Abstract:

Aim: was to study the mutual influence of new coronavirus infection COVID-19 and acute coronary syndrome and to evaluate the effectiveness of percutaneous coronary interventions in these conditions.

Material and methods: for the period from March 21, 2020 to October 31, 2021, 5093 patients were treated for COVID-19. Including 208 patients with acute coronary syndrome with concurrent COVID-19 disease. All patients underwent following diagnostic procedures: computed tomography of the chest, electrocardiography, echocardiography, coronary angiography and, if necessary, percutaneous coronary intervention.

Results: we present data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on the nature of coronary interventions and mortality in these groups. A high frequency of massive thrombosis of infarct-related coronary arteries was demonstrated in the group of patients with STEMI. Possible mechanisms of left ventricular dysfunction that persist after percutaneous coronary intervention are described. A positive effect of endovascular myocardial revascularization on the degree of hypoxia in patients with COVID-19 was shown.

Conclusions: development of acute coronary syndrome with concurrent coronavirus infection significantly worsens the prognosis of the disease. Despite of the success of endovascular treatment, worsening COVID-19 infection can be accompanied by a sharp deterioration in the condition of patients, leading to death.

Abstract:

Introduction: the problem of restenosis prevention and its early detection is very important in patients who underwent coronary intervention with bare-metal stent (BMS) implantation in acute coronary syndrome (ACS). But when is it necessary to perform elective coronary angiography in order not to miss possible restenosis development? This question needs to be answered.

Aim: was to define the correct period to perform elective coronary angiography after bare-metal stent implantation in acute coronary syndrome.

Material and methods: the study included 124 patients who underwent coronary intervention with BMS implantation in ACS, in period of 1-14 months before current admission. All patients included in this study had indications for repeating coronary angiography and were diagnosed hemodynamically relevant in-stent restenosis. No risk factors of restenosis were revealed at these patients.

Results: average time of restenosis detection was 7,9±1,99 months. Average percent of restenosis among all included patients was 68,6±13,1%. We also revealed direct correlation of percent of restenosis with time of restenosis detection (r=0,5785, p <0,05). Correlation between time and percentage of restenosis and stent type or TIMI grade, was also estimated in this study.

Conclusion: according to results of our study, there are good reasons to repeat coronary angiography in 7-9 month after BMS implantation in ACS, even if patients have no risk factors of restenosis.

References

1.     Bokerija LA, Alekjan BG, Anri M. Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov. 3-e izd. Tom. 3. Rentgenojendovaskuljarnaja hirurgija ishemicheskoj bolezni serdca [Guide on endovascular surgery of heart and vessels. 3rd ed. Vol. 3. Endovascular surgery of ischemic heart disease]. Moscow: Bakulev Scientific Center of Cardiovascular Surgery. 2008. 648 pages [In Russ].

2.     Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis. 2016; 8(10): 1150-1162.

3.     Ibanez B, James S, Agewall S, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2017; 39(2): 119-177.

4.     Cortese B, Berti S, Biondi-Zoccai G, et al. Italian Society of Interventional Cardiology. Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology. Catheter Cardiovasc Interv. 2014; 83(3): 427-35.

5.     Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014; 63(24): 2659-73.

6.     Agostoni P, Valgimigli M, Biondi-Zoccai GG, et al. Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J. 2006; 151(3): 682-9.

7.     Goncharov AI, Kokov LS, Likharev AYu. Otsenka effektivnosti stentirovaniya koronarnyh arterij razlichnymi tipami stentov u bol'nyh IBS. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2009; 19: 23-24 [In Russ].

Abstract

The phenomenon of unrecovered coronary blood flow, or the «no-reflow» phenomenon, is the most formidable and insufficiently studied example of clinical failures after percutaneous coronary intervention (PCI) and is manifested as the absence of filling of distal coronary arteries. As a result, endovascular treatment may be completely unsuccessful or may be complicated by delayed recovery, the development of systolic dysfunction, the formation of heart aneurysm and other serious problems. Many experimental and clinical studies have been devoted to «no-reflow», but the evidence for this or that way of influencing the appearance of this phenomenon is very ambiguous. This article presents modern aspects related to risk factors, pathophysiology and methods for diagnosing this complication, as well as an analysis of methods for the prevention and correction of the developed «no-reflow» phenomenon.

References

1.     Alekyan B.G. Endovascular diagnosis and treatment of heart and vascular diseases in the Russian Federation - 2017. Endovaskulyarnaya hirurgiya. 2018. T.5, №2. S.93- 240 [In Russ]. 

2.     Van de Werf F. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST- Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Van de Werf F., [et al.] Eur Heart J. 2008. Vol. 29, P. 2909-2945.

3.     Bazanov I.S. Endovascular interventions on venous bypass (literature review). Vestnik RUDN. Seriya: Medicina. 2017. T.21, №2. S.171-183. [In Russ].

4.     Interventional Cardiology. Coronary angiography and stenting: a guideline. M.: GEOTAR-Media, 2010. S.410. [In Russ].

5.     Kaul, S. The «no reflow» phenomenon following acute myocardial infarction: Mechanisms and treatment options. Kaul, S. Journal of Cardiology. 2014. Vol. 64, No.2, P. 77-85.

6.     Kloner R.A. The «no-reflow» phenomenon after temporary coronary occlusion in the dog. Kloner R.A., Ganote C.E., Jennings R.B. J Clin Invest. 1974, Vol. 54, P. 14961508. 

7.     Czarnowska E. Ultrastructural demonstration of endothelial glycocalyx disruption in the reperfused rat heart. Involvement of oxygen free radicals. Czarnowska E, Karwatowska-Prokopczuk E. Basic Res Cardiol. - 1995, Vol. 90, No. 5, P. 3573-64

8.     Kloner R.A. Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: which comes first? Kloner R.A., Rude R.E., Carlson N., [et al.] Circulation. 1980, Vol. 62, P. 945-952.

9.     Kleinbongard P. Vasoconstrictor potential of coronary aspirate from patients undergoing stenting of saphenous vein aortocoronary bypass grafts and its pharmacological attenuation. Kleinbongard P., Bose D., Baars T., [et al.] Circ Res. 2011, Vol. 108, P 344352

10.   Galagudza M.M., Sonin D.L., Pochkaeva E.I. Postischemic non-restoration of blood flow: mechanisms and therapeutic targets. Regionarnoe krovoobrashchenie i mikrocirkulyaciya. 2018. T. 17, №1. S.5-12. [In Russ].

11.   Higginson L.A. Determinants of myocardial hemorrhage after coronary reperfusion in the anesthetized dog. Higginson L.A., White F., Heggtveit H.A., Sanders T.M., Bloor C.M., Covell J.W. Circulation. 1982, Vol.65, P 62-69. 

12.   Kaul S. Microvasculature in acute myocardial ischemia: part II: evolving concepts in pathophysiology, diagnosis, and treatment. Kaul S., Ito H. Circulation. 2004, Vol. 109, P 310-315.

13.   Theilmeier G. Hypercholesterolemia in minipigs impairs left ventricular response to stress: association with decreased coronary flow reserve and reduced capillary density. Theilmeier G., VerhammeP, DymarkowskiM., [et al.] Circulation. — 2002; Vol. 106, P 1140-1146.

14.   Dogan N.B. Simple clinical risk score for no-reflow prediction in patients undergoing primary percutaneous coronary intervention with acute STEMI. Dogan N.B., Ozpelit E., Akdeniz S., Bilgin M., Baris N. Pak J Med Sci. - 2015, Vol. 31, No. 3. P 576-581.

