasive coronary physiology methods prolong the procedure, make additional risks for the patients, and prolong the fluoroscopy time for an interventional cardiologist. Otherwise, there is a non-invasive coronary physiology evaluation method QFR, which can be safely used even in STEMI patients. Methods 198 patients admitted with STEMI and at least one intermediate (35–75%) diameter stenosis other than culprit artery between July 2020 and June 2021 have been prospectively included in this single-centre study. All patients were randomized into one of two groups (1 - QFR-guided PCI; 2 - visual-estimation-only guided PCI). A 12-month follow-up with echocardiography, exercise stress test, and quality of life evaluation was performed in all included patients. For the QOF evaluation, the Seattle angina score questionnaire was chosen. Statistical analysis was performed using Kolmogorov-Smirnov, Stjudent T, Mann-Whitney, Pearson Chi-square tests and Kaplan Meier survival analysis. Results 98 (49.5%) patients were randomized to the first group, and 100 (50.5%) patients were included in the second group. Statistically, significantly more patients had a medical history of dyslipidaemia (98 vs 91, p = 0.002) and slightly better left ventricular ejection fraction (42.21 ± 7.88 vs 39.45 ± 9.62, p = 0.045) in the QFR group. Six times fewer patients required non-culprit artery revascularization within 12-month FU in the QFR group (1.02% vs 6%, p = 0.047). Survival analysis proved that patients in the Angio group had more than 6-time greater risk for death within a 12-month period after MI (OR 6.23, 95% CI 2.20-17.87, p = 0.006), with the highest mortality risk within the first two months after initial treatment. Conclusions Using QFR in non-culprit lesions for patients with ST-elevation myocardial infarction reduces mortality rate and revascularization in 12-month follow-up and increases the patient's quality of life. Trial registration The study was approved by the Regional Bioethical Committee and conducted under the principles of the Helsinki Declaration and local laws and regulations.

Aim: we choose to evaluate, whether type of cardioplegia is an important predictor to determine biventricular function changes after CABG. Methods: 81 patients who underwent CABG surgery and matched inclusion criteria were enrolled in this study. The exclusion criteria were acute MI within 30 days, impaired systolic left ventricle function (LVEF ⩽35%), atrial fibrillation.TTE was performed for all patients and echocardiographic parameters of biventricular geometry and function were assessed before CABG surgery, first postoperative day and 6 months after surgery. Cardioplegia type was randomly chosen. First group consisted of 49 patients (60.5%) when CC was performed and the others 32 patients (39.5%) formed the second - BC group. Results: Patients’ demographic characteristics were similar in both groups, except the lower rates of AH and BSA in BC group ( p = 0.015, p = 0.001 respectively). Longer duration of XCT and CBP time was observed in BC group (p = 0.019 and p = 0.028). BC group patients showed more efficient right heart chambers size reduction ( p = 0.001 for RV diameter; p = 0.015 for RA diameter) and better improvement of longitudinal RV function ( p = 0.02 for TAPSE; p = 0.001 for RV S’) 6 months after surgery when compared with CC group patients. RV global systolic function diminished in both groups postoperatively, but the reduction was higher in CC group, although the difference was significant in comparing early postoperative measurements with the late after CABG surgery ( p = 0.03). Changes of LV systolic function as well as diameter of LA did not differ between groups ( p = 0.165 and p = 0.279, respectively), while diastolic function improved significantly in BC group patients at the late follow-up period: E/e’ decreased (p Conclusion: BC is associated with better RV reverse remodelling and improvement of longitudinal RV function, as well as LV diastolic function improvement after CABG surgery.

