[Nonpharmacological methods of prevention of thromboembolic complications in patients with atrial fibrillation].

We present in this review modern methods of prevention of thromboembolic complications in patients with atrial fibrillation and give comparative description of evidence base, efficacy and safety of available techniques.

[Results of implantation of drug-eluting stents in extensive lesion of the coronary bed according to angiographic and intravascular ultrasound findings].

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.

[Clinical results of the use of new bioengineering technologies (endothelial precursor cell-capturing stents) in the treatment of coronary heart disease].

OBJECTIVE: to study the long-term results of the use of precursor cell-capturing stents (bioengineering stents) and to analyze the factors influencing late prognosis. SUBJECTS AND METHODS: The study included 447 coronary heart disease patients with primary atherosclerotic lesion in the coronary bed, damage to aortocoronary shunts, and restenosis of a previously implanted stent. The clinical and morphological risk factors for stent restenosis and late stent thrombosis were analyzed during a 2-year follow-up. RESULTS: In the first year of the follow-up, there were no fatal outcomes, evolving myocardial infarction was observed in 2.6% of cases; recurrent angina pectoris was noted in 10.7%. No late stent thromboses were identified; the incidence of stent restenosis was 8.3%. The risk of restenosis was significantly increased after interventions on arteries less than 2.75 mm in diameter and extended lesions. During the 2-year follow-up, 2 (0.4%) patients died; 14 (1.4%) patients experienced transmural myocardial infarction; 35 (3.3%) patients had non-Q wave myocardial infarction. Forty-four (9.8%) and 15 (1.5%) patients underwent repeated endovascular revascularization and coronary artery bypass grafting, respectively. Late stent thromboses were absent; the incidence of restenosis was 11.7%. CONCLUSION: Within the 2-year follow-up after implantation of bioengineering stents, recurrent angina was seen in 14.8% of the patients, which required repeated endovascular interventions in 9.8% of cases and coronary artery bypass surgery in 1.5% of cases. The incidence of bioengineering stent restenosis was 11.7%; no late thrombotic events were found. The risk factors for bioengineering stent restenosis were extended lesions and small-diameter vessel interventions.

[Efficiency of endovascular re-interventions for evolving restenosis of different types of stents].

The paper compares the results of different treatment options (balloon angioplasty and restenting) for in-stent restenosis in case of evolving restenosis of drug- and nondrug eluting stents. The investigation enrolled 496 coronary heart disease patients with clinical presentation of angina pectoris and/or signs of myocardial ischemia, as well as hemodynamic restenosis of a previously implanted stent. Of them, 216 and 280 patients had restenosis of previously implanted drug- and nondrug-eluting stents, respectively. In the patients with non-drug-eluting stent restenosis, recurrent angina pectoris and the frequency of repeated restenosis were significantly more frequently observed after balloon dilatation than after drug-eluting stent implantation (28.4 and 10.2%; p < 0.05; 19.9 and 8.7%; p < 0.05). In those with drug-eluting stent restenosis, recurrent angina pectoris and the frequency of repeated restenosis did not differ significantly between balloon dilatation of restenosis and implantation of a second drug-eluting stent.

[Efficiency of medical versus endovascular treatment using drug-eluting stents in coronary heart disease patients with extensive lesion of the coronary bed].

The goal of the study was to assess the long-term results of endovascular treatment using drug-eluting stents in coronary heart disease patients with extensive coronary artery lesion. The study covered 478 patients with diffuse coronary artery lesion, including 220 patients receiving endovascular treatment and 258 having medical treatment (a comparison group). The immediate angiographic results and long-term clinical efficiency of endovascular treatment using rapamycin-eluting stents were studied. The follow-up was 2 years. Repeat follow-ups were undertaken1and 2 years later. The immediate angiographic success rate of endovascular treatment for diffuse coronary artery lesions was 89.5%. The two-year follow-up showed the efficiency and expediency of endovascular treatment for extensive coronary artery lesions: the symptoms of angina pectoris occurred significantly less frequently symptoms, the exercise endurance was higher, and the need for antianginal medications was less in the invasively treated patients.

[Long-term follow-up use of "cypher" sirolimus-eluting stents in patients with coronary heart disease after coronary artery bypass grafting with occlusive lesions of the coronary artery].

UNLABELLED: The aim of this study is to assess the 1 and 2-year follow-up of treatment with Cypher drug- eluting stents (Cordis, Johnson & Johnson, USA) for chronic symptomatic coronary artery occlusions in CHD patients after coronary artery bypass graft. That was a retrospective study that included 51 patients who had been implanted Cypher stents. A control group comprised 65 symptomatic patients with coronary heart disease (CHD) after coronary artery bypass grafting with occlusive lesions of the coronary artery, who was carried out only conservative treatment (without PTCA). Patients received standard medicamentous treatment. The groups did not differ in clinical characteristics. 79 stenoses in the eluting stent groups were subject to revascularization. The immediate cure rate was 84.3%. During the follow-up, one patient (2.3%) died and 4 (9.3%) underwent coronary bypass surgery in the drug- eluting stent group; there were 3 (4.6%) deaths and 10 (15.4%) patients had coronary bypass surgery in the control group. After stenting we noted a reliable decrease of patients with anginal attacks, of the used nitrates, increase the average physical tolerance by stress- testing (p < 0.05) than by patients in control group. CONCLUSION: stenting chronic coronary artery occlusions in patients with coronary heart disease (CHD) after coronary artery bypass grafting with the use of Cypher drug- eluting stents (Cordis, Johnson & Johnson, USA) is an effective procedure from the viewpoint of long-term results, with low frequency of recurrent angina and repeated myocardial revascularization.

[Long-term results of implantation of bioengineered and drug-eluting stents in patients with coronary heart disease: comparative characteristics of predictors of poor prognosis].

The purpose of the investigation was to study the morphological and clinical characteristics affecting the long-term prognosis after implantation of bioengineered and drug-eluting stents in patients with coronary heart disease (CHD). The investigation covered 2362 patients with CHD. Genous bioengineered stents were implanted in 316 patients; Cypher rapamycin-eluting stents were in 2046 patients. The independent poor factor for complications was discontinuation of antiaggregatory therapy due to surgical interventions of different types in the drug-eluting stent group and stenting of extensive stenoses in the bioengineered stent group.

[Apelin--a new protein-regulator in the cardiovascular system].

Apelin is an endogenic ligand of apelin (APJ) receptors widely expressed in human tissues. This protein is a peripheral vasodilator having a powerful positive inotropic action on myocardial contractility. This review describes mechanisms of interaction and apelin role in health and pathology.