15.   Plechev V.V., Risberg R.YU., Buzaev I.V. [et al.] Predictors of the development of intraoperative and early complications with planned stenting of coronary arteries. Permskij medicinskij zhurnal. 2017. T.34, №5. S.5-12. [In Russ].

16.   Kundin V.YU. Quantification of viable myocardium by radionuclide method. Serdechnaya nedostatochnost’. - 2010. №1. S.20-25. [In Russ].

17.   Strauss H.W. Procedure guideline for myocardial perfusion imaging 3.3. Strauss H. W., Miller, D. D., Wittry M.D., [et al.]. Journal of Nuclear Medicine Technology. 2008, Vol. 36, No. 3, P 155-161.

18.   Lockie T. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. Lockie T., Nagel E., Redwood S., Plein S. Circulation. 2009, Vol. 119, P 1671-1681

19.   Hayat S.A. Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Hayat S.A., Senior R. Eur Heart J. 2008, Vol. 29, P 299214. 

20.   Granfeldt A. Protective ischemia in patients: preconditioning and postconditioning. Granfeldt A., Lefer D.J., Vinten-Johansen J. Cardiovasc. Res. 2009, Vol. 83, No. 2, P. 234-246.

21.   M. R. Schmidt. Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a KATP-dependent mechanism: first demonstration of remote ischemic preconditioning. M. R. Schmidt [et al.] Am. J. Physiol. Heart Circ. Physiol. 2007, Vol. 292, No. 4, P 1883-1890.

22.   Heusch G. Remote ischemic conditioning. Heusch G., Botker H.E., Przyklenk K., [et al.] J Am Coll Cardiol. 2015, Vol. 65, P 177-195.

23.   Vinten-Johansen J. Perconditioning and postconditioning: current knowledge, knowledge gaps, barriers to adoption, and future directions. Vinten-Johansen J., Shi W. J. Cardiovasc. Pharmacol. Ther. 2011, Vol. 16, No. 34, P 260-266.

24.   Mojbenko A. A., Dosenko V.E., Parhomenko. A.N Endogenous mechanisms of cardioprotection as a basis for pathogenetic therapy of heart diseases. Kiev, Naukova dumka, 2008. C. 520. [In Russ]. 

25.   Lishmanov YU.B., Maslov L.N. Ischemic postconditioning of the heart. Receptor mechanisms and clinical applications. Kardiologiya. 2010. №6. S.68-74.

26.   Zhao Z.Q. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Zhao Z.Q., Corvera J.S., HalkosM.E. , [et al.] Am. J. Physiol. Heart Circ. Physiol. 2003, Vol. 285, No. 2, P 579-588.

27.   Jivraj N. Ischaemic postconditioning: cardiac protection after the event. Jivraj N., Liew F, Marber M. Anaesthesia. 2015, Vol. 70, P 598-612.

28.   Limalanathan S. Effect of ischemic postconditioning on infarct size in patients with ST-elevation myocardial infarction treated by primary PCI results of the POSTEMI (POstconditioning in ST-Elevation Myocardial Infarction) randomized trial. Limalanathan S., Andersen G.lll., Klaw N.E., Abdelnoor M., Hoffmann P, Eritsland J. J. Am. Heart Assoc. 2014, Vol. 3, No. 2, e000679.

29.   Cung T.T. Cyclosporine before PCI in patients with acute myocardial infarction. Cung T.T., Morel O., Cayla G., Rioufol G., Garcia-Dorado D., Angoulvant D., [et al.] New Engl. J. Med.-2015, Vol. 373, P 1021-1031.

30.   Tissier R. The small chill: Mild hypothermia for car- dioprotection? Tissier R., Chenoune M., Ghaleh B., Cohen M.V., Downey J.M., Berdeaux A. Cardiovasc Res. 2010, Vol. 88, P 406-414.

31.   O'Neill W. COOL-MI: Cooling as an Adjunctive Therapy to Percutaneous Intervention in Patients with Acute Myocardial Infarction. O'Neill W. Paper presented at: 15th Annual Transcatheter Cardiovascular Therapeutics Washington DC 2003.

32.   Erlinge D. Rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction (The CHILL-MI trial). Erlinge D., Gutberg M., LangI., [et al.] J Am Coll Cardiol. 2014, Vol. 63, No. 18, P. 1857-1865

33.   Marzilli M. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Marzilli M., Orsini E., Marraccini P., [et al.] Circulation. - 2000, Vol. 101, P. 2154-2159.

34.   Liu G.S. Evidence that the adenosine A3 receptor may mediate the protection afforded by preconditioning in the isolated rabbit heart. Liu G.S., Richards S.C., Olsson R.A., Mullane K., Walsh R.S., Downey J.M. Cardiovasc Res. 1994, Vol. 28, P. 1057-1061.

35.   Liu G.S. Protection against infarction afforded by preconditioning is mediated by A1 adenosine receptors in rabbit heart. Liu G.S., Thornton J., Van Winkle D.M., Stanley A.W., Olsson R.A., Downey J.M. Circulation. 1991, Vol. 84, P. 350-356.

36.   Niu X. Effect of intracoronary agents on the noreflow phenomenon during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: a network meta-analysis. Niu X., Zhang J., Bai M., Peng Y, Sun S., Zhang Z. BMC Cardiovascular Disorders. 2018, Vol.18, P. 3.

37.   Pan W. Intracoronary nitroprusside in the prevention of the no-reflow phenomenon in acute myocardial infarction. Pan W., Wang L.F., [et al.] Chin Med J (Engl). 2009, Vol. 122, No. 22, P. 2718-2723

38.   Zhao S. Effect of intracoronary nitroprusside in preventing no reflow phenomenon during primary percutaneous coronary intervention: a meta-analysis. Zhao S., Qi G., Tian W., Chen L., Sun Y J Interv Cardiol. 2014, Vol. 27, No. 4, P. 356-364.

39.   Haeck J.D. Infarct size and left ventricular function in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-segment Elevation (PREPARE) trial: ancillary cardiovascular magnetic resonance study. Haeck J.D., Kuijt W.J., Koch K.T., et al. Heart. 2010, Vol. 96, P. 190-195.

40.   Haeck J.D. Proximal embolic protection in patients undergoing primary angioplasty for acute myocardial infarction (PREPARE): core lab adjudicated angiographic outcomes of a randomised controlled trial. Haeck J.D., Koch K.T., Gu YL., [et al.] Netherlands Heart Journal. - 2010, Vol. 18, No. 11, P. 531-536.

41.   Gurvitch R. Protection Devices and Thrombectomy for Native Coronary Artery ST Elevation Myocardial Infarction. Gurvitch R., Ajani A., Yan B., [et al.] J. Invasive Cardiol. 2008, Vol. 20, No. 4, P. 190-195.

42.   Stone G. Distal Microcirculatory Protection During Percutaneous Coronary Intervention in Acute ST Segment Elevation Myocardial Infarction. Stone G., Webb J., Cox D., [et al.] J. Am. Heart Assoc. - 2005, Vol. 293, No. 9, P. 10631072.

43.   De Luca G.. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction: a metaanalysis of randomized trials. De Luca G., Dudek D., Sardella G., [et al.] Eur. Heart J. - 2008, Vol. 29, P. 3002-3010.

