Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography.

PURPOSE: to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. MATERIALS AND METHODS: We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1-88 patients with score 7-9 (in whom SPECT imaging was appropriate), group 2-19 patients with score 1-6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. RESULTS: Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5-10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. CONCLUSION: According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.

Gender features of comorbidity in patients with coronary artery disease.

AIM: To study the factors associated with high levels of comorbidity in men and women with coronary artery disease (CAD). MATERIALS AND METHODS: The data analyzed 742 patients who were screened in the clinic of the research Institute CPSS in 2011, before planned operation coronary artery bypass grafting. All patients were divided into 2 groups: group I - men (n=595; 58 [54; 64] years), group II - women (n=147; 63 [57; 69] years). RESULTS: The analysis showed that the presence of arterial hypertension and atrial fibrillation prevailed in the group of women (p<0.05), and postinfarction cardiosclerosis (PIC) in the group of men (p=0.004). Men mainly observed lighter I and II functional classes (FC) of angina (p=0.057 and p=0.007) and I stage of chronic heart failure (CHS; p<0.001), women, on the contrary, III and IV FC angina (p=0.005 and p=0.050) and stage III CHS (p<0.001). Atherosclerotic lesions of the arteries of the lower extremities (ALE) were significantly more common in men (p=0.022). Diabetes mellitus (DM), thyroid disease, varicose disease and bronchial asthma (BA) prevailed in the group of women (p<0.05), and chronic hepatitis (p=0.079) and urolithiasis in the group of men (p=0.028). Calculation of the level of comorbidity did not show significant intergroup differences (p>0.05). Although the average level of comorbid pathology prevailed in the whole population - 66% among women and 70.4% among men. Independent predictors that increase the level of comorbidity in male group were: the presence of underground experience, PIC in anamnesis, diabetes, chronic lung disease, stenosis of the ALE for more than 50% increase in the level of glucose in the group of women - the presence of the clinic of angina pectoris IV FC, PIC and movements in the history of the ALE stenosis more than 50%, diabetes, peptic ulcer disease, chronic lung disease, ASTHMA, improving glucose levels (p<0.05). CONCLUSION: According to the analysis, a high level of comorbidity was found in 13.6% of women and 11.6% of men. Factors associated with high levels of comorbidity, both in men and women were: the presence of diabetes, chronic lung disease, PIC, atherosclerosis of the ALE. At the same time only in women the high level of comorbidity was associated with angina IV FC, peptic ulcer disease, BA, and only in men - with the presence of underground experience. Detection of comorbid pathology in patients with IHD taking into account gender features is advisable for the implementation of patient-oriented approaches in daily clinical work.

[The Problem of Minimally Changed Coronary Arteries at Elective Coronary Angiography].

AIM: to study rates and possible causes of detecting "clean" coronary arteries at elective coronary angiography. MATERIAL AND METHODS: Medical records of 711 patients who had undergone elective coronary angiography (ECAG) between 01/04 and 31/05 2014 were retrospectively reviewed. Four groups were distinguished: group 1 - patients with normal coronary arteries (n=234), group 2 - patients with coronary artery stenoses (CAS) <60% (n=94), group 3 - patients with 60-69% CAS (n=22), group 4 - patients with CAS more or equal 70% (n=361). RESULTS: Most patients were men (p<0.001), except group 1, where women prevailed (p<0.05). Patients in groups 3 and 4 were older than in groups 1 and 2 (p=0.019). Symptoms of angina were less likely to be found in group 1 (p<0.001). History of myocardial infarction (MI) prevailed in group 4 (p<0.001). Arrhythmias were detected more frequently in group 1 (p<0.001); there were less diabetics in this group (p=0.010). Group 1 contained more patients examined before cardiac valve surgery (p<0.001). Typical angina was more often found in group 4, whereas atypical angina - in group 1 (p<0.001). Cardialgia prevailed in groups 1 and 2 (p<0.001). Holter ECG monitoring was used more frequently in group 1 (p<0.001). Symptoms of latent coronary insufficiency were mainly reported in group 1 (p=0.006). The pretest probability of ischemic heart disease (IHD) was higher in groups 2 and 4 compared to group 1 (p<0.001). CONCLUSION: Among patients who had undergone ECAG 32.9% had no CAS. Younger females without history of MI and diabetes as well as patients with atypical angina or cardialgia prevailed in this group. This group of patients had the lowest pretest probability of IHD (58%). Patients without CAS were more often scheduled for EGAG before valvular heart surgery and because of cardiac arrhythmias.