Introduction The SYNTAX score is an angiographic tool used to grade coronary artery disease (CAD) burden and complexity. SYNTAX score predicts 1-year adverse outcomes for patients with multivessel and/or left main CAD who undergo percutaneous coronary intervention (PCI). However, the relationship of the pre-PCI (basal) SYNTAX score to long-term outcomes of patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI is unknown. Purpose To evaluate the short-term (in-hospital) and long-term (5-year) prognostic value of basal SYNTAX score in patients with STEMI who were treated with primary PCI. Methods We retrospectively reviewed records of consecutive patients presenting with STEMI, admitted from January 2014 to December 2016, who underwent primary PCI. We categorized patients into two groups according to SYNTAX scores: low/intermediate (≤22, 23–32) and high (>33). We utilized the Cochran-Armitage test for trend, Chi-square test, Fisher's Exact test, and Kruskal-Wallis tests to assess differences in baseline characteristics and outcomes as appropriate. We used logistic regression and calculated the area under the receiver operating characteristic curve to determine the prognostic ability of SYNTAX score groups on 5-year outcomes for stroke, myocardial infarction (MI), cardiovascular death, target vessel revascularization (TVR), all-cause mortality, and major adverse cardiovascular events (MACE). Results There were 768 patients who met inclusion criteria for this study. 559 (72.8%) patients were in the low/intermediate SYNTAX score group and 209 (27.2%) patients were in the high SYNTAX score group. Baseline characteristics did not differ significantly between the two groups. In-hospital pacemaker implantation, in-hospital stent thrombosis, and in-hospital cardiac arrest and in-hospital death were rare and did not differ according to SYNTAX group (Table 1). However, the odds of experiencing stroke, MI, cardiovascular death, TVR, all-cause mortality, and MACE at 5 years were significantly higher in the high SYNTAX score group, even when adjusted for heart failure, total cholesterol, and age. The associated areas under the receiver operating characteristic curve indicated moderate-to-strong prognostic ability of the basal SYNTAX score (Table 2). Conclusion A high SYNTAX score in patients with STEMI who undergo primary PCI is associated poorer long-term outcomes, compared to patients with an intermediate/low score. This work confirms that a high burden of CAD in patients with STEMI portends a poorer long-term prognosis. Funding Acknowledgement Type of funding sources: None.

Prieširdžių virpėjimas (PV) išlieka dažniausias ritmo sutrikimas su kuriuo susiduriame klinikinėje praktikoje. Pacientai, kurie turi šį ritmo sutrikimą, turi žymiai didesnę insulto tikimybę, todėl jiems įprasta skirti vitamino K antagonistus (varfariną) arba tiesioginius geriamuosius antikoaguliantus (NGAK). Dėl pacientų jau esamo polimorbidiškumo tinkamai palaikyti terapinę hipokoaguliaciją sudėtinga, todėl galima kraujavimo rizika. Iki šiol sunkios būklės pacientai, kurie dėl gretutinių patologijų arba jau buvusių kraujavimo įvykių, negalėjo vartoti varfarino ir dėl to turėjo vartoti redukuotas NGAK dozes, gydymo aspektu vis sunkiau būdavo išlaikyti pusiausvyrą tarp didžiausios naudos ir mažiausios naujų komplikacijų rizikos pacientui. JAV maisto ir vaistų administracija (angl. American Food & Drug Administration, USFDA), reglamentuojanti ir aprobuojanti naujus gydymo metodus, 2015 m. kovo mėn. patvirtino kairiosios prieširdžio ausytės uždariklių (KPAU) naudojimą. Taigi, pacientams sergantiems nevožtuvinės kilmės prieširdžių virpėjimu ir negalintiems vartoti antikoaguliantų, oficialiai atsirado alternatyva – kairiosios prieširdžio ausytės uždarikliai. Deja, ilgą laiką klinikinės indikacijos implantuoti pacientui KPAU nebuvo aiškiai apibrėžtos ir nebuvo įvertintos intervencinės komplikacijos bei vėlyvieji rezultatai po uždariklio implantavimo. Neseniai atliktų didžiausių atsitiktinių imčių tyrimų (PREVAIL, PROTECT­AF) duomenimis, kairiosios prieširdžio ausytės uždariklio implantavimo procedūra yra efektyvi ir saugi. Tyrimai įrodė, jog sėkmingai atlikus uždariklio implantavimą, sumažėja insulto tikimybė, sumažėja kraujavimo ir mirties rizika lyginant su varfarinu. Esant pakankamam įrodymų kiekiui, 2019 m. gegužės mėn., Kauno klinikose pirmą kartą atlikta sėkminga kairiosios prieširdžio ausytės uždarymo procedūra. Išvada. Remiantis pasauline klinikine praktika ir pirmosiomis patirtimis Kauno klinikose, kairiosios prieširdžio ausytės uždariklio implantavimas yra saugi ir efektyvi procedūra.