44.   Jolly S.S. Thrombus Aspiration in ST-Segment- Elevation Myocardial Infarction: An Individual Patient MetaAnalysis: Thrombectomy Trialists Collaboration. Jolly S.S., James S., Dhavнk V., [et al.] Circulation. 2017, Vol. 135, P. 143-152.

45.   Ibanez B.. Acute Myocardial Infarction in patients presenting with ST-segment elevation (Management of) ESC Clinical Practice Guidelines 2017. Ibanez B., James S.,    Ag S., [et al.] Eur. Heart J. 2017, P. 1-66

46.   Schroder R. Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction. Schroder R., Dissmann R., Bruggemann T., [et al.] J. Am. Coll. Cardiol. 1994, Vol. 24, P. 384-391.

47.   Taghizadeh B. AngioJet trombectomy and stenting for reperfusion in acute MI complicated with cardiogenic shock. Taghizadeh B., Chiu J.A., Papaleo R., [et al.] Cathet. Cardiovasc.Invervent. - 2002, Vol. 57, P. 79-84. 

Abstract

Aim: was to explore clinical efficacy and safety of two distal radial approach (DRA) types in primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) patients.

Materials and methods: 113 ACS patients with endovascular procedure that had been performed through DRA - met entry criteria. Standard DRA was performed within anatomic snuffbox in 82 patients (72,6%) and modified - on the dorsal surface of the palm (dorsopalmar type) in 31 patients (27,4%). Approach conversion was performed in 7 patients (6,2%). PCI on syndrome- related artery was performed in 94 patients (83,2%). On completion of PCI and final approach angiography, hemostasis was performed with bandage application for 6 hours. Hemostasis comfort was determined by 10 point verbal descriptor Gaston-Johansson scale. On the 5th-7th day after PCI, all patients underwent visual check, palpation and ultrasound duplex scan (UDS).

Results: procedure and fluoroscopy time, X-ray load, hemostasis comfort - didn't depend on DRA type. Examination, palpation, UDS performed on the 5th-7th day after PCI didn't reveal cases of forearm radial artery occlusion (RAO). Subcutaneous forearm hematoma (EASY III - IV) was registered in 3 cases (2,7%). RAO was registered in standard DRA group only in 4 cases (3,5%). There were no cases of access side RAO in dorsopalmar DRA group.

Conclusion: DRA modifications for PCI in ACS patients are valuable addition to classic radial approach. Dorsopalmar DRA can be considered as basic approach.

References

1.     Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989; 16:3-7.

2.     Kiemeneij F, Laarmann Gj, de Melker E. Transradial coronary artery angioplasty (Abstr). Circulation. 1993; 88: I-251.

3.     Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018; 39 (2): 119-77.

4.     Neumann F.J., Sousa-Uva M., Ahlsson A. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2018; Aug. 25.

5.     Valgimigli M, Gagnor A, Calabro P. et al. MATRIX Investigators. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: A randomised multicentre trial. Lancet. 2015; 385:2465-2476.

6.     Bazemore E, Tift Man J, Problems and Complications of the Transradial Approach for Coronary Interventions: A Review Issue Number J Invasive Cardiol. 2005 Mar;17(3):156-9.

7.     Stawin J, Kubler P, Szczepanski A. et al. (2013). Radial artery occlusion after percutaneous coronary interventions - an underestimated issue. Postepy Kardiol Interwencyjnej. 2013 18; 9(4):353-61. Epub 2013 Nov 18.

8.     Avdikos G, Karatasakis A, Tsoumeleas A. et al. Radial artery occlusion after transradial coronary catheterization. Cardiovasc Diagn Ther. 2017; 7(3):305-316.

9.     Kotowycz MA, DГlavнk V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv. 2012; 5:127-33.

10.   Karpov YA, Samko AN, Buza VV. Coronary angioplasty and stenting. Moscow, 2010; 235 [In Russ].

11.   Babunashvili A, Dundua D. Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure. Catheter. Cardiovasc. Interv. 2011; 77 (4): 530-6.

12.   Kaledin AL, Kochanov IN, Seletskiy SS. et al. Peculiarities of arterial access in endovascular surgery in elderly patients. Uspekhi Gerontologii. 2014; 27 (1): 115-9 [In Russ].

13.   Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017; 13 (7): 851-7.

14.   Al-Azizi KM, Lotfi AS. The distal left radial artery access for coronary angiography and intervention: a new era. Cardiovasc. Revasc. Med. 2018; Dec 26; 19(8S): 35-40.

15.   Valsecchi O, Vassileva A, Cereda AF. et al. Early clinical experience with right and left distal transradial access in the anatomical snuffbox in 52 consecutive patients. J. Invasive Cardiol. 2018; 30(6): 218-23.

16.   Soydan E, Akin M. Coronary angiography using the left distal radial approach - an alternative site to conventional radial coronary angiography. Anatol. J. Cardiol. 2018; 19: 243-248. Mar. 21.

17.   Manchurov VN, Orlov OS, Anisimov KV. et al. Distal transradial access for percutaneous coronary interventions in patients with acute coronary syndrome and ischemic heart disease. Endovasculyarnaya. khirurgiya. 2018; 5 (4): 438-44 [In Russ].

18.   Kaledin AL, Kochanov IN, Podmetin PS., et al. Distal part of the radial artery for endovascular interventions. Endоskulyarnaya khirurgiya. 2017; 4(2): 125-133 [In Russ].

19.   Amsterdam EA, Wenger NK, Brindis et al. (23 September 2014). "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 130 (25): e344-e426.

20.   Gaston-Johansson F, Albert M, Fagan et al. Similarities in pain descriptions of four different ethnic-culture groups. J Pain Symptom Manage. 1990; 5: 94-100.

21.   Bertrand OF. Acute forearm muscle swelling post transradial catheterization and compartment syndrome: prevention is better than treatment! Catheter Cardio Interv. 2010; 75:366-8.

22.   Radial access for percutaneous coronary procedure: relationship between operator expertise and complications. Clin Exp Emerg Med. 2018 Jun; 5(2): 95-99.

23.   Rafael J Ruiz-Salmeryna, Ramyn Moraa, Manuel Velez-Gimyna et al. Radial Artery Spasm in Transradial Cardiac Catheterization. Assessment of Factors Related to Its Occurrence, and of Its Consequences During Follow-Up. Revista Espanola de cardiologia. 2005; 58(5): 465610.

Abstract:

Cardiovascular disease is a leading cause of mortality and morbidity in octogenarian patients. The number of such patients and the number of percutaneous coronary interventions are increasing.

Methods: literature report is based on data, searched in PubMed database, Elibrary, electronic catalog of the Russian State Library, published until January 2017.

Results: review showed reasons why this group of patients refers to high-risk patients. Also, we analyzed modern approaches to the treatment of such patients, significance of PCI, intraoperative factors affecting the outcome of treatment of patients with myocardial infarction.

Conclusion: worse results of PCI in elderly patients in comparison with younger group have multifactorial reasons. Different authors point on higher percent of comorbidity, and previous MI, worse cardiac function, higher iatrogenity Based on received data, we showed clinical problems in these patients, the solution of which would improve results of treatment of this group of challenging patients. 

References

1.     Mark Mather, Linda A. Jacobsen, and Kelvin M. Pollard. Aging in the United States. Population Bulletin 70, no. 2 (2015).