[Immediate Outcomes of Coronary Artery Bypass Grafting in Patients With Multifocal Atherosclerosis: Gender Differences].

AIM: To assess the impact of presence of multifocal atherosclerosis (MFA) and gender differences on immediate outcomes after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Medical records of patients with MFA, who underwent elective CABG (n=764, 655 men, 109 women) were reviewed retrospectively. RESULTS: Women were older (<0.001), and more often were overweight (<0.001), had diabetes (<0.001), high angina functional class (=0.012) and congestive heart failure (=0.002). Cigarette smoking was more common among men. Men more often had reduced left ventricular ejection fraction (<0.001). Three-vessel coronary artery disease prevailed among women (=0.080). Rate of hemodynamically significant carotid stenosis was higher among women (=0.010), whereas that of peripheral artery disease - among men (=0.001). Total number of perioperative complications was 48.8% among women and 53.0% among men (=0.399). According to multivariate analysis, history of CABG was associated with increased risk of perioperative complications (=0.034), and combined involvement of left main coronary artery (LMCA) and three coronary arteries - with in-hospital mortality (=0.003). CONCLUSION: There were no gender differences in the incidence of perioperative complications. Women more often had carotid lesions, men - lesions in arteries of lower limbs. Women had more risk factors (other than smoking) what could explain high prevalence of three-vessel disease as well as more severe coronary insufficiency and heart failure. Regardless of patients gender and presence of MFA history of previous CABG and presence of combined LMCA and three coronary arteries involvement increased risk of perioperative complications and in-hospital mortality, respectively.

[GENDER-RELATED FEATURES AND QUALITY OF LIFE OF THE PATIENT ONE YEAR AFTER CORONARY ARTERY BYPASS GRAFTING].

AIM: To study the influence of gender features on the quality of life (QL) of the patient one year after coronary artery bypass grafting and to determine factors associated with low QL after surgery. MATERIALS AND METHODS: The study included 408 patients (70 women and 338 men) whose QL was estimated 1 year after surgery based on the SF-36 questionnaire. The groups were compared in terms of QL parameters before and after surgery, clinical data, and peculiarities of surgical treatment. In addition, factors associated with clinical data of QL were assessed in each group by logistic regression analysis. RESULTS: One year after surgery, QL improved in women and men of both groups: depression--48 [45, 54] and 50 [46,55] (p = 0.37], physical component--72 [61,78] and 72 [61, 81] P = 0.61) and psychological component--69 [60, 75] and 67 [56.76] (p = 0.43]. Multifactor analysis revealed association of multifocal atherosclerosis with the low level of physical and psychological components in women and depression in men. Diabetes mellitus had independent influence on the reduction of QL physical component in women. The absence of gender differences 1 year after surgery was due in the first place to the absence of differences between men and women in the number of affected coronary arteries, the number of shunts, the use of artficial circulation, and duration of surgery. CONCLUSION: Decreased frequency of depression, significant increase in the parameters of QL psychological and physical components one year after surgery are independent of the patients' sex due to the absence of differences in QL components between groups, severity of affection of the coronary bed and peculiarities of surgery.

[Predisposition to Psychological Distress in Patients After Coronary Bypass Surgery: Relation to One Year Prognosis].