Introduction: As coronary artery disease is the most frequent cause of cardiac arrest, early invasive strategies may be beneficial for such patients. This study analyses the impact of in-hospital treatment on short-term outcomes of out-of-hospital cardiac arrest survivors. Material and methods: Patients admitted to the Cardiac Intensive Care Unit of our hospital within 2-year period were prospectively included in the study. Results: One-hundred-thirty-one patients were included in the study, which showed that in-hospital mortality increases uniformly with the severity of the coronary artery lesion (p = 0.044), but an effect of revascularization on number of deaths was not observed (p = 0.64). The presence of coma (p = 0.005) and the combination of male sex and age above 60-year as 2.2-fold (p = 0.048) increasing in-hospital mortality were found. The highest mortality rate occurred during the first 3 days and the death rate of the patients who survived this period is low. We found reduced left ventricular ejection fraction (OR = 6.54; 95% CI: 1.98–21.63; p = 0.002), non-ventricular fibrillation initial rhythm (OR = 2.94; 95% CI: 1.25–6.90; p = 0.014), unconscious at admission (OR = 6.46; 95% CI: 1.96–21.24; p = 0.002) and post-resuscitation coma (OR = 6.00; 95% CI: 2.63–13.66; p < 0.001) or encephalopathy (OR = 2.71; 95% CI: 1.9–6.72; p = 0.031) to be significant prognostic factors for higher in-hospital mortality rate. Conclusions: We recommend immediate coronary interventions for all survivors of OHCA regardless of their state of consciousness and absence of ischaemic changes on ECG. Early intensive treatment for OHCA patients is indispensable, as the highest mortality rate is within the first 3 days after an event.

Introduction. Trans-radial intervention has several advantages such as reduction of bleeding risk, improvement of patients’ convenience, and immediate ambulation as compared with the trans-femoral intervention. In the trans-radial intervention, there are some anatomical and technical differences between right and left radial approach. The aim of this study is to evaluate the impact of the choice of the right or left radial approach on 12-month clinical outcomes in patients undergoing the trans-radial intervention. Methods. A total of 506 consecutive patients who underwent trans-radial intervention were enrolled from Nov 2013 to Oct 2014 in the Lithuanian University of Health Sciences Trans-radial Intervention Registry. The patients were divided into two groups; a right radial approach group and a left radial approach group. To adjust potential confounders, propensity score-matched analysis was performed using the logistic regression model. Results. After propensity score matching, the baseline clinical and angiographic characteristics were balanced between the two groups. However, contrast volumes during the procedure were larger and fluoroscopic times were longer in the right radial approach group, whereas procedure times were longer in the left approach group. Procedural and in-hospital complications were similar between the two groups. The cumulative clinical outcomes up to 12 months, including mortality, recurrent myocardial infarction, repeat revascularisation, stent thrombosis, and MACE, were similar between the two groups. Conclusions. In this study, despite the procedural efficacy including procedural time and contrast volume were increased in the right artery approach, however, 12-month cumulative clinical outcomes were similar between the two groups.