2.     Predpolozhitel'naja chislennost' naselenija Rossijskoj Federacii do 2030 goda. [Presumptive population of the Russian Federation until 2030]. Statisticheskij bjulleten'. Federal'naja sluzhba gosudarstvennoj statistiki. M., 2016 [In Russ].

3.     Roth, Gregory A. et al. «Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality.» The  New England journal of medicine 372.14(2015):1333-1341. PMC. Web. 9 Jan. 2017.

4.     Zdravoohranenie v Rossii 2015. [Healthcare in Russia 2015]. Statisticheskij sbornik. Federal'naja sluzhba gosudarstvennoj statistiki. M., 2015 [In Russ].

5.     Bogomolov A.N. Retrospektivnyj analiz rezul'tatov koronarnogo stentirovanija u bol'nyh pozhilogo i starcheskogo vozrasta. Dis. kand. med. nauk. [Retrospective analysis of coronary stenting in elderly and very elderly patients. Cand. of Dr. med. sci. diss]. SPb. 2013 [In Russ].

6.     Bauer T., Mollmann H., Weidinger F., Zeymer U., SeabraGomes R., Eberli F., Serruys P, Vahanian A., Silber S., Wijns W., Hochadel M., Nef H.M., Hamm C.W., Marco J., Gitt A.K. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int J Cardiol. 2011; 151:164-169.

7.     Antonsen L., Jensen L.O., Terkelsen C.J., Tilsted H. H., Junker A., Maeng M., Hansen K.N., Lassen J.F., Thuesen L., Thayssen P Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with STsegment elevation myocardial infarction: from the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013; 81:912-919.

8.     Daniel I. Bromage, Daniel A. Jones, Krishnaraj S. Rathod. Outcome of 1051 Octogenarian Patients With STSegment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. Journal of the American Heart Association. 2016;5:e003027.

9.     Caretta G., Passamonti E., Pedroni PN., Fadin B.M., Galeazzi G.L., Pirelli S. Outcomes and predictors of mortality among octogenarians and older with ST-segment elevation myocardial infarction treated with primary coronary angioplasty. Clin Cardiol. 2014; 37:9:523-529.

10.   Spoon D.B., Psaltis PJ., Singh M., et al. Trends in cause of death after percutaneous coronary intervention. Circulation. 2014; 129:1286-1294.

11.   Goch A., Misiewicz P, Rysz J., Banach M. The clinical manifestation of myocardial infarction in elderly patients. Clin Cardiol. 2009; 32:E46-E51

12.   Dangas G.D., Singh H.S. Primary percutaneous coronary intervention in octogenarians: navigate with caution. Heart. 2010; 96:813-814.

13.   Semitko S.P. Metody rentgenjendovaskuljarnoj hirurgii v lechenii ostrogo infarkta miokarda u bol'nyh starshego

Abstract:

Aim: was to review the efficiency of complex methods of bleeding prevention in elderly patients with acute coronary syndrome (ACS) receiving combined anticoagulant and antiplatelet therapy during percutaneous coronary interventions (PCI).

Materials and methods: between January of 2011 to 2015 in «Pokrovskaya City Hospital» of St. Petersburg, 1435 PCI were performed in patients with ACS, the percentage of patients older than 80 years was more than 9%. To reduce bleeding risk we used: transradial access, diminished time of eptifibatide infusion, bivalirudin, intraoperative control of activated clotting time (ACT).

Results: significant decrease of bleeding episodes in patients with high risk of bleeding requiring transfusion at 0, 25% in the early postoperative period was shown.

Conclusions: the reduction of the bleeding risk will increase management efficiency among patients undergoing PCI.  

References 

1.    Biostatistical Fact Sheet: Older Americans and Cardiovascular Diseases. Chicago, AHA, 1998.

2.    Rich M.W. et al. PRICE-2 Investigators. Am. J. Geriart. Cardiol. 2003;12(5):307-18, 327.

3.    Angeja B., Rundle A., Death or nonfatal stroke in patients with acute myocardial infarction. Am. J. Card. 2001 Mar 1;87(5):627-30.

4.    Tiefenbrunn A.J. et al. A report from the NRMI -2. J. Am. Coll. Card. 1998;31: 1240.

5.    Thiemann D.R., Coresh J., et al.: Lack of benefit for intravenous thrombolysis in patients with MI who are older than 75 years. Circulation. 2000;101: 2239.

6.    Brown D. Deaths associated with platelet glycoprotein 11 b/111 a treatment. Heart. 2003 May;89(5): 535-7.

7.    ESPRIT Investigators. Lancet. 2000;356:2037-44

8.    Fung et al. The Brief-PCI Trial. JACC 53: 2009: 837-45.

9.    Gibson C.M., Morrow D.A., Murphy S.A., et al. A randomized trial to evaluate the relative protection against post-percutaneous coronary intervention microvascular dysfunction, ischemia, and inflammation among antiplatelet and antithrombotic agents: the PROTECT-TIMI 30 trial. J. Am. Coll. Cardiol. 2006; 47:2364-73.

10.  Bertrand O.F. Meta-Analysis Comparing Bivalirudin Versus Heparin Monotherapy on Ischemic and Bleeding Outcomes After Percutaneous Coronary Intervention. Am. J. Cardiol. 2012; 110:599-606.

11.  Marso S.P, Amin A.P Assotiation between of bleeding avoidance strategies and risk of bleeding among patients undergoing PCI. JAMA. 2010 2; 303 (21): 2156-64.

12.  Mehran R., Lansky A.J., Witzenbichler B., et al. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomized controlled trial. Lancet. 2009; 374:1149-59.

13.  Reduction in Cardiac Mortality With Bivalirudinin Patients With and Without Major Bleeding. Gregg W. Stone et all. J. Am. Coll. Cardiol. 2014;63:15-20.

14.  Michael Lincoff A., John A. Bittl. Bivalirudin and Provisional Glycoprotein 11 b/111 a Blockade Compared With Heparin and Planned Glycoprotein IIb/IIIa Blockad During Percutaneous Coronary Intervention. REPLACE-2 Randomized Trial. JAMA. 2003 February; 289: 19.

15.  Stone G.W., White H.D., Ohman E.M., et al. Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. Lancet. 2007; 369:907-19.

16.  Lopotovskiy P.Yu., Parkhomenko M.V., Larin A.G., Korobenin A.Yu. Primenenie bivalirudina v klinicheskoi praktike. [The use of bivalirudin in clinical practice.] Diagnosticheskaya i intervencionnaya radiologia. 2012 (6) #4: 79-88 [in Russ].

Abstract:

The cardiac complications' risk factors and it’s stratifications in patients with non-ST elevation acute coronary syndrome are considered in detail. The interrelation between risk factors, features and character of defeat of coronary arteries is defined. Early selective coronarograthy is most informative to identify patients with culpite lesion in this category. Early interventional radiology treatment has allowed to reach more favorable in-hospital and 12-month follow-up period results (patients’s lethality, non-fatal MI).

Abstract:

Aim: was to identify relationship between risk factors (RF) and severity of coronary artery (CA) defeat in patients, hospitalized with acute coronary syndrome (ACS), without the presence of ishemic heart disease (IHD) earlier.

