The influence of the Ini-tial Severity of Coronary Artery Lesion (by the Syntax Score) on the Midterm Prognosis of Patients With Acute Myocardial Infarction Without ST Segment Elevation.

Aim      To study the effect of the baseline severity of coronary artery damage according to the SYNTAX scale (baseline score of coronary lesions, BSCL) on the mid-term prognosis in patients with non-ST segment elevation acute myocardial infarction (AMI) (NSTEMI), and to identify the threshold BSCL value that determines high and low risks of adverse cardiac outcomes.Material and methods  A retrospective analysis was performed for the hospital treatment of patients with NSTEMI (n=421) who had undergone percutaneous coronary intervention (PCI). 256 patients with a repeated hospitalization in mid-term (11.6±3.2 months) were selected for the study. These patients were followed up for the incidence of acute coronary syndrome (ACS), unscheduled repeated myocardial revascularization (URR), and of the composite endpoint (CEP) that included at least one the following events: death, recurrent AMI, unstable angina (UA), and URR. The effect of BSCL on the incidence of these events in mid-term was proven (р<0.05), and then the BSCL threshold value was determined, which allowed segregation of patients into groups of high and low risk of adverse cardiac outcomes.Results The threshold BSCL value for the risk of ACS was determined as score 14 (odds ratio, OR, 2.79; 95 % confidence interval, CI: 1.32-5.89); for URR and CEP, score 13 (OR, 2.21; 95 % CI: 1.22-4.01 and OR, 2.38; 95 % CI: 1.32-4.31, respectively). Since these threshold values were comparable, for the composite category of events (CEP), the BSCL threshold comprised score 13, and namely this value was taken as a base. According to the multifactorial Cox regression at BSCL score ≥13, the probability of earlier CEP in mid-term was 2.44 times higher than at lower BSCL values (OR, 2.44; 95 % CI: 1.41-4.21; р=0.001). Furthermore, according to the Kaplan-Meier estimate, the effect of BSCL on the survival without adverse cardiac outcomes becomes significant starting from the second half-year (р=0.001, log-rank test).Conclusion      In NSTEMI patients, the SYNTAX baseline score of coronary lesions >13 is an independent predictor of adverse cardiac outcomes in mid-term starting from the second half-year. Thus, patients with BSCL ≥13 should undergo a follow-up examination no later than at 6 months independent on their clinical condition..

Prognostic Value of Residual Coronary Artery Lesions on the SYNTAX Scale in Patients with Acute Myocardial Infarction without SТ Segment Elevation in the Mid-Term Period.

Aim      To study the effect of residual coronary injury after a percutaneous coronary intervention (PCI), as evaluated with the SYNTAX scale (residual SYNTAX score, RSS), on the mid-term prognosis for patients with non-ST elevation acute myocardial infarction (NSTEMI) and also to determine threshold RSS values for patients at high and low risk of adverse cardiac events.Material and methods  A single-center, retrospective study was performed. From 421 patients with NSTEMI after PCI with stenting, 169 patients were selected who originally had multivessel coronary disease and who had undergone a repeated inpatient examination, including mid-term (11.7±3.0 mos.) coronary angiography. The endpoints were recurrent clinical manifestations of angina, repeat revascularization (RR), unstable angina (UA), recurrent acute myocardial infarction (AMI), cardiac death, and also a composite endpoint (major adverse cardiac events, MACE) that included UA, recurrent AMI, and cardiac death. After revealing a significant direct correlation between RSS and the probability of recurrent AMI, UA, MACE, or RR (p <0.05) using the ROC analysis, we have established threshold RSS values that divided patients into groups with high and low risk of the cardiac events listed above.Results For a significantly high risk of recurrent AMI (area under the curve, AUC 0.79±0.05; 95 % confidence interval, CI 0.68-0.89; р=0.048), the threshold RSS score was 8 (sensitivity 100 %, specificity 70.9 %). For UA and MACE, the RSS scores were both 3 (AUC 0.68±0.5; 95 % CI 0.58-0.79; p=0.005 and AUC 0.71±0.05; 95 % CI 0.61-0.8; p=0.001, respectively). The probability of UA during the observation period with RSS >3 was 4.07 times higher and that of MACE was 5.23 times higher than with RSS<3 (95 % CI 1.44-11.49; р=0.01 and 95 % CI 1.88-14.53; р=0.001, respectively).Conclusion      The study demonstrated a significant, direct correlation between the RSS and the risk of adverse cardiac events in patients with NSTEMI during one year of observation. Specific threshold values were obtained, which may help in choosing both the extent of revascularization and the tactics for postoperative management of patients.

Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults.

AIM: to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. MATERIALS AND METHODS: Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. RESULTS: At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. CONCLUSION: Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.