Introduction. Stenting is a widespread procedure for patients suffering from coronary artery disease. The use of drug-covered stents has improved stenting safety and treatment efficiency. Using second-generation Biolimus drug-covered A9 stents is associated with reduced risk of stent thrombosis compared with first-generation ones. The aim of the study was to evaluate two years’ treatment results after implantation of Biolimus A9 stents in coronary arteries in patients who suffer from coronary artery disease. Methods. The study included 216 patients who suffered from coronary artery disease and were treated using Biolimus A9 drug-covered stents, in order to eliminate all greater-than-50% stenoses. Patients’ data were collected from hospital case histories and e-Biomatrix PMR questionnaire. Decisions regarding whether to use Biolimus A9 stents during percutaneous coronary intervention were made by the respective operators. The rate of complication after stenting was evaluated when stenosis was eliminated or reduced to 30% or TIMI 3 flow was determined. Results. Out of 216 patients included in the study, 151 were males (69.91%) and 30.09% (65) were females. Mean of age of patients was 60.2 ± 10.1 years; 19% of patients had diagnosed diabetes. The success rate of implanting Biolimus A9 stents was 100% with no complications during hospital stay.

Background and objective: The aim of this study was to evaluate and compare various parameters between complete and incomplete ST-segment resolution (STR) patients' groups and to identify associates of STR in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) (primary outcome). Materials and methods: A total of 203 consecutive patients were divided into two groups according to the degree of STR: &lt, 70% (incomplete) and ≥70% (complete resolution) 5–15 min after the PPCI. The cardiovascular risk factors, sex, Killip class, Thrombolysis in Myocardial Infarction (TIMI) flow, symptom-onset-to-balloon time and door-to-balloon time, and adverse cardiovascular events (secondary outcome) were assessed and compared between two groups. Results: There were 147 patients with incomplete STR and 56 patients with complete STR. Patients with complete STR were younger, had lower Killip class, shorter duration of the chest pain and were less likely to have anterior myocardial infarction (AMI). Patients in the incomplete STR group had longer symptom-onset-to-balloon and door-to-balloon intervals. TIMI3 flow after PPCI was more common in the complete STR group. TIMI flow ≤2 after PCI, AMI and symptom onset-to-balloon time were inversely associated with STR (beta coefficients 28.635, 28.611, and 0.917, respectively). AMI (OR = 29.9), symptom onset-toballoon time (OR = 1.7) and patient's age (OR = 1.1) were associated with an increased likelihood of having incomplete STR. Conclusions: Patients with complete STR were younger, had lower Killip class, shorter duration of STEMI, were less likely to have AMI, were more likely to recover TIMI3 flow. Age, TIMI-flow grade 2 or less after PPCI, AMI and symptom-onset-to-balloon time were associated with STR.

LV function may improve after revascularization of coronary occlusions or using a significant amount of medication. However the quality of life of every patient who is indicated with a acute coronary syndrome is not well characterized. The purpose of the current study was to evaluate the effect of

We present an illustrative case report of the mid-vessel left anterior descending (LAD) coronary artery spasm, which has been enhanced by straightening of the tortuous LAD segment with a guidewire ("accordion effect") thus resistant to intracoronary nitroglycerine and mimicking a coronary artery dissection. Dynamic appearance of this iatrogenic pseudo-lesion upon administration of intracoronary nitrates and recognition of these angiographic phenomena prevented from unnecessary further intervention.

Objective: The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multi- vessel disease (MVD). Materials and methods: A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (&gt, 140 mmHg) were assigned to the first group ( n = 58), with normal ASBP (&lt, 140 mmHg), to the second group ( n = 46), with increased myocardial mass index (MMI) (&gt, 100 g/m2), to the third group ( n = 70), and with normal MMI (&lt, 100 g/m2), to the fourth group ( n = 34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months. Results: There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58% 8.25% vs. 46.8% 7.13%, P = 0.018). Conclusion: Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.