Materials and methods: the research includes 201 patients, who were hospitalized to N.V Sklifosovsky Research Institute of Emergency Medicine from february 2011 to apri 2012 with the diagnosis «ACS». Main criteria of patients selection was the absence of IHD clinics in past. All patients underwent coronarography, obtained data was fixed in data base. At the time of arrival to hospital - risk factors were determined. To identify relationship between RF and CA defeat - statistic analyzes were made: the number of defeated CA (1,2 or 3); severity of CA defeat was measured with Syntax Score (SS) Scale (<22 and >22 points); praesence or absence of acute occlusion of CA of infarction zone.

Results: research consisted of 149 male (74,1%) and 52(25,9%) female, mean age of all patients was 56,6±10,6 yrs. ACS with elevation of ST-segment was diagnosed in 136 (67,7%) of patients. Haemodynamic significant stenosis (HSS) of 1, 2 or 3 CA were found in 56 (27,9%), 61 (30,4%) and 64 (30,8%) respectively In 20 (10%) patients - there was no HSS. Acute thrombotic occlusion (ATO) in myocardial infarction related(MI-related) CA was revealed in 146 (72,6%) of patients. It was noted, tht such RF as arterial hypertention (AH), smoking, low physical activity (LPA), was more spread with increasing numer of defeated CA. Patients with lot of defeated CA, were older, had higher figures of systolic arterial pressure (SAP). After examination and primary analysis, only age and number of RF had independent relation with prevalence of CA defeat. Patients with SS >22 points in comparison with patients <22 points, had higher AP, obesity, diabetes mellitus (DM), and more ofted had lack of fruits and vegetables. Also they were older had higher SAP, more RF. Analysis showed that only AH, DM, and age had independent relation with savere CA defeat (Syntax Score >22 points). Patients with ATO of CA, had higher such RF as smoking, LPA, DM. They also had more RF. After analysis - smoking and LPA were independently connected with ATO.

Conclution: such RF as age, AH, DM, LPA and number of combined RF in patient can have independent relation with volume and prevalence of CA defeat. Smoking and LPA can have relation with ATO, with clinics of ST-elevated ACS and macrofocal MI. Obtained data show necessity of inlarged reseach for a broad understanding og RF in connection with coronary atherosclerosis and thrombosis. All that can increase effectiveness of treatment and prophylaxis of cardiovascular morbidity and mortality.

References

1.     Ford E.S., Ajani U.A., Croft J.B., et al. Explaining the decrease in U.S. deaths from coronary disease, 19802000. N. Engl. J. Med. 2007; 356: 2388-2398.

2.     Kesteloot H., Sans S., Kromhout D., Dynamics of cardiovascular and all-cause mortality in Western and  Eastern Europe between 1970 and 2000. Eur. Heart. J. 2006; 27: 107-113.

3.     Беленков Ю.Н., Оганов РГ. Кардиология. Национальное руководство. Геотар-медиа. 2007: 37-52. Belenkov Ju.N., Oganov R.G.; Kardiologija. Nacional'noe rukovodstvo [Cardiology. National recommendations.] Geotar-mediaju. 2007: 37-52 [In Russ].

4.     John G. Canto, Catarina I. Kiefe., William J. Rogers., Eric D. Peterson, et al. Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial Infarction JAMA, November 16, 2011: Vol 306, No.19.)

5.     Kappetein A.P, Feldman T.E., Mack M.J., et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur. Heart J. 2011;32: 2125-2134.

6.     Frederick G. Kushner, Mary Hand, Sidney C. Smith, Jr, Spencer B. King, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Am. Coll. Cardiol. 2009;54;2205-2241; originally published online Nov 18, 2009; doi: 10.1016/ j.jacc.2009.10.015.

7.     Голощапов-Аксенов РС., Жамгырчиев Ш.Т., Терновых М.В., Лебедев А.В., Обидин А.В. Рентгенохирургия в комплексном лечении больных острым инфарктом миокарда с множественным атеросклеротическим поражением коронарных артерий. Диагностическая и интервенционная радиология. 2010; 4(2): 21-28. Goloshhapov-Aksenov R.S., Zhamgyrchiev Sh.T., Ternovyh M.V., Lebedev A.V., Obidin A.V. Rentgenohirurgija v kompleksnom lechenii bol'nyh ostrym infarktom miokarda s mnozhestvennym ateroskleroticheskim porazheniem koronarnyh arterij [Endovascular surgery in complex treatment in patients with acure myocardial infarction with multivessel coronary defeat.]. Diagnosticheskaja i intervencionnaja radiologija. 2010; 4(2): 21-28 [In Russ].

8.     Kennelly B.M., Gersh B.J., Lane G.K., Beck W. The relationship between angiographic findings and risk factors in young men with myocardial infarction. S. Afr. Med. J. 1982; 61(14): 508-512.

9.     Ryczek R., Dziuk M., Zagrodzka M., et al. Clinical and angiographic correlates of coronary calcium scoring in multislice computed tomography (MSCT). Pol. Arch. Med. Wewn. 2005; 113(3): 207-212.

10.   Koliaki С., Sanidas E., Dalianis N., Panagiotakos D., et al. Relationship Between Established Cardiovascular Risk Factors and Specific Coronary Angiographic Findings in a Large Cohort of Greek Catheterized Patients. Angiology. 2011; 62(1): 74-80

11.   Jin Z., Zhang Y, Chen J., et al. Study of the correlation between blood lipid levels and the severity of coronary atherosclerosis in a Chinese population sample. Acta Cardiol. 2006; 61(6): 603-606.

12.   Gensini G.G. The coronary artery disease scoring and retrrieval system. In: Gensini GG, ed. Coronary arteriography. Mount Kisco, New York: Futura Publishing Co.; 1975: 271-274. 

13.   Ning X.H., Xiang X.P, Lu N., et al. Relation of risk factors to coronary artery stenosis severity in coronary atherosclerotic heart disease. Zhonghua YiXue Za Zhi. 2008; 88(18): 1267-1269

14.   Wang X.L., Tam C., McCredie R.M., Wilcken D.E. Determinants of severity of coronary artery disease in Australian men and women. Circulation. 1994; 89(5): 1974-1981.

15.   Saleem T., Mohammad K.H., Abdel-Fattah M.M., Abbasi A.H. Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease. Diab. Vasc. Dis. Res. 2008; 5(3): 184-189.

16.   Zornitzki T., Ayzenberg O., Gandelman G., et al. Diabetes, but not the metabolic syndrome, predicts the severity and extent of coronary artery disease in women. QJM. 2007; 100(9): 575-581.

17.   Mehta L., Devlin W., McCulloughPA., et al. Impact of body mass index on outcomes after percutaneous coronary intervention in patients with acute myocardial infarction. Am. J. Cardiol. 2007; 99(7): 906-910.

18.   Rubinshtein R., Halon D.A., Jaffe R., Shahla J., Lewis B.S. Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography. Am. J. Cardiol. 2006; 97(9): 1277-1280.

19.   Phillips S.D., Roberts W.C. Comparison of body mass index among patients with versus without angiographic coronary artery disease. Am. J. Cardiol. 2007; 100(1): 18-22.

20.   Wessel T.R., Arant C.B., Olson M.B., et al. Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women. JAMA. 2004; 292(10): 1179-1187

21.   Niraj A., Pradhan J., Fakhry H., Veeranna V., Afonso L. Severity of coronary artery disease in obese patients undergoing coronaroangiography: «obesity paradox» revisited. Clin. Cardiol. 2007; 30(8): 391-396.

