Abstract:

Introduction: the importance of intravascular diagnostic methods and the frequency of their use in clinical practice is steadily increasing. However, in the Russian Federation, studies on the analysis of possibilities of intravascular imaging or physiology are sporadic, and statistical data are presented only in very generalized form. This makes it relevant to create a specialized register dedicated to these diagnostic methods.

Aim: was to present the structure, tasks and possibilities of the Russian registry for the use of intravascular imaging and physiology based on results of the first year of its operation.

Material and methods: In total, in 2021, forms were filled out for 2632 studies in 1356 patients.

Studies included all types of intravascular imaging and physiology - intravascular ultrasound, optical coherence tomography, measurement of fractional flow reserve and non-hyperemic indices.

The registry's web-based data platform includes 14 sections and 184 parameters to describe all possible scenarios for applying these methodologies. Data entry is possible both from a stationary computer and from mobile devices, and takes no more than one minute per study. Received material is converted into Excel format for further statistical processing.

Results: 13 departments participated in the register, while the share of the eight most active ones accounted for 97,5% of all entered forms. On average, 1.9 studies per patient were performed, with fluctuations between clinics from 1,6 to 2,9. Studies of the fractional flow reserve accounted for 40% of total data array, intravascular ultrasound - 37%, optical coherence tomography - 23%. Of all studies, 80% were performed on coronary arteries for chronic coronary artery disease, 18% - for acute coronary syndrome, 2% were studies for non-coronary pathology. In 41% of cases, studies were performed at the diagnostic stage, without subsequent surgery. In 89,6% of cases, this was due to the detection of hemodynamically insignificant lesions, mainly by means of physiological assessment. In 72% of cases, the use of intravascular imaging or physiology methods directly influenced the tactics or treatment strategy - from deciding whether to perform surgery or not to choose the optimal size of instruments or additional manipulations to optimize the outcome of the intervention. In the clinics participating in the register, the equipment of all major manufacturers represented on the Russian market was used.

Conclusions: the design of the online registry database is convenient for data entry. Participation in the registry of most departments that actively and systematically use methods of intravascular imaging and physiology ensured the representativeness of obtained data for analysis in interests of both practical medicine and industry, as well as for scientific research in the field of intravascular imaging and physiology. The register has great potential for both quantitative and qualitative improvement.

Abstract:

Introduction: improving the technique of radiofrequency denervation of renal arteries seems to be extremely important for optimizing the effectiveness of lowering blood pressure in patients with resistant arterial hypertension. Our study presents an assessment of the comparison of long-term results of renal artery denervation (RAD) using various techniques and instruments.

Aim: was to compare the use of various techniques for renal artery denervation and to evaluate longterm results in patients with resistant arterial hypertension using various radio frequency catheters.

Materials and methods: in a prospective study, three groups of patients (n = 58) aged 18-85 years with resistant systolic-diastolic arterial hypertension of 1-2 stages were studied: patients underwent denervation of renal arteries by various methods, against background of standardized antihypertensive therapy. In group I (n = 21), denervation was performed only in the proximal segment of the renal artery (before the first bifurcation). In group II (n = 19), ablation was performed both in proximal segment and in branches of the second and third order, as well as in the accessory renal arteries with a diameter of more than 3 mm. The third control group included 18 patients who received only standardized drug antihypertensive therapy.

Results: technical success of the operation was achieved in 100% of cases. According to the 24-hours ambulatory blood pressure monitoring (ABPM) data, the decrease in blood pressure (BP) in group I by the second year of observation was 6,7 mm Hg, p <0,05 for systolic BP (SBP) and ? 2,7 mm Hg, p> 0,05 for diastolic BP (DBP). In the second group, a greater decrease in mean SBP and DBP was recorded: ? 9,2 mm Hg, p <0,05 and ? 4,3 mm Hg, p <0,05, respectively. In the control group of drug treatment, the weakest antihypertensive effect of treatment was revealed. The average indicators of SBP and DBP decreased by - 4,9/1,9 mm Hg, p> 0,05.

Conclusion: results of the use of prolonged radiofrequency denervation of the main, segmental and accessory renal arteries with a large number of ablation points demonstrate a similar safety and greater efficacy in treatment of patients with resistant arterial hypertension, in comparison with denervation of only main trunk of renal artery.

