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1.
Kardiologiia ; 61(7): 36-43, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397340

RESUMO

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.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Intervenção Coronária Percutânea , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Humanos , Infarto do Miocárdio/diagnóstico , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
2.
Kardiologiia ; 59(2): 56-60, 2019 Mar 07.
Artigo em Russo | MEDLINE | ID: mdl-30853022

RESUMO

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.


Assuntos
Comunicação Interatrial , Intervenção Coronária Percutânea , Idoso , Cateterismo Cardíaco , Ecocardiografia , Ecocardiografia Transesofagiana , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
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