AIM: to assess effect of type D personality (TDP) on one year prognosis after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: Personality type was evaluated using the DS-14 scale in 683 patients before and in 1 year after CABG; 152 patients had TDP, 531 had not. After 1 year of follow-up we assessed functional class of angina and chronic heart failure, and registered cardiovascular complications (CVC): deaths, myocardial infarctions, strokes, amputations, thromboses of arteries of lower extremities, hospitalizations, requirements in repetitive angiographies of coronary grafts. Rate of development of combined end point comprising all these events was also evaluated. RESULTS: During follow-up CVC developed more often in patients with TDP compared with those without TDP (31.8 and 14.6%, respectively, =0.049). According to multifactorial regression analysis TDP was independently associated with 3.21 fold increase in risk of CVC. CONCLUSION: Detection of TDP after CABG is advisable for conducting subsequent interventions directed at improvement of long term results of treatment.

[Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis].

UNLABELLED: Multifocal atherosclerosis (MFA) has negative effect on prognosis in various groups of patients with cardiovascular diseases. However, gender-specific features of MFA are practically unexplored which provided a rationale for the present work. AIM: To study gender-specific features of MFA in patients with atherosclerosis of different localization. MATERIALS AND METHODS: 1018 patients examined and treated prior to planned surgical intervention on coronary arteries, carotid basin, aorta, and arteries of lower extremities. Group 1 included 193 women aged 59 = 69 (mean 63) years, group 2 was comprised of 825 men aged 53-63 (mean 57 years). All the patients underwent coronarography (CG). Analysis of MFA prevalence was made. RESULTS: The women were older than the men, they were more frequently overweight, suffered arterial hypertension and diabetes mellitus (p < 0.001), showed the higher left ventricular ejection fraction (p = 0.011). Smokers more frequently occurred among men (p < 0.001). CG revealed more lesions in a single vessel (p = 0.023) and less t lesions affecting three vessels (p = 0.015) in men. Signs of MFA were recorded in 28.0% of the men and 24.4% of the women (p = 0.306). Combined lesions of the coronary and carotid basins were more frequent in women (p = 0.048). Clinically significant stenosis of the coronary bed, aortoiliac segment or lower limb arteries occurred more frequently in men (p = 0.012). All three basins were more frequently affected in men (p = 0.061). CONCLUSION: MFA before planned cardiovascular surgery was diagnosed in 27.3% of the cases. Combined lesions in coronary and carotid arteries more frequently occurred in women and those in coronary and lower limb arteries in men (p < 0.05). Most risk factors (except smoking) are more frequently inherent in women in association with the enhanced frequency of three-vessel lesions affecting coronary arteries.

[Role of multidetector computed tomography and stress- echocardiography in assessment of risk of cardiological complications of non-cardiac surgery].

AIM: to compare results of coronary angiography with data of multi-slice computed tomography (MSCT) - angiography, and analyze rate of detection of hemodynamically significant coronary artery lesions during preoperative examination of patients. MATERIAL AND METHODS: We analyzed case histories of 92 patients (median age 59 years) examined prior to surgery on non-coronary vessels or for exclusion of ischemic heart disease. All patients were subjected to selective coronary angiography (CA) and MSCT - angiography. According to results of CA we formed 2 groups - with coronary artery stenoses >70% (n=55, group 1) and <70% (n=37, group 2). In 46 patients (50%) dobutamine stress echocardiography was performed for detection of concealed coronary insufficiency. RESULTS: CA revealed hemodynamically significant stenoses >70% (>50% in left main coronary artery) in 91 of 324 arteries. MSCT angiography detected stenosis >50% in 184 of 324 arteries; in 148 patients results of MSCT were confirmed by presence of hemodynamically significant stenoses at coronary angiography (sensitivity 86%). Absence of lesions or presence of stenoses <50% were noted at MSCT in 368 arteries; in 345 cases this was confirmed by coronary angiography (predictive value of negative result 94%, specificity 91%). Result of dobutamine stress echocardiography was positive in 41% of patients in group 1 and in 20% - of group 2 (<0.001). Sensitivity of stress echocardiography for detection of significant stenoses was 41%, specificity - 80%, negative predictive value - 14%. CONCLUSION: Diagnostic value of MSCT for detection of coronary artery stenoses >70% have better sensitivity, specificity, negative and positive predictive value of compared with stress echocardiography. Results of this study confirm value of MSCT angiography for diagnosis of coronary atherosclerosis and allow to recommend it as a screening method for detection hemodynamically significant coronary artery involvement before extracardiac surgery.