References 

1.     Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: 49-73.

https://doi.org/10.1161/01.cir.0000437741.48606.98

2.     Group SR, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373: 2103-2116.

https://doi.org/10.1056/NEJMoa1511939

3.     Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013; 34: 2940-2948.

https://doi.org/10.1093/eurheartj/eht295

4.     Fengler K, Ewen S, Hцllriegel R, et al. Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients with Resistant Hypertension. J Am Heart Assoc. 2017; 6(8): 006196.

https://doi.org/10.1161/JAHA.117.006196

5.     Reshetnik A, Gohlisch C, Scheurig-M?nkler C, et al. Predictors for success in renal denervation-a single centre retrospective analysis. Sci Rep. 2018; 8(1): 15505.

https://doi.org/10.1038/s41598-018-33783-3

6.     Wang A. 2019 Consensus Statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on Renal Denervation for the Management of Arterial Hypertension. Acta Cardiologica Sinica. 2019; 35(3): 199-230.

https://doi.org/10.6515/ACS.201905_35(3).20190415A

7.     Steigerwald K, Titova A, Malle C, et al. Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model J Hypertens. 2012; 30(11).

https://doi.org/10.1097/HJH.0b013e32835821e5

8.     Пекарский С.Е., Баев А.Е., Фальковская А.Ю. и др. Анатомически оптимизированная дистальная ренальная денервация — стойкий гипотензивный эффект в течение 3 лет после вмешательства. Патология кровообращения и кардиохирургия. 2020; 24(3S): 98-107.

Pekarskij SE, Baev AE, Fal'kovskaya AYU, et al. Anatomically optimized distal renal denervation – permanent hypotensive effect for 3 years after intervention. Patologiya krovoobrashcheniya i kardiohirurgiya, 2020; 24(3S): 98-107 [In Russ].

http://dx.doi.org/10.21688/1681-3472-2020-3S-98-107

9.     Mahfoud F, Tunev S, Ewen S,et al. Impact of Lesion Placement on Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation. Journal of the American College of Cardiology. 2015; 66: 1766-1775.

https://doi.org/10.1016/j.jacc.2015.08.018

10.   Bertog S, Fischel T, Vega F, et al. Randomised, blinded and controlled comparative study of chemical and radiofrequency-based renal denervation in a porcine model. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2017; 12: 1898-1906.

https://doi.org/10.4244/EIJ-D-16-00206

11.   Mahfoud F, Pipenhagen C, Moon L, et al. Comparison of branch and distally focused main renal artery denervation using two different radio-frequency systems in a porcine model. International journal of cardiology. 2017; 241: 373-378.

https://doi.org/10.1016/j.ijcard.2017.04.057

12.   Vink E, Goldschmeding R, Vink A, et al. Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study. Nephrology, dialysis, transplantation - European Renal Association. 2014; 29: 1608-1610.

https://doi.org/10.1093/ndt/gfu192

13.   Агаева Р.А., Данилов Н.М., Щелкова Г.В. и др. Радиочастотная денервация почечных артерий моно-электродным и мультиэлектродным устройствами у пациентов с неконтролируемой артериальной гипертонией: результаты 6-месячного наблюдения. Системные гипертензии. 2020; 17(1): 46-50.

Agaeva RA, Danilov NM, Shchcelkova GV, et al. Radiofrequency renal denervation with mono-electrode and multielectrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up. Sistemnye gipertenzii. 2020; 17(1): 46-50 [In Russ].

https://doi.org/10.26442/2075082X.2020.1.200077

14.   Mahfoud F, Tunev S, Ewen S, et al. Impact of lesion placement on efficacy and safety of catheter-based radiofrequency renal denervation. J Am Coll Cardiol. 2015; 66: 1766-1775.

https://doi.org/10.1016/j.jacc.2015.08.018

15.   Henegar JR, Zhang Y, Hata C, et al. Catheter-based radiofrequency renal denervation: location effects on renal norepinephrine. Am J Hypertens. 2015; 28: 909-914.

https://doi.org/10.1093/ajh/hpu258

16.   Konstantinos PT, Lida F, Kyriakos D. Safety and performance of diagnostic electrical mapping of renal nerves in hypertensive patients. EuroIntervention. 2018; 14: 1334-1342.

https://doi.org/10.4244/EIJ-D-18-00536

Abstract:

Aim: was to elucidate factors of poor prognosis for chronic brain ischemia in «asymptomatic» patients with atherosclerotic stenosis of vertebral arteries, who regularly take optimal medical therapy.