Objective. The aim of present study was to evaluate the diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block. Materials and methods. Twenty-four patients who underwent both multislice computed tomography coronary angiography and invasive coronary angiography were enrolled in the study. Findings of these imaging modalities were compared in order to determine the sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography in identifying hemodinamically significant stenoses (≥50%). All segments ≥2 mm in diameter were visually assessed independently from their degree of calcification and image quality. Results. In total, 328 segments were analyzed. The Spearman correlation coefficient between multislice computed tomography and invasive coronary angiography was 0.76 (P&lt, 0.0001). On a per-segment basis, sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography were 75%, 97.7%, 72%, and 98%, respectively, on a per-vessel basis, these values were 77.8%, 92.3%, 70%, and 94.7%, respectively, on a per-patient basis – 81.8%, 84.6%, 81.8%, and 84.6%, respectively.Conclusions. Multislice computed tomography coronary angiography provides a high diagnostic accuracy in detecting significant coronary artery stenoses in patients with left bundle branch block.

Objective. To show differences in the changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct related artery with and without stent implantation and to assess the value of QRS score in the follow-up period. Material and methods. A total of 248 consecutive patients were divided into these groups: early angioplasty (≤24 hours) without stents (n=114) or with stents (n=6) and later (&gt, 24 hours) angioplasty without stents (n=114) or with stents (n=14). The changes in QRS score and echocardiographic left ventricular ejection fraction during the hospital and 3-month follow-up periods were compared between the groups. Results. QRS score did not increase in a hospital in early or late angioplasty with stents groups, while in the groups without stents especially of early angioplasty increased (2.6±2.5 vs. 3.6±2.4, P=0.001). Left ventricular ejection fraction increased after 3 months only in early angioplasty groups especially with stents (30.0±3.5 vs. 38.4±5.2, P=0.008), but there were no significant differences between the QRS score at discharge and after 3 months (5.4±4.3 vs. 5.0±1.9). Conclusions. Myocardial injury did not increase in a hospital in the cases of early or late angioplasty with stents, while in the cases without stents increased. Left ventricular ejection fraction increased after 3 months only in the cases of early angioplasty especially with the stent implantation, but the QRS score showed no differences, so the QRS score may be not predictive of improvement in ejection fraction at follow-up.

Pirmąją perkutaninę vainikinių arterijų angioplastiką 1977 m. atliko A. Gruentzig. Taigi perkutaninės intervencijos įgavo didelę reikšmę gydant išeminę širdies ligą. Tačiau per pirmuosius šešis mėnesius po vainikinių arterijų angioplastikos procedūrų išlieka tam tikra vidinės kraujagyslės sienelės sluoksnio įtrūkimo ir susiaurėjimo atsinaujinimo (angl. restenosis) rizika. Dviejų didelių klinikinių studijų (STRESS ir BENESTENT) tyrėjai dar 1994 m. įrodė, jog, naudojant kraujagyslių plėtiklius (angl. stent), žymiai sumažėjo susiaurėjimo atsinaujinimo atvejų. Nuo 1994 m. iki šiol kraujagyslių plėtikliai dažnai ir sėkmingai naudojami nepaisant dviejų problemų: poūmės kraujagyslių plėtiklio trombozės (1–2 proc.) ir susiaurėjimo atsinaujinimo (5–40 proc.). Poūmė plėtiklio trombozė įvyksta per pirmąjį mėnesį po procedūros. Jos galima išvengti skiriant ligoniui du antitrombozinius medikamentus, t. y. aspiriną ir klopidogrelį. Nedidelė poūmės plėtiklio trombozės rizika išlieka ir ilgiau nei po vieno mėnesio implantavus vaistus išskiriančius kraujagyslių plėtiklius. To galima išvengti pratęsus antitrombozinį gydymą. Vaistus išskiriantys plėtikliai yra svarbi naujovė intervencinėje kardiologijoje. Naudojant kraujagyslių plėtiklius, kraujagyslės susiaurėjimo atsinaujinimą galima sumažinti iki 3–5 proc. natyvinėse vainikinėse arterijose, jei yra stabili vainikinių arterijų būklė. Tačiau ilgalaikės studijos, kurių metu buvo lyginami standartiniai metaliniai plėtikliai su vaistus... [toliau žr. visą tekstą] Since the first percutaneous transluminal coronary angioplasty performed by A. Gruentzig in 1977, percutaneous coronary interventions have become the most important treatment modality for coronary heart disease. Coronary angioplasty carried a significant risk of coronary flow-limiting dissections and restenosis during the first six months following the procedure. Two main studies comparing percutaneous transluminal coronary angioplasty and coronary stenting (STRESS and BENESTENT) performed in 1994 showed a significant reduction in restenosis rate using stents. Thus, until now stents are the most widely used devices for coronary intervention despite two problems: subacute stent thrombosis (1–2%) and still high restenosis rate (5–40%). Subacute stent thrombosis occurs within the first month after stent placement and can be prevented using the double antiplatelet regimen with aspirin and clopidogrel. Some risk of subacute thrombosis remains beyond the first month when drug-eluting stents are used. This requires prolonged antiplatelet therapy. Drug-eluting stents are the most significant innovation in interventional cardiology. They can reduce the incidence of restenosis in native stable coronary arteries to 3–5%. However, the long-term studies comparing bare-metal stents and drug-eluting stents did not show any significant differences in the rate of major adverse cardiac events (death, myocardial infarction), especially in patients with diabetes after the treatment of... [to full text]

