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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 ; 61(2): 99-105, 2021 Mar 06.
Artigo em Russo | MEDLINE | ID: mdl-33715614

RESUMO

Despite successful and timely revascularization of the infarct-related artery, myocardial tissue remains underperfused in some patients. This condition is known as the no-reflow phenomenon, which is associated with a worse prognosis. The first part of the systematic review on no-reflow focuses on description of the no-reflow pathogenesis and predictors. This phenomenon has a complicated, multifactorial pathogenesis, including distal embolization, ischemic injury, reperfusion injury, and a component of individual predisposition. Meanwhile, this phenomenon undergoes spontaneous regression in some patients. Several studies have demonstrated the role of definite biomarkers and clinical indexes as risk predictors for no-reflow. The significance of each pathogenetic component of no-reflow is suggested to be different in different patients, which may warrant an individualized approach in the treatment.


Assuntos
Trombose Coronária , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Humanos , Miocárdio , Fenômeno de não Refluxo/diagnóstico , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
3.
Angiol Sosud Khir ; 26(2): 76-83, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597887

RESUMO

The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.


Assuntos
Angiografia , Artéria Radial/cirurgia , Humanos , Radiografia , Federação Russa , Extremidade Superior
4.
Klin Lab Diagn ; (2): 23-6, 2014 Feb.
Artigo em Russo | MEDLINE | ID: mdl-25069229

RESUMO

The sampling consisted of 102 patients with acute cardiac infarction with ST elevation up to 6 hours from the onset of disease. The subjects were divided into three groups: group I with primary stent procedure, group II with deferred stent procedure during 24 hours after effective thrombolytic therapy and group III with isolated effective thrombolytic therapy. The Doppler-echocardiography was applied to all patients. In every group the evaluation was carried out to dynamics NT-proBNP and C-reactive protein. In group III with isolated effective thrombolytic therapy in sub-acute period of cardiac infarction NT-proBNP increased more than twice in comparison with groups of patients with stent procedure. The values of C-reactive protein were lower than in groups I and II. The dynamics of NT-proBNP and C-reactive protein depend on mode of regeneration of coronary blood flow and level of increase of NT-proBNP corresponds the type of diastolic dysfunction of left ventricle of heart.


Assuntos
Proteína C-Reativa/análise , Infarto do Miocárdio/sangue , Peptídeo Natriurético Encefálico/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia
5.
Klin Med (Mosk) ; 87(8): 25-8, 2009.
Artigo em Russo | MEDLINE | ID: mdl-19827526

RESUMO

Coronary artery stenting is a priority treatment of different forms of coronary heart disease. Hence, the importance of intrastent restenosis. This study demonstrates the relationship between acetylation rate and frequency of restenosis following coronary stenting with special reference to patients with chronic coronary heart disease. This knowledge may be helpful for the improvement of endovascular treatment using drug-coated stents.


Assuntos
Acetiltransferases/genética , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/epidemiologia , Stents , Acetilação , Acetiltransferases/sangue , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/enzimologia , Oclusão de Enxerto Vascular/enzimologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Retrospectivos
6.
Kardiologiia ; 45(3): 4-9, 2005.
Artigo em Russo | MEDLINE | ID: mdl-15821700

RESUMO

Since July 2002 we have been conducting a study of efficacy of prehospital thrombolytic therapy combined with subsequent endovascular procedures in the treatment of patients with acute myocardial infarction. Fifty nine patients received prehospital fibrinolysis with tissue-type plasminogen activator (TPA, n=28) or streptokinase (n=31) within 6 hours after onset of symptoms. TPA infusion compared with that of streptokinase was associated with smaller ischemic myocardial damage and lower frequency of side effects (3.6 and 38.7%, respectively). Angioplasty or stenting of infarct related arteries were carried out in 47 of these patients. The group of patients subjected to endovascular interventions was characterized by a low rate of in-hospital cardiac events and zero mortality.


Assuntos
Angioplastia Coronária com Balão , Serviços Médicos de Emergência/métodos , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/terapia , Terapia Trombolítica , Angiografia Coronária , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Estreptoquinase/uso terapêutico , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
7.
Angiol Sosud Khir ; 10(3): 125-8, 2004.
Artigo em Russo | MEDLINE | ID: mdl-15622403

RESUMO

Combination of the methods of interventional cardioangiology with current techniques of vascular surgery allows a considerable broadening of the potential for the treatment of different signs of multifocal atherosclerosis in "high risk" patients. For instance, a 70-year-old patient (height 152 cm, weight 32 kg; initial concentration of serum creatinine 174 mumol/l) with the clinical evidence of progressing angina pectoris and critical ischemia of the lower extremities underwent angioplasty (the first stage) using a transradial access and stenting of the critically narrowed circumflex branch of the left coronary artery and angioplasty of the proximal segment of the right coronary artery. Good angiographic and clinical results were obtained. This provided a possibility of accomplishing aortofemoral bifurcation bypass grafting. So, the staged combined treatment made it possible to eliminate the life- threatening signs of multifocal atherosclerosis and to improve disease prognosis in an elderly patient classified with a group of inoperable subjects.


Assuntos
Aorta/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Artéria Femoral/cirurgia , Idoso , Angiografia Coronária , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Stents
8.
Kardiologiia ; 44(10): 107-12, 2004.
Artigo em Russo | MEDLINE | ID: mdl-15477802

RESUMO

Linkage between acute coronary syndrome and narcotic drug (cocaine) intake was first described by D. Colleman in 1982. However risk of development of acute myocardial infarction during replacement therapy after opioid withdrawal has not been elucidated. The paper contains description of two cases of development of myocardial infarction in young persons with intact coronary arteries who received synthetic opioid methadone for facilitation of heroine discontinuation. These clinical cases should draw attention of physicians to side effects of the use of methadone for the treatment of heroine addiction.


Assuntos
Dependência de Heroína/reabilitação , Metadona/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , Entorpecentes/efeitos adversos , Adulto , Angiografia Coronária , Eletrocardiografia , Seguimentos , Humanos , Masculino , Metadona/uso terapêutico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Entorpecentes/uso terapêutico , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento
9.
Klin Med (Mosk) ; 80(11): 24-6, 2002.
Artigo em Russo | MEDLINE | ID: mdl-12516335

RESUMO

A study has been carried out on long-term results of transluminal balloon angioplasty (TLBAP) in case of mono- and multivascular lesion of coronary bed (CB). During long-term follow-up (16.3 +/- 3.8 months) a high survival rate was observed after treatment procedure both in mono- (97.1%) and multivascular (98.75%) lesion. However, patients with monovascular lesion had lesser probability of being subjected to additional revascularization procedure and greater probability of avoiding angina pectoris in long-term follow-up unlike patients with multivascular lesion of coronary arteries (85.7% vs 63.8%). At the same time a good angiographic angioplastic effect of dilated vessel remained in equal number of patients: 66.7% with monovascular lesion and 68.6% with multivascular lesion. Therefore, it is advantageous to use TLBAP both in mono- and multivascular CB lesion.


Assuntos
Angina Pectoris/cirurgia , Angioplastia Coronária com Balão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Tempo
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