Methods: in 1st group (n = 44), secondary prevention of cerebrovascular accidents was carried out in a combined strategy - stenting of vertebral arteries in combination with medication therapy, and in 2nd group (n = 56) - only medication therapy. Long-term follow-up was planned after 12, 24 and 36 months. Inclusion criteria: «asymptomatic» patients with stenosis of vertebral arteries 50-95%; diameter of vertebral arteries is not less than 3.0 and not more than 5 mm; presence of cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of chronic brain ischemia (according to E.V. Schmidt). Primary endpoint: total frequency of cardiovascular complications (death, transient ischemic attack or stroke, myocardial infarction).

Results: the total frequency of major cerebral complications over 36 months of follow-up was 4.5% in group 1 and 37.5% in group II (? ²=15.101; p<0.0001). The frequency of cardiac events was 9.1 and 19.6%, respectively, to 1st and 2nd groups (? ²=14.784; p<0.0001). These indicators were obtained against the background of high patient adherence to treatment and high rates of achieving tough target lipid values. Restenosis of stents was observed in general, in 38.67% of patients from group I. Moreover, restenosis alone did not affect the incidence of major cerebral complications in the long-term period (? ²=0.1643; p=0.735). Most significant poor prognosis factors of chronic brain ischemia in «asymptomatic» patients with vertebral artery stenosis, who regularly take optimal medical therapy are: arrhythmia, total cholesterol more than 6.0 mmol/l, incomplete circle of Willis, arterial hypertension, bilateral defeat of vertebral arteries, (low-density lipoprotein) LDL levels of more than 3.5 mmol/I, combined lesion of vertebral and carotid arteries, calcification of vertebral arteries, coronary heart disease in anamnesis.

Conclusion: endovascular intervention in combination with medical therapy could help to avoid the development of major brain complications arising from the instability of atherosclerotic plaque in «asymptomatic» patients with vertebral artery stenosis, and in the presence of poor prognosis factors identified can be regarded as a method of secondary prevention of cerebral circulatory disorders.

References 

1.     Britov AN, Pozdnyakov YuM, Volkova EG, et al. National guidelines on cardiovascular prevention. Kardio-vaskulyarnaya terapiya i profilaktika. 2011;10(6)2: 1-64 [In Russ].

2.     Suslina ZA, Guglevskaja TS, Maksimova MJu, Morgunov VA. Cerebrovascular accidents: diagnosis, treatment, prevention. Moscow: MEDpress-inform, 2016, 440 [In Russ].

3.     Shchukin IA, Lebedeva AV, Burd GS, et al. Chronic cerebral ischemia: syndromological approaches to thera­py. Nevrologiya irevmatologiya. 2015;1:17-24 [In Russ].

4.     Zakharov W, Voznesenskaya TG. Neuropsychiatric Disorders: Diagnostic Tests; podobshch. red. N.N.Yakhno. M.: MEDpress-inform, 2015: 320 [In Russ].

5.     Chechetkin AO, Skrylev SI, Koshheev AJu, et al. Clinical and instrumental assessment of the effectiveness of stenting of the vertebral arteries in the near and remote postoperative periods. Annaly klinicheskoj i jeksperimental'noj nevrologii. 2018;12(3): 13-22 [In Russ].

http://doi.org/10.25692/ACEN.2018.3.2

6.     Sermagambetova ZhN, Maksimova MJu, Skrylev SI, et al. Interventional technologies for the prevention of stroke in the vertebral-basilar system. Consilium Medicum. 2017;19(2): 96-103 [In Russ].

7.     Migunova SG. Clinical and epidemiological study of cerebrovascular diseases and a comparative analysis of the effectiveness of treatment of patients with cerebral atherosclerosis: Diss. kand. med. Ekaterinburg, 2018: 145 [In Russ].