The comparative value of different factors of reperfusion technique and strategy in restoring of myocardial function is underestimated. The aim of this study is to assess the value of reperfusion strategy for restoring of myocardial function in follow-up period.From 1999 to 2001, 4260 patients with acute coronary syndromes were analyzed. Coronarography was performed for 2990 patients and percutaneous coronary interventions - for 1257 patients. QRS score was calculated; electrocardiogram and echocardiograms were done for 248 patients with acute myocardial infarction after reperfusion therapy by percutaneous transluminal coronary angioplasty (PTCA) (228 patients) and by stenting (20 patients). Urgent PTCA was used for 114 patients, urgent stenting for 14 patients, delayed PTCA for 114 patients and delayed stenting for 6 patients.Coronarography was performed for 66% of all hospitalized patients; percutaneous coronary interventions - for 825 (45.6%) of patients with acute myocardial infarction and only for 11.7% of patients with unstable angina pectoris. In hospital period QRS score increased for all patients with the exception of patients with delayed stenting (p from 0.05 to 0.001). LVEF had tendency to increase in all groups of patients during 3 months.Coronarography can be performed for 65-70% of hospitalized patients with acute coronary syndromes and percutaneous coronary interventions for 45% of patients with acute myocardial infarction. Differences in reperfusion strategy do not have manifest value on restoring of left ventricle function.

Percutaneous coronary angioplasty is very well known percutaneous revascularization procedure. Results of the percutaneous coronary angioplasty vary according to the stage of ischemic heart disease. The aim of our study was to evaluate and to compare the results of percutaneous coronary angioplasty in patients with stable and unstable angina. We analyzed data from 1148 patients in both groups. The extent of atherosclerosis was significantly higher in unstable angina group, however there was no significant difference in procedural as well in in-hospital outcomes between two groups. Success rate was 86% in unstable angina group and 83.3% in stable angina group. Major adverse cardiac events occurred in 1.48% patients with no difference in both groups. Left ventricular ejection fraction and end-diastolic diameter improved more in unstable angina group.

Rare clinical case of myocardial infarction, conditioned by neoplasmal obturation of coronary artery, is presented in the article. Primary nidus of the neoplasmal growth was in 3 and 4 segments of the lung. Tumor penetrated pleura, pericardium, epicardium and infiltrated wall of the circumflex branch and formed neoplasmal thrombus.

Cocaine abuse has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. The first report of myocardial infarction temporally related to the recreational use of cocaine appeared in 1982. This article discusses the possible pathological mechanisms underlying the pathogenesis of myocardial ischemia and infarction secondary to cocaine abuse, and current ideas on the management of cocaine-induced myocardial infarction. We report a case of acute myocardial ischemia in a young healthy male patient and his 5-year follow-up.