22.   O’Callaghan PA., Fitzgerald A., Fogarty J., et al. New and old cardiovascular risk factors: C-reactive protein, homocysteine, cysteine and von Willebrand factor increase risk, especially in smokers. Eur. J. Cardiovasc. Prev. Rehabil. 2005; 12(6): 542-547

23.   Peer A., Falkensammer G., Alber H., et al. Limited utilities of N-terminal pro B-type natriuretic peptide (NT- pro BNP) and other newer risk markers compared with traditional risk factors for prediction of significant angiographic lesions in stable coronary artery disease. Heart. 2009; 95(4): 297-303.

24.   AHA. Heart disease and stroke statistics—2008 update. American Heart Association. Availableat: http://www.americanheart.org/presenter.jhtml? identifier 3000090. Accessed February 18, 2009.

25.   Nemetz PN., Roger V.L., Ransom J.E., Bailey K.R., Edwards W.D., Leibson C.L. Recent trends in the prevalence of coronary disease: a population-based autopsy study of non natural deaths. Arch. Intern. Med. 2008; 168: 264 -270

26.   Roger V.L., Go A.S., Lloyd-Jones D.M., Adams R.J., Berry J.D., et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011; 123: 18-209.

27.   Virmani R., Kolodgie F.D., Burke A.P, Farb A., Schwartz S.M. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler. Thromb. Vasc. Biol. 2000; 20: 1262-1275

28.   El-Menyar A., Zubaid M., Shehab A., Bulbanat B., et al. Prevalence and Impact of Cardiovascular Risk Factors Among Patients Presenting With Acute Coronary Syndrome in the Middle East Clin. Cardiol. 2011; 34, 1, 51-58 

Abstract:

The presented research on studying the efficiency and safety of various anticoagulants used in patients with acute coronary syndrome during percutaneous coronary interventions (PCI). High efficiency of a Bivalirudin is shown, in comparison with Unfractionated Heparin and Monofram on the amount of bleeding arising in the postoperative period and main adverse coronary events (MACE). 

References

1.     Bolezni serdca: Rukovodstvo dlja vrachej [Heart diseases: Manual for doctors]. (Pod red. R.G. Oganova, I.G. Fominoj) M. Litera. 2006; 1328 [In Russ].

2.     Rukovodstvo po kardiologii. Pod red. V.N. Kovalenko [Manual on cardiology edited by V.N.Kovalenko]. K. MORION. 2008; 1424 [In Russ] .

3.     Volozh O.I., Deev A.D., Kal'juste T.I. Prognosticheskoe znachenie nekotoryh faktorov dlja smertnosti trudosposobnogo vozrasta (prospektivnoe jepidemiologicheskoe issledovanie) [Prognostic value of some factors for estimation of mortality of able-bodied age (prospective epidemiologic study)]. Kardiologija. 1997; 9: 43-48 [In Russ].

4.     Oganov R.G. Pervichnaja profilaktika ishemicheskoj bolezni serdca [Primary prophylaxis of ischemic heart disease]. M. Medicina. 1990; 160 [In Russ].

5.     Paolo G. Camici, Sanjay Kumak Prosad, Omela E. Rimoldi. Stunning, Hybernating and Assesment of Myocardial Viability. Circulation, 2008; 117: 103-114.

6.     Aasa M., Dellborg M., Herlitz J. et al. Risk reduction for cardiac events after primary coronary intervention compared with thrombolysis for acute ST elevation myocardial infarction (five year results of the Swedish early decision reperfusion strategy [SWEDES] trial). Am. J. Cardiol. 2010; 106 (12): 1685-1691.

7.     2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 - Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011; 123: e426-e579.

8.     The Direct Thrombin Inhibitor Trialists' Collaborative Group. Direct thrombin inhibitors in acute coronary syndromes: principal results of a meta-analysis based on individual patients' data. Lancet. 2002; 359: 294-302.

9.     Doyle B.J., Rihal C.S., Gastineau D.A., Holmes D.R. Jr. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am. Coll. Cardiol. 2009; 53: 2019-2027.

10.   Kastrati A., Neumann F.J., Schulz S., Massberg S. et al. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. N. Engl. J.Med. 2011; 365(21): 1980-1989.

11.   Kessler D.P., Kroch E., Hlatky M.A. et al. The effect of bivalirudin on costs and outcomes of treatment of ST-segment elevation myocardial infarction. Am. Heart. J. 2011; 162: 494-500.

12.   Linkins L.A., Warkentin T.E. Heparin-induced thrombocytopenia: real-world issues. Semin Thromb Hemost 2011; 37(6): 653-663.

13.   Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur. Hear. J. 2008; 29: 2909-2945.

14.   Budaj A., Eikelboom J.W., Mehta S.R. et al. Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur. Heart J. 2009; 30:655-661.

15.   Mehran R., Pocock S.J., Stone G.W. et al. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-eleva- tion acute coronary syndromes: a risk model from the ACUITY trial. Eur Heart J. 2009; 30:1457-1466.

16.   Bittle J.A., Chaitman B.R., Feit F. et al. Bivalirudin versus heparin during coronary angioplasty for unstable or postinfarction angina: Final report reanalysis of the Bivalirudin Angioplasty Study. Am. Heart J. 2001; 142(6):952-959.

17.   Montalescot G., Baldit-Solier C., Chibedit D. et al. for the ARMADA investigators. ARMADA study: a randomized comparison of enoxaparin, dalteparin and unfractional heparin on markers off cell activation in patients with unstable angina. Am. J. Cardiol. 2003; 91: 925-930.

18.   Montalescot G., Collet G.P., Lison L. et al. Effects of various anticoagulant treatments on von Willebrand factor release in unstable angina. J. Am. Coll. Cardiol. 2000; 36:100-114.

19.   Kokov L.S., Lopotovsky P.Yu., Parkhomenko M.V., Larin A.G., Korobenin A.Yu. Experience with the Use of Angiox (Bivalirudin) in Acute Coronary Syndrome (ACS) Patients with Complications Caused by Percutaneous Coronary Intervention (PCI). International Journal of InterventionalCardioangiology, 2013; 34: 39-42.

20.   Manoukian S.V., Feit F., Mehran R. et al. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. J. Am. Coll. Cardiol. 2007; 49(12): 1362-1368.

21.   Stone G.W., Witzenbichler B., Guagliumi G. et al. Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicenter, randomized controlled trial. Lancet 2011; 377(9784): 2193-2204.

22.   Steg G., Stefan K. James, Atar D. et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33:2569-2619. 

Abstract:

Coronary flow limitation during high risk angioplasty in acute coronary syndrome (ACS) patients is an important problem, connecting with inadequate myocardial protection during the coronary intervention.

Aim: was to compare intraoperative cardiohemodynamic in ACS patients during the high risk angioplasty of difficult stenoses in anterior heart arteries with- or without a coronary venous retroperfusion support.

Methods: intervention results of 14 ACS patients were analyzed. In 1st group there were 6 patients (42,9%) with intraoperative myocardial retroperfusion support. In 2nd group - 8 patients (57,1%) without any intraoperative myocardial perfusion support.

Results: during the retroperfusion support in the 1st group , «ST»-segment elevation at 60 sec left main (LM) or left anterior descending artery (LAD) occlusion was significantly lower (ST in V4-V6 - 1,9±1,7 mm) than in patients without retroperfusion (ST in V4-V6 - 3,1±1,7; p = 0,043). In the 2nd group, patients without coronary flow support the «ST»-segment elevation at 60 sec LM or LAD occlusion was significantly higher (ST в V4-V6 - 2,5±0,5; p = 0,043) than at 5 sec LM or LAD occlusion. No significant differences between «ST»-segment and «T»-wave deviation in the beginning and in the end of intervention were in both groups. The same dynamics was demonstrated at the time of blood pressure indexes measurement.