8.     Aboyans V, Ricco JB, Bartelink MEL et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Soci­ety for Vascular Surgery (ESVS). Eur J Vase Endovasc Surg. 2017 Aug 26.

http://doi.org/10.1093/eurhearti/ehx095

9.     Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardio­vascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal. 2020;41:255-323.

http://doi.org/10.1093/eurhearti/ehz486

10.   Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal. 2020;41: 111-188.

http://doi.org/10.1093/eurhearti/ehz455

11.   Kamchatnov PR, Umarova HJa, Kabanov AA, Abieva NA. The problem of diagnosis and treatment of patients with vertebrobasilar insufficiency. Lechebnoedelo. 2017;3: 68-75 [In Russ].

12.   Kocak B, Korkmazer B, Islak C, et al. Endovascular treatment of extracranial vertebral artery stenosis. World J. 2012;4:391-400.

http://doi.org/10.4329/wir.v4.i9.391

13.   Markus HS, Larsson SC, Kuker W, et al. VIST Investigators. Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischemia Stenting Trial. Neurology. 2017;89(12):1229-1236.

http://doi.org/10.1212/WNL.00000000000Q4385

14.   Babayan GB, Zorin RA, Pshennikov AS, et al. Predictors of neurological deficiency in hemodynamically significant stenoses of the carotid and vertebral arteries. Nauka molodykh (Eruditio Juvenium). 2019;7(4): 533-540 [In Russ].

http://doi.org/10.23888/HMJ201974533-540

15.   Rakhmonov RA, Todzhiddinov ТВ, Isoeva MB, Zuurbekova DP. Total Cardiovascular Risk - A New Approach to Stroke Prediction. Vestnik Avitsenny. 2017;19(4): 471-475. [In Russ].

http://doi.org/10.25005/2074-0581-2017-19-4-471-475

16.   Shao JX, Ling YA, Du HP, et al. Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis. M edicine(Baltimore). 2019;98( 13): e14899.

http://doi.org/10.1097/md.0000000000014899

Abstract:

We have analyzed long-term results of different revascularization strategies in 171 patients with multivessel coronary artery defeat. Duration of follow up observation ranged from 12 to 18 months. Complete revascularization of the myocardium was performed in 63 pts, culprit vessel revascularization - in 86 and incomplete revascularization - in 22 patients. All patients undervwent SYNTAX scoring analysis to find out possible risks of transcutaneus coronary interventions. Survival rate, incidence of myocardial infarction, repeat myocardial revascularization procedures and major adverse cardiac events were comparable among the patients with low and intermediate SYNTAX Score. Among the patients with high SYNTAX Score the incidence of myocardial infarction (8,82%, р = 0,002), repeat PCI procedure (32,35%, р = 0,001) and major adverse cardiac events (32,35%, р = 0,002) was reliably higher compared to patients with low and intermediate SYNTAX Score. The mpact of the SYNTAX Score rate on the long-term results in the different revascularization strategy groups was also analyzed. In the 1st group the incidence of major adverse cardiac events among the patients was comparable. In the 2nd group patients with the high SYNTAX Score rate had reliably higher rate of major adverse cardiac events (43,75%, р = 0,002). The rate of major adverse cardiac events were higher in the 3rd group of patients with the high SYNTAX Score rate compared in patients with low and intermediate SYNTAX Score rate, but this difference didn't reach statistically reliable difference. Use of the strategy of culprit vessel revascularization in the patients with high SYNTAX Score rate, leads to increased rate of major adverse cardiac events and repeat PCI procedures in the long-term follow up period.

References 

1.    Silber S. et al. Guidelines for percutaneous        coronary interventions. Eur. Heart. J.2005; 26: 804-847.

2.    Bourassa M.G. et al. Strategy of complete revascularization in patients with multivessel coronary artery disease (a report from the 1985-1986 NHLBI PTCA Registry).

3.    Am. J. Cardiol. 1992; 70: 174. Bourassa M.G. et al. Long-term outcome of 5 patients with incomplete vs complete revascularization after multivessel PTCA (a report from NHLBI PTCA Registry). Eur. Heart. J. 1998; 19: 103-111.

4.    Hannan E.L. et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation. 2006; 113; 2406-2412.

5.    Hannan E.L. et al. Incomplete revascularization in the era of drug-eluting stents. Impact on adverse outcomes. J. Am. Coll. Cardiol. Intv. 2009; 2: 17-25.

