[The Pathways to Increase the Efficacy of Drug Therapy in Patients with Ischemic Heart Disease after Coronary Artery Bypass Grafting].

PURPOSE: to assess drug therapy and achievement of target parameters of treatment in patients with ischemic heart disease (IHD) during 3-5 years of follow-up aſter coronary bypass surgery. MATERIALS AND METHODS: From the initial sample of the coronary bypass surgery registry (n=680) we selected for this study 111 men (mean age 61 [55; 65] years) hospitalized in 2011 with clinical picture of IHD for coronary artery bypass graſting (CABG). RESULTS: Mean duration of follow-up was 4.2 years. Mortality was 11.7 % (n=13), 11 deaths were cardiovascular, 2 - from unknown causes. End points defined as repeat hospitalizations and IHD progression were registered in 18 of 98 patients (18.4 %). Only in 25 % of patients during 3-5 years of observation aſter CABG there were no clinical signs of angina. Five patients (5.1 %) developed new type 2 diabetes. Drug therapy: 80 patients (81.6 %) received acetylsalicylic acid, 60 (61.2 %) - angiotensin converting enzyme inhibitors, 80 (81.6 %) - ß-adrenoblockers. Eighty-one men (82.6 %) received statins, but only 20 of 98 re-examined patients (20.4 %) took high doses. Target levels of low density lipoprotein cholesterolConclusion. Data of clinical practice illustrate insufficient quality of basic and antianginal therapy in patients with IHD aſter CABG. Indicators of control of angina, heart rate, achievement of target levels of parameters of lipid metabolism remain unsatisfactory.

[Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome].

PURPOSE: to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical course of ischemic heart disease (IHD) during 3-5 years of follow-up in men after coronary artery bypass grafting (CABG). Materials and methods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwent color duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT) of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels was assessed by the Agatston method. After 3-5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followup was 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcification scores. RESULTS: Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinical and anamnestic factors only one risk factor - smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval [CI] 1.2-78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenic syndrome and BCA involvement. In the group of patients with baseline coronary calcification index >400 there were more smokers (р=0.026) and patients with lesions in >3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage we revealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= -0.24, р=0.06), Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3-5 years after CABG a medium positive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029). Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoral bone as the only significant predictor of calcium score increase during 3-5 years of follow-up. CONCLUSION: Dynamics of calcification of CAs in men with IHD during 3-5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive. There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone prior to CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary  calcification was found. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral density of femoral bone.

[NON-CORONARY ATHEROSCLEROSIS PROGRESSION AFTER MYOCARDIAL INFARCTION IN PATIENTS OF DIFFERENT AGE GROUPS].

The initial rate of non-coronary atherosclerosis progression in patients of different age groups before and after myocardial infarction (MI) was studied. 168 patients with ST elevation myocardial infarction (STEMI) were enrolled in the study; the age of 60 was a criterion for patients distribution into the study groups. It is established that one year after MI the patients younger than 60 years of age had recurrent acute coronary syndromes (ACS), and older patients had cerebral vascular accidents. Thus in both younger and older patients a correlation, between the presence and intensity of atherosclerosis progression and the rates of cardiovascular events was observed; however, in older patients atherosclerosis progression is associated not only with higher coronary but also cerebrovascular events rates.

[The role of subclinical inflammation in progression of multifocal atherosclerosis during one year after myocardial infarction].

AIM: To elucidate role of subclinical inflammation in progression of atherosclerotic process in magistral noncoronary arteries in patients during one year after ST-elevation myocardial infarction (MI). MATERIAL AND METHODS: We examined 168 men with MI (mean age 59.5 years). All patients during hospitalization underwent coronary angiography and color duplex scanning of brachiocephalic arteries. In a year ultrasound study of noncoronary vessels was repeated and progression of atherosclerosis assessed. Parameters of inflammation in blood serum were measured on days 10-14 of MI and after one year. RESULTS: At repeat study most patients demonstrated progression of noncoronary atherosclerosis. Some biomarkers measured during inhospital phase of MI (low concentration of anti-inflammatory interleukin 10 - IL-10, elevated N-terminal pro brain natriuretic peptide) allowed to distinguish group of patients with subsequent progression of noncoronary atherosclerosis. Elevated concentrations of C-reactive protein and 11-10 registered in a year after MI were also associated with more severe progression of atherosclerosis. Serum levels of neopterin and IL-12 remained stable in patients with and decreased in patients without pronounced progression of atherosclerosis.