Conclusion: coronary venous retroperfusion is an effective method of coronary flow support during the high risk angioplasty in ACS patients. Retroperfusion technology had no influence on cardiohemodynamic, but reduced the risk of intraoperative adverse cardiac events. 

References

1.     Antman E.M., Anbe D.T., Armstrong P.W. et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J. Am. Coll. Cardiol. 2004; 44: E1-E211.

2.     Trusov V.V., Kazakova I.A., Kuznecov D.N. Analiz raboty pervichnogo sosudistogo centra na baze MUZ MSCh «ZhMASh» [Analysis of functioning of primary angiologic center on the base of medical-sanitary unit of «IZhMASh»]. PJeM . 2011; 43-44(3-4):20-22 [In Russ].

3.     Silber S., Albertsson P., Aviles F.F., et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur. Heart J. 2005; 26: 804-847. P05-04673.

4.     Kononov A.V., Kostjanov I.Ju., Kuznecova I.Je., Aligishieva Z.A., Abil'dinova A.Zh., Cereteli N.V., Koledinskij A.G., Gromov D.G., Suhorukov O.E., Ioseliani D.G. Stentirovanie stvola levoj koronarnoj arterii u bol'nyh s razlichnymi formami ishemicheskoj bolezni serdca: blizhajshie i sredneotdalennye rezul'taty [Stenting of left main coronary artery in patients with different forms of ischemic heart disease: early- and long-term results.]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii (Moskva). 2013;23: 26-33 [In Russ].

5.     ACC/AHA Guidelines for the Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). JACC. 2000; 36: 970-1062.

6.     ESC/EACTS Guidelines. Guidelines on myocardial revascularization/The Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAP- CI). European Heart Journal.2010; 31: 2501-2555.

7.     Almany S.L. Interventional in patient with LV dysfunction. PI 57 in New manual of interventional radiology by Mark Freed et al. - Birmingham, Michigan: Physicians T. Press, 1997.

8.     ACC/AHA Guidelines for Percutaneous Coronary Intervention. PTCA Guidelines. JACC 2001; 37: 8: 2239-2306.

9.     Kardiologija: nacional'noe rukovodstvo [Cardiology: national guide-book] (pod red. Ju.N. Belenkova, R.G. Oganova) M.: GJeOTAR-Media, 2008; 1232 s [In Russ].

10.   Belov Ju.V. Varaksin V.A. Postinfarktnoe remodelirovanie levogo zheludochka serdca. Ot koncepcii k hirurgicheskomu lecheniju [Postinfarction remodeling of left atrium. From concept to surgical treatment]. M.: DeNovo, 2002; 5587 [In Russ].

11.   Shiller N.B., Osipov M.A. Klinicheskaja jehokardiografija [Clinical echocardiography]. M.: Praktika, 2005; 344 [In Russ].

12.   Serruys P.W., Onuma Y, Garg S. et all. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009; 5:50-56.

13.   Incorvati R.L., Tauberg S.G., Pecora M.G., et all. Clinical applications of coronary sinus retroperfusion during high risk percutaneous transluminal coronary angioplasty. JACC. 1993; 22(1): 127-34.

14.   Petrov V.I., Nedogoda S.V. «Medicina, osnovannaja na dokazatel'stvah»: Uchebnoe posobie [Medicine, based on evidence]. Moskva: Gjeotar-Media, 2009; 144 s [In Russ].

15.   Javelov I.S. Vybor antikoaguljanta dlja rannego lechenija ostrogo koronarnogo sindroma [Choise of anticoagulants for early treatment of acute coronary syndrome]. Trudnyj pacient (Moskva). 2013;11(10): 12-24 [In Russ].

16.   Lazar H.L. Coronary sinus retroperfusion: can forward progress still be achieved by using a backward technique? J. Thorac. Cardiovasc. Surg., 2004; 127(6): 1549-52.

17.   Zemgulis V., Wikstrom G., Bjerner T., Henze A., Lahtinen M., Waldens^m A., Thelin S., Ronquist G. Discrepant outcome between myocardial energy-related metabolites and infarct size limitation during retroperfusion of the coronary sinus. Scand. J. Clin. Lab. Invest. 2001; 61(8): 651-62.

18.   Leung W.H. Coronary and circulatory support strategies for percutaneous transluminal coronary angioplasty in high-risk patients. Am. Heart J., 1993; 125(6): 1727-38.

19.   Thiele H., Zeymer U., Neumann F.J. et all. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N. Engl. J. Med. 2013; 368:80-81. 

Abstract:

Aim: was to study the safety and efficacy of the use of the drug bivalirudin in patients with acute coronary syndrome (ACS) with ST-segment elevation.

Materials and methods: the study included 20 patients which were admitted to hospital with a diagnosis of ACS with ST-segment elevation. Among patients - 3 women and 17 men. The age of patients ranged from 31 to 79 years, mean 56±10,8 years. Myocardial infarction of bottom wall of left ventricular (LV) was diagnosed in 9 (45%) patients, front wall - 11(55%) patients. All patients in the emergency order underwent coronary angiography (CA) with further PCI. Multivessel coronary disease was found in 35% of patients, occlusion of a coronary artery - in 20% of cases, bifurcation lesion - 15% of patients, the left main coronary artery - in 30% of cases. Before performing the PCI, 14(70%) of patients were given clopidogrel (600 mg), 6 (30%) of patients - ticagrelor (180 mg) in combination with aspirin. Intraoperative, patients received bivalirudin («Angioks») under the scheme: 0.75 mg/kg intravenous bolus, further - intravenous infusion at a rate of 1.75 mg/kg/h during the whole period of endovascular intervention.

Three patients due to technical features during the operation underwent intracoronary thrombolytic therapy In 2 cases, situation required the installation of intra-aortic balloon counterpulsation. Results: 20 patients underwent implanting of 27 stents (mean 1,35). Immediate technical success of endovascular intervention was 100%. In the intensive care unit for 4 hours after surgery lasted bivalirudin infusion at a dose of 0.25 mg/kg/h, after the transfer to the Department of Cardiology continued therapy with enoxaparin within five days. After endovascular intervention patients were converted to standard doses of clopidogrel (75 mg daily) or ticagrelor (90 mg, 2 times a day), depending on drug, that patient was given during PCI and aspirin (100 mg); and patients receive adequate medical therapy of main disease according to standards of the disease. We presented clinical experience that shows safety of bivalirudin: in the group of patients was not observed any hemorrhagic complication during the time that patients were in a hospital.

References

1.     Bolezni serdca: Rukovodstvo dlja vrachej [Cardiac diseases: guide-book for doctors]. (pod red. R.G. Oganova, I.G. Fominoj) M.: Litera. 2006; 1328 [In Russ].

2.     Byrne C.E., Fitzgerald A., Cannon C.P., Fitzgerald D. J., Shields D. C. Elevated white cell count in acute coronary syndromes: relationship to variants in inflammatory and thrombotic genes Text. BMC Med. Genet. 2004; 5: 13.

3.     Nacional'nye klinicheskie rekomendacii [National clinical recommendations] (pod red. R.G. Oganova, M.N. Mamedova) M.: MEDI-Jekspo, 2009; 390 [In Russ].