[Quality of life of patients after coronary bypass surgery: effect of age and personality type D].

AIM: To study effect of age and presence of personality type D on quality of life (QL) of patients in one year after coronary bypass surgery (CBS). MATERIAL AND METHODS: Assessment of QL before and after surgery was carried out in 408 patients. Two groups were formed: patients younger than 60 years (n=233) and older than 60 years (n=175). Quality of life and presence of personality type D was assessed by questionnaires SF-36 and DS-14, respectively. RESULTS: In a year after CBS improvement of physical and psychological components of QL (p<0.05) was noted in both groups. Personality type D was more frequent among patients older than 60 years (p<0.01). Patients with personality type D had worse parameters of irrespective of age (p<0.01). Personality type D correlated directly with age QL (p=0.003) and inversely with parameters of QL (p<0.01). Presence of personality type D was an independent predictor of low level of physical (together with index of atherogenecity prior to surgery) and psychological components of QL at multiple logistic regression analysis. CONCLUSION: Assessment of personality traits of patients before CBS can be helpful for targeted measures aimed at improvement of QL what is especially important for older age groups.

[Factors influencing life quality improvement in patients of different age one year after coronary artery bypass surgery].

The study was aimed at examining the factors having an impact on changes in the quality of life (QL) parameters a year after coronary artery bypass surgery (CABG) in different age groups. 408 patients aged 31-79 years had their QL assessed by means of the SF-36 questionnaire before and one year after elective CABG. Additionally, the patients were tested for the presence of type D personality before and one year after CABG by means of the DS-14 questionnaire. The groups were comparable in terms of previous carotid endarterectomy, peripheral arterial and aortic reconstruction number (p > 0.05). One year after CABG the improved QL (p < 0.01) was reported whereas type D patients had significantly poorer psychological test results (p < 0.01). One year after CABG type D personality and high Euroscore had an independent impact on the QL improvement while previous carotid endartectomies resulted in a significantly improved psychological health component. Thus, along with the detection and treatment of non-coronary lesions the personality type assessment and focused behavioral interventions can contribute to the QL improvement in long-term CABG period.

[Myocardial revascularization before abdominal aortic surgery in patients with ischemic heart disease].

We retrospectively analyzed 2 cohorts of patients treated in two clinics implementing different strategies of preoperative examination and lowering of perioperative cardiac risk. Patients in clinic 1 (group I, n=86, mean age 59.4+/-7.7 years) were subjected to coronary angiography (CAG) and if indicated - to preventive myocardial revascularization. In patients of clinic 2 (group II, n=95, mean age 54.3+/-6.5 years) only medical therapy was used. In group I CAG was performed in 90%, and myocardial revascularization - in 28% of patients. Total number of complications and hospital mortality were significantly higher in group II compared with group I (20 vs. 8%, p=0.023; 10.5 vs. 2.3%, =0.026). Myocardial infarction was the cause of 6 deaths (6.3%) in group II, while in group I there were no cardiac complications. Thus compared to control group strategy with routine CAG and preventive myocardial revascularization before abdominal aortic surgery was associated with less perioperative complications, myocardial infarctions, and lower mortality.

[Long-term survival after reconstructive surgery on non-coronary arteries in different age groups].