6.    Ijsselmuiden A.J.J. et al. Complete versus culprit vessel percutaneous coronary intervention in multivessel disease. A randomized comparison. Am. Heart. J.2004; 148: 467-474.

7.    Martuscelli E. et al. Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded. Data from the CABRI trial. Eur. J. of Card.Thorac. Surg. 2008; 33: 4-8.

8.    Van den Brand M.J.B.M. et al. The effect of completeness of revascularization on event-free survival at one year in the arts trial. J. Am. Col. Cardiol. 2002; 39; 559-564.

9.    Беленков Ю.Н., Акчурин Р.С., Савченко А.П. и др. Результаты коронарного стентирования и хирургического лечения у больных ИБС с многососудистым поражением коронарного русла. Кардиология. 2002; 5: 42-45.

10.  Ong A.T.L., Serruys P.W. Coronary artery bypass graft surgery versus percutaneous coronaryintervention. Circulation. 2006; 114: 249-255.

11.  Patil C.V. et al. Multivessel coronary artery disease. Current revascularization strategies. Eur. Heart. J. 2001; 22: 1183-1197.

12.  Buda A.J. et al. Long-term results following coronary bypass operation. Importance of preoperative factors and complete revascularization. J. Thorac. Cardiovasc. Surg. 1981; 82: 383-290.

13.  Rodriguez A.E. et al. Revascularization strategies of coronary multiple vessel disease in drug eluting stent era. One year follow-up results of ERACI III trial. Eurointervention. 2006; 2: 53-60.

14.  Rodriguez A.E. et al. Late loss of early benefit from drug-eluting stents when compared with bare-metal stents and coronary artery bypass surgery. 3 years follow-up of the ERACI III registry. Eur. Heart. J. 2007; 28: 2118-2125.

15.  Serruys P.W. et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent. Insights from the Arteкial Revascularization Therapies Study Fart II (ARTS II). Eur. Heart. J. 2007; 28 (4): 433-442.

16.  Serruys P.W. et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N. Engl. J. Med. 2009; 360: 961-972.

17.  Serruys P.W. Sirolimus-eluting stents for the treatment of patients with multivessel de novocoronary artery lesions. EuroInterv. Arterial, Revascularis. Therap. Study PartII. 2005; 2: 147-156.

18.  Serruys P.W. et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009; 5 (1): 50-56.

Abstract:

Aim: was to evaluate results of endovascular treatment of patients with acute coronary syndrome (ACS) without ST-segment elevation, with multivessel coronary disease.

Materials and methods: 346 patients were enrolled in study and initially randomized into 3 groups. 1st group included 100 patients with complete myocardial revascularization which had been performed during initial PCI. 2nd group included 124 patients with complete myocardial revascularization, performed during initial hospitalization: 3rd group - 122 patients with complete revascularization, performed at different times after initial hospitalization. Inclusion criteria: ACS patients without ST-segment elevation; multivessel coronary disease (risk SYNTAX score = 23-32); high and medium risk for the GRACE scale; absence of previous myocardial revascularization.

Results: long-term results of treatment were evaluated in 192 patients. After 12 months, patients in 3rd group was significantly more likely to have greater cardiovascular complications and re-interventions on the target vessel. It was found that complete myocardial revascularization, performed after 30 days from the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease (r = 0,58, p <0,05). Risk factors adversely affecting the prognosis of ACS patients without ST-segment elevation and presence of multivessel disease include: subtotal stenosis in non-symptomatic arteries; circulation failure Killip class III; myocardial infarction in past; high risk on GRACE scale; lesion length in non-symptomatic arteries more than 20 mm diabetes mellitus; degree of risk on a SYNTAX scale-score> 25; overweight/obesity; high cholesterol 6.5 mmol/l.

Conclusions: when performing PCI in patients with ACS without ST-segment elevation with multivessel coronary disease, performing a complete myocardial revascularization 30 days after the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease.

References

1.     Bockeria L.A., Alekyan B.G.(eds). Rentgenjendovaskuljarnaja diagnostika i lechenie zabolevanij serdca i sosudov v Rossijskoj Federacii - 2015 god. [Endovascular diagnosis and treatment of the heart and blood vessels diseases in Russian Federation - 2015]. Moscow: Nauchnyy tsentr serdechno-sosudistoi khirurgii imeni A.N. Bakuleva; 2016 [In Russ].