4.     Dovgalevskij P.Ja. Ostryj koronarnyj sindrom: patogenez, klinicheskaja kartina, aspekty lechenija. Chto my znaem i chto nado delat'? [Acute coronary syndrome: pathogenesis, clinical picture, aspects of treatment. What we know and what to do?] Serdce. 2002; 1(1): 1315 [In Russ].

5.     Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet. 2003; 361: 13-20.

6.     Steg G., Stefan K. James, Atar D. et al. ESC Guidelines for the management of acute myocardial infarction in patients with ST-segment elevation. Eur. Heart J. 2012; 33: 2569-2619.

7.     Wright R.S., Anderson J.L., Adams C.D. et al. 2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2011; 57: 1920-59.

8.     Averkov O.V. Teoreticheskoe obosnovanie i prakticheskie aspekty ispol'zovanija bivalirudina pri chrezkozhnyh vnutrikoronarnyh vmeshatel'stvah u bol'nyh s ostrym koronarnym sindromom [Theoretical basis and practical aspects of the use of bivalirudin during PCI in patients with acute coronary syndrome.]. Rossijskij kardiologicheskij zhurnal. 2012; 3 (95): 102-112 [In Russ].

9.     Mehran R., Pocock S.J., Stone G.W. et al. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial. Eur. Heart J. 2009; 30: 655-661.

10.   Bittle J.A., Chaitman B.R., Feit F. et al. Bivalirudin versus heparin during coronary angioplasty for unstable or postinfarction angina: Final report reanalysis of the Bivalirudin Angioplasty Study. Am. Heart J. 2001; 142(6): 952-959.

11.   Nicolas W. Shammas. Bivalirudin: Pharmacology and Clinical Applications. Cardiovascular Drug Reviews. 2005; 23( 4): 345-360.

12.   Kelton J.G., Warkentin T.E. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008; 112 (7): 2607-16.

13.   Montalescot G., Collet G.P, Lison L. et al. Effects of various anticoagulant treatments on von Willebrand factor release in unstable angina. J. Am. Coll. Cardiol. 2000; 36: 100-114.

14.   Stone G.W., Witzenbichler B., Guagliumi G. et al. for the HORIZONS-AMI Trial Investigators. Bivalirudin during primary PCI in acute myocardial infarction. N. Engl. J. Med. 2008 May 22; 358 (21): 2218-30.

15.   Stone G.W., Witzenbichler B., Guagliumi G. et al. Heparin plus a glycoprotein 11 b/111 a inhibitors versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-years results from a multicenter, randomized controlled trial. Lancet. 2011; 377 (9784): 2193-2204.

16.   Guidelines on myocardial revascularization, Eur. Heart J. 2010; doi 10.1093/eurheartj/ehj277.

17.   Kushner F.G., Hand M., Smith S.C., et al. 2009 Focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guidline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): A report of the American College of Cardiology Foundation/ American Heart Assotiation Task Force on practice guidelines. J. Am. Coll. Cardiol. 2009; 54: 2205-2241. 

Abstract:

Revascularization strategy definition in acute coronary syndrome in patients with multivessel coronary artery disease is a significant problem of modern intervention cardiology Aim: was to evaluate effectiveness of special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» designed to the revascularization strategy definition ir acute coronary syndrome patients.

Materials and methods: revascularization strategy of 50 acute coronary syndrome patients was analyzed. In all cases the revascularization strategy was defined by the group of intervention cardiologists with the help of independent experts and special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance». Experts-, physicians-, and soft- based revascularization strategies were compared among themselves.

Results: complete coincidence between expert-based and soft-based revascularization strategies was registered in 66% patients and the incomplete coincidence - in 32% patients. Complete mismatch between expert-based and soft-based revascularization strategies was registered in 2% patients. The complete coincidence between physicians-based and soft-based revascularization strategies was registered in 42% patients and the incomplete coincidence - ir 52% patients. Complete mismatch between physicians-based and soft-based revascularization strategies was registered in 6% patients

Conclusion: as well as experts, special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» provide success in the revascularization strategy definition 1г acute coronary syndrome patients with multivessel coronary artery disease.

References

1.     Hsieh V., Mehta S.R. How should we treat multi-vessel disease in STEMI patients? Curr. Treat. Options. Cardiovasc. Med. 2013; 15(1): 129-136.

2.     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; 67(3): 264-272.

3.     Ayalon N., Jacobs A.K. Incomplete revascularization in patients treated with percutaneous coronary intervention. When enough is enough. J. Am. Coll. Cardiol. Intv. 2016; 9(3): 216-218.

4.     Iqbal M.B., Ilsley C., Kabir T. et al. Culprit vessel versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction and multivessel disease: real-world analysis of 3984 patients in London. Circ. Cardiovasc. Qual. Outcomes. 2014; 7: 936-943.

5.     Kornowski R., Mehran R., Dangas G. et al. Prognostic impact of staged versus «one-time» multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J. Am. Coll. Cardiol. 2011; 58: 704-711.

6.     Tarasov R.S., Ganyukov V.I., Shilov A.A. i dr. Prognosticheskaya znachimost shkaly SYNTAX v ocenke iskhodov i vybora taktiki revaskulyarizacii u pacientov s infarktom miokarda i podemom segmenta ST pri mnogososudistom porazhenii koronarnogo rusla. [Prognostic impact of the SYNTAX scale in the evaluation of outcomes and choice of revascularization tactic in patients with myocardial infarction and ST-segment elevation with multi-vessel coronary artery disease]. Terapevtichesky arhiv. 2012; 84 (9): 17-21 [In Russ].

7.     Petrosyan Yu.S., Ioseliani D.G. O summarnoy ocenke sostoyaniya koronarnogo rusla u bolnyh ishemicheskoy boleznyu serdca. [About cumulative assessment of coronary arteries disease in patients with myocardial ischemia]. Mezhdunarodny zhurnal intervencionnoy kardioangiologii. 2013; 37: 49-55 [In Russ].

8.     Petrov V.I., Nedogoda S.V. Medicina, osnovannaya na dokazatelstvah: uchebnoe posobie. [Medicine-based evidence: a tutorial]. Moscow. 2009: 144 [In Russ].

9.     Kaul P., Ezekowitz J.A., Armstrong P.W. et al. Incidence of heart failure and mortality after acute coronary syndromes. Am. Heart J. 2013; 165(3): 379-385.

10.   El-Hayek G.E., Gershlick A.H., Hong M.K. et al. Metaanalysis of randomized controlled trials comparing multivessel versus culprit-only revascularization for patients with ST-segment elevation myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention. Am. J. Cardiol. 2015; 115(11): 1481-1486.

11.   Antman E.M., Anbe D.T., Armstrong P.W. et al. ACC/AHA Guidelines for the management of patients with ST-Elevation myocardial infarction-executive summary. A report of the American College of Cardiology / American Heart Association task force on practice guidelines (Writing Committee to revise the 1999 Guidelines for the management of patients with acute myocardial infarction). Circ. 2004; 110: 588-636.

12.   Windecker S., Kolh P., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. The task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2014; 35: 2541-2619.

13.   Bainey K.R., Mehta S.R., Lai T. et al. Complete versus culprit only revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a systematic review and meta-analysis. Am. Heart J. 2014; 167: 1-14.

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.