[Evaluation of coronary artery lesion in men with osteopenic syndrome and coronary artery disease].

AIM: To examine the relation between coronary atherosclerosis (CA), coronary artery calcification (CAC), and bone mineral density (BMD) in men with coronary artery disease (CAD). SUBJECTS AND METHODS: The investigation included 74 males aged 60.1 (range, 55-70) years with verified CAD. All the patients underwent X-ray contrast-enhanced selective coronary angiography and coronary artery calcium score (CS) and BMD measurements by osteodensitometry. The severity of a coronary artery lesion was evaluated using the SYNTAX score. According to the T score, the patients were divided into 3 groups: 1) 23 patients with osteoporosis (OP), 2) 30 patients with osteopenia, and 3) 21 patients with normal BMD. RESULTS: Osteopenic syndrome (OS) (OP and osteopenia) was found in 71.6% of the patients with angiographically confirmed CAD. Single-vessel lesion in the coronary bed (CB) was more frequently recorded in the normal BMD group than in the OP one (p = 0.023). Severe CB lesion was more common for the patients with OP (p = 0.029). There were statistically significant differences between the osteopenia and normal BMD groups in the severe degree of CB lesion (p = 0.042). Differences were noted in total CS between Groups 1 and 2 (p = 0.0122). CS significantly correlated with the severity of CA lesion according to the SYNTAX score (r = 0.53; p = 0.002). CONCLUSION: Severe CB lesion in males correlates with CAC and is associated with decreased BMD, suggesting the commonness of the pathogenetic components of AS and OS.

[Multifocal atherosclerosis as a factor of unfavorable prognosis in patients with ST elevation myocardial infarction and type 2 diabetes mellitus].

Multifocal atherosclerosis (MFA) and diabetes mellitus (DM) determine less favorable course of acute vascular catastrophes. We analyzed dependence of one year prognosis of patients with myocardial infarction (MI) with and without DM on the presence of multifocal atherosclerosis. The analysis showed that number of cardiovascular complications increased with increase of degree of severity of atherosclerosis. Negative impact of DM on prognosis was more pronounced in patients with MFA. This effect rose with rise of atherosclerosis severity. Moreover in patients with MI stenoses of extracranial arteries including those less than 50% appeared to be markers of the disease severity and unfavorable prognosis especially at the background of DM.

[Factors determining progression of atherosclerosis in extracoronary arteries after myocardial infarction].

UNLABELLED: Aim of the study was to determine association between clinical-anamnestic factors and degree of progression of atherosclerotic process in magistral noncocronary arteries during one year after ST-elevation (STE) myocardial infarction (MI). MATERIAL: We included into this study 168 men (mean age 59.5 years) with STEMI subjected during hospitalization to coronary angiography and duplex color scanning of brachiocephalic arteries and main arteries of lower extremities. In a year we performed repeat ultrasound examination of same noncoronary arteries and assessed development of vascular complications. RESULTS: Greatest degree of atherosclerosis progression in noncoronary arteries was registered in patients older than 60 years, with hypertension, presence of atherosclerotic stenoses in noncoronary vascular beds at initial examination, those who had undergone percutaneous coronary intervention or coronary artery bypass grafting, and patients with higher levels of total and low density lipoprotein cholesterol at examination after 12 months post MI.

[Ambulatory blood pressure monitoring in doctors of various specialties].

We compared parameters of 24-hour blood pressure (BP) monitoring during off duty free day and 24-hours on duty in male surgeons (n=76) and internists (n=53) aged 30 - 60 years. Arterial hypertension (AH) was diagnosed in 17.1 and 13.2% of surgeons and internists, respectively (p > 0.05). During on duty 24-hour BP monitoring surgeons without AH had higher nocturnal systolic and both nocturnal and diurnal diastolic BP than internists without AH. Moreover surgeons significantly more often had non-dipper type of systolic and diastolic BP (SBP and DBP) curve. In internists only mean nocturnal SBP differed between on and off duty days. Surgeons had higher levels of mean SBP and DBP, higher values of nocturnal indexes of time and SBP and DBP measurements. Percent of subjects with non-dipper 24-hour SBP and DBP rhythms during on duty day was higher among surgeons. Possibly high mortality and rate of vascular catastrophes in surgeons are to some extent related to the presence of stress induced cardiovascular phenomena described above.