2.     Filatov A.A, Krylov V.V. Rezul'taty jendovaskuljarnogo lechenija bol'nyh infarktom miokarda bez zubca Q na jelektrokardiogramme. [Results of endovascular treatment of patients with myocardial infarction without Q-wave on the ECG]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2012;30:29-32 [In Russ].

3.     Alfredsson J., LindbAck J., Wallentin L., Swahn E. Similar outcome with an invasive strategy in men and women with non-ST-elevation acute coronary syndromes: from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Eur Heart J. 2011;32:3128-36.

4.     Savonitto S., Cavallini C., Petronio A.S., et al. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC: Cardiovasc Interv 2012;5:906-16.

5.     Tegn N., Abdelnoor M., Aaberge L. et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomized controlled trial. Lancet. 2016;387:1057-65.

6.     Thiele H., Rach J., Klein N. et al. Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late Percutaneous coronary Intervention trial in NSTEMI (LIPSIA-NSTEMI Trial). Eur Heart J. 2012;33(16):2035-43.

7.      Henderson  R.A., Jarvis C., Clayton T. et al. 10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial. J Am Coll Cardiol. 2015; 66(5):511-20. doi: 10.1016/j.jacc.2015.05.051.

8.     Damman P, Nan van Geloven, Wallentin L. et al. Timing of Angiography With a Routine Invasive Strategy and Long-Term Outcomes in Non-ST-Segment Elevation Acute Coronary Syndrome: A Collaborative Analysis of Individual Patient Data From the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials. J Am Coll Cardiol Intv. 2012;5(2):191-199. doi:10.1016/j.jcin.2011.10.016.

9.     Badings E.A., Salem H.K., Dambrink J.E. et al. Early or late intervention in high-risk non-ST-elevation acute coronary syndromes: results of the ELISA-3 trial. EuroIntervention. 2013;9:54-61.

10.   Roffi M., Patrono C., Collet J.P et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-seg- ment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016 Jan 14;37(3):267- 315. doi: 10.1093/eurheartj/ehv320.

11.   Sardella G., Lucisano L., Garbo R. et al. SingleStaged Compared With Multi-Staged PCI in Multivessel NSTEMI Patients: The SMILE Trial. J Am Coll Cardiol. 2016 Jan 26;67(3):264-72. doi: 10.1016/j.jacc.2015. 10.082.

12.   Tang E.W., Wong C.K., Herbison P Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am Heart J. 2007 Jan;153(1):29-35.

13.   Sumeet S., Bach R.G., Chen A.Y et al. Baseline Risk of Major Bleeding in Non-ST- Segment-Elevation Myocardial Infarction The CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines) Bleeding Score. Circulation. 2009;119:1873-1882.

14.   Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736-2747.

15.   Martensson S., Gyrd-Hansen D., Prescott E. et al. Trends in time to invasive examination and treatment from 2001 to 2009 in patients admitted first time with non-ST elevation myocardial infarction or unstable angina in Denmark. BMJ Open. 2014.;4;3004052

16.   Ganjukov V.I., Tarasov R.S., Kochergin N.A., Barbarash O.L. Chreskozhnoe koronarnoe vmeshatel'stvo pri ostrom koronarnom sindrome bez pod’ema segmenta ST. [Percutaneous coronary intervention for acute coronary syndrome without ST-segment elevation]. Jendovaskuljarnaja hirurgija. 2016;3(1):19-5 [In Russ] .

17.   Amsterdam E.A., Wenger N.K., Brindis R.G et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes. JACC. 2014; 64(24):2645-87.

18.   E.B. Shahov, B.E. Shahov, E.B. Petrov. Opredelenie taktiki I ob’ema endovaskularnoi revaskularizatsii u patsientov s ostim koronarnim sindromom I mnogososudistim porazheniem venechnogo rusla serdtsa. [Revascularization strategy definition in acute coronary syndrome patients with multivessel coronary artery disease] Diagnosticheskaya I interventionnaya radiologia. Tom 10 (№3)2016:43-50.