The study was aimed at assessing long-term survival after reconstructive surgery on non-coronary arteries in different age groups as well as the confounding factors. 469 case histories were analyzed retrospectively. The most patients underwent coronary angiography (CA) and preventive myocardial revascularization along with non-coronary artery exam. The mean follow-up period was 57.5 +/- 14.9 months. The groups were similar in terms of aspirin and statin therapy; however, older patients more often received beta-blockers and ACE inhibitors (p < 0.03). The number of patients who undergone CA increased with age (p = 0.002). Older patients had higher long-term mortality (p = 0.008) and poorer long-term survival (p = 0.001) as compared to patients below 60 years of age. The risk of death increased with age (OR 1.11; p = 0.001), in smokers (OR 2.79; p = 0.009) and in case of complications in the postoperative period (OR 4.09; p = 0.001). In turn, lower mortality was associated with CA and further preventive myocardial revascularization, if medical reasons (OR 0.15; p = 0.001). Thus, routine CA and preventive myocardial revascularization were associated with lower long-term mortality. This allows recommending an aggressive preoperative assessment to this category of patients.

[Personality types in patients with atherosclerosis of different localization: prevalence and clinical features].

The aim of the work was to study the influence of D-type personality on clinical characteristics and extent of the pathological process in patients with atherosclerosis (AS) of different localization. A total of 943 patients (774 men and 169 women, mean age 58.6+-3 yr) were examined prior to arterial surgery. D-type personality was identified using a DS-14 questionnaire. The patients were divided into those with D-type personality (n=182) and without it (n=761). The following parameters were recorded: risk factors of AS, severity of clinical symptoms, history of myocardial infarction, acute cerebrovascular accidents, transitory ischemic attacks, concomitant pathology, and echocardiographic measuremnents. AS of non-coronary basins was diagnosed by color duplex scanning or angiograpgy. The number of affected vascular basins with stenosis of 30% or more arteries was detected. D-type personality was revealed in 19.3% of the patients with AS of different localization. It did not correlate with the social status, risk factors, and clinical symptoms. However D-type was associated with AS of extracranial arteries and combined lesions in several vascular basins as well as with the enhanced level of anxiety and depression and impaired quality of life.

[Prevalence of multifocal atherosclerosis in different age groups].

Aim of the study was to assess prevalence of lesions in several arterial beds in patients with atherosclerosis of various localization in the clinic of cardiovascular surgery. We examined 1018 patients (825 men and 193 women, aged 31-78 years, mean age 59+/-12 years) in the period of preparation to elective surgical interventions on coronary arteries or other arterial beds. All patients were divided into 4 age groups: group 1 - younger than 60 years (n=542), group 2 - 60-64 years (n=215), group 3 - 65-69 years (n=141), group 4-70 years and older (n=120). All patients were subjected to coronary angiography and Doppler ultrasound investigation (USI) of extracranial arteries. USI of arteries of lower extremities and angiography of peripheral arteries were carried out if indicated. Presence of 50% or greater stenosis was considered a criterion of involvement of an arterial vascular bed. Lesions in 2 or more beds were found in 321 patients (31.5%). Stenoses in 2 and 3 arterial beds were revealed in 24 and 3.5%, respectively, of patients in group 1, and in 31.8 and 10%, respectively, of patients in group 4 (p=0.008). Purposeful diagnostics of multifocal atherosclerosis in patients of the given category apparently should not be limited by older age groups.

[Impact of old age on risk of perioperative complications in non-coronary vascular surgery].

The objective of the study was to assess coronary arteries and the rate of perioperative complications in elderly patients undergoing non-coronary vascular surgery. 412 medical records of patients aged 60.8 +/- 8.5 years undergone non-coronary vascular surgery were analyzed retrospectively. All the patients had a coronary angiography and, if indicated, a preventive myocardial revascularization performed before a surgery. Patients who were over 70 years old had more often significant coronary stenotic lesions (64.5%) than those who were less than 60 years old (59.4%). A myocardial revascularization was significantly more often (p = 0.03) done for patients, who were less than 70 years old (32.7-36.5%), than for those aged over 70 years (14.5%). The groups did not differ in the frequency of beta-blockers, statins and ACE-inhibitors administration (p = 0.42). The groups were also similar in the rate of perioperative complications, including mortality rates. A preventive myocardial revascularization strategy in patients with significant coronary artery disease appears to be an essential stage in the treatment nondependent of the coronary artery disease clinical course. The age per se should not be a reason to refuse those patients in performing non-coronary vascular surgery.

[Quality of life in patients of different age groups with ischemic heart disease: effect of multifocal atherosclerosis].

The aim of the research was to study the quality of life for the patients of different age groups with coronary artery disease and to evaluate the factors affecting its decline. The present study included 709 patients aged 31 to 79 years examined before elective coronary artery bypass graft surgery. All patients underwent coronary angiography, echocardiography, ultrasonography of the aorta, brachiocephalic, and peripheral arteries. With age, significantly increased incidence of multifocal atherosclerosis (p = 0.01 for the trend). To study the quality of life (QL) a non-specific questionnaire SF-36 was used, according to which the reduction of QL equally in all the groups (p > 0.05) was detected. Multivariate analysis showed that the level of QL was influenced by diabetes, myocardial infarction and the presence of multifocal atherosclerosis (p < 0.05). Thus, in order to improve the QL in aged patients with multifocal atherosclerosis is reasonable to conduct of reconstructive operations at different arterial basins.

[Role of coronary angiography in decreasing cardiac complications rate during vascular operations].

In order to assess the prevalence of coronary artery lesions in patients running various clinical risks of cardiovascular complications prior to surgical interventions on cardiac vascular basins, we performed a retrospective analysis of 392 case histories (340 men and 52 women, mean age 61.0±8.5 years). All patients in the preoperative period underwent coronary angiography (CAG). For the analytical purposes, the patients were subdivided into four groups. Group One (n=44) comprised patients without clinical risk factors, Group Two (n=184) was composed of those diagnosed as having one clinical risk factor. Group Three (n=122) comprised those with two clinical risk factors, and finally Group Four (n=42) was composed of those presenting with three and more clinical risk factors. CAG revealed that 91% of patients had coronary artery lesions. Haemodynamically significant lesions of three coronary arteries and/or stenosis of the left coronary artery trunk were observed in 15.6% of patients with no clinical risk factors of cardiac complications, in 19.0% of patients with one such factor, in 28.5% of those with two risk factors, and in 42.2% of patients with three and more risk factors. Preventive myocardial revascularization was performed in 22.7% of cases, more often in Group Three and Group Four patients. The number of postoperative complications in the groups did not differ significantly. The total hospital mortality rate was low (0.8%), with all 3 lethal outcomes observed amongst the patients with one clinical risk factor (1.6%). Hence, clinical preoperative stratification of the risk by means of the Lee index prior to vascular operations fails to reveal a considerable part of patients with prognostically unfavourable lesions of coronary arteries, and thus it should seemingly be used in this patient cohort with caution.

[Prevalence of distress and coronary behaviour in patients with atherosclerosis of various localization].

Prevalence of distressor personality traits and coronary behavioral type was studied in 943 patients (774 men and 169 women) with clinical forms of atherosclerosis of various localization. Intermediate behavioral type AB prevailed (69.9%), while types A (25.3%) and B (4.8%) were less frequent. Patients with type B more frequently had involvement of several vascular beds. They also had greater intima-media thickness, and lower left ventricular ejection fraction. Patients with type B behavior were characterized by higher level of distressor personality traits (<0.00001). Rate of type D personality in patients with type B behavior (44.4%) was higher than in patients with behavior types AB (21.7%) and A (8.3%). Reverse correlations were noted between pronouncedness of "coronary" behavior and number of involved vascular beds and the presence of distressor personality traits (personality type D, levels of depression and anxiety).