Abstract:

Aim: was to compare results of using of direct stenting and coronary artery stenting after pre-dilation (CSaPD) in STEMI patients with occlusive coronary artery thrombosis in terms of frequency of no-reflow syndrome and adverse cardiovascular events (MACE) during in-hospital period.

Material and methods: study included 620 patients with acute myocardial infarction with elevation of the ST segment of the electrocardiogram and occlusive thrombosis of the infarct-dependent coronary artery, who successfully underwent endovascular revascularization by stenting. The CSaPD group included 297 patients who underwent stenting after a preliminary balloon angioplasty. The direct stenting group consisted of 323 patients who underwent stenting without prior dilation. The primary endpoint of the study was the occurrence of no-reflow syndrome, secondary endpoints were cardiac death, certain stent thrombosis, recurrence of myocardial infarction, as well as the combined MACE point. Patients of both groups were monitored during in-hospital period.

Results: there were no significant differences between the groups of CSaPD and direct stenting in main clinical-demographic and clinical-angiographic indicators, with the exception of the average length of hospitalization (11 [8;12] vs 8 [7;9], respectively, p = 0,04). Endpoint analysis revealed differences in the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting groups, respectively, p = 0,03), cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04), as well as the combined MACE point (37 (12,46%) vs 8 (2,48%) in the CSaPD and direct stenting groups, respectively, p = 0,02).

Conclusion: in STEMI patients with occlusive coronary artery thrombosis, direct stenting of the infarct-dependent artery during the restoration of coronary blood flow to TIMI I after passage of coronary guide-wire, significantly reduces the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting, respectively, p = 0,03) and cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04).

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: one of directions in development of intravascular diagnostic methods is creation of stations or development of methods that allow combining or uniting possibilities of different modalities. This approach makes it possible to overcome limitations inherent in each method of invasive vascular diagnostics, including angiography. This work is devoted to the analysis of possibilities and first results of using the SyncVision station (Philips Volcano), which allows, in various combinations, to carry out joint registration of angiography data, intravascular ultrasound (IVUS) and instantaneous blood flow reserve (iFR) in various combinations - a non-hyperemic version of fractional flow reserve study.

Aim: was to describe possibilities provided by the use of joint recording of data from angiography, IVUS and real-time instantaneous blood flow reserve, the technique for performing these procedures, as well as to analyze the application of these methods in a department with a large volume of intravascular studies.

Material and methods: the first experience in Russian Federation of the clinical use of the SyncVision station, which is an addition to the s5i intravascular ultrasound system (Philips Volcano), is presented. The station allows you to implement five options that expand the operator's ability to analyze study data and develop a treatment strategy directly at the operating table: co-registration of angiography and intravascular ultrasound (IVUS) data; co-registration of angiography data and instantaneous flow reserve (iFR); triple co-registration - angiography, IVUS and iFR; modification of the program for the quantitative calculation of coronary artery stenosis (QCA); real-time image enhancement software for interventional devices.

Results: studies using co-registration with angiography accounted for 21% of all IVUS procedures and 62,4% of iFR procedures. In 67,3% of all studies with angio-IVUS co-registration, the indication for this diagnostic variant was an extended lesion of artery, which required clarification of length of stenotic area, localization of reference segments, and diameter of artery at different levels. In 30 of these patients, triple co-registration was performed. To clarify the hemodynamic significance of lesion with an angiographically indeterminate or borderline picture, co-registration was performed in 13,2% of all cases, to study a bifurcation lesion with a significant difference in the reference segments and angiographically difficult to determine the entry of lateral branch - in 7,3%.

Based on results of triple co-registration, the decision to perform surgical treatment was made in 30 out of 42 patients (71,4%).

Conclusion: joint registration of IVUS data, coronary angiography, and instantaneous flow reserve (iFR) in real time, forms a new diagnostic modality that significantly expands possibilities of intraoperative examination and affects the planning or analysis of intervention results.

Abstract:

Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization.

Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access.

Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration.

Medical consilium decided to perform staged endovascular revascularization of the myocardium.

For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used.

Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis.

Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.

Abstract:

Aim: was to evaluate the safety and efficacy of delayed endovascular treatment without stent implantation in ST-elevation myocardial infarction (STEMI) caused by massive thrombotic load and ectasia of infarct-related coronary artery.

Material and methods: out of 4263 primary percutaneous coronary interventions (PCI) performed for STEMI for the period from January 2016 to September 2021, retrospective analysis included data of 21 patients with ectasia of infarct-related coronary artery and massive thrombotic load (TTG ? 3).

Results: method of delayed endovascular treatment, without stent implantation, in STEMI caused by massive thrombotic load and ectasia of infarct-related coronary artery, allowed to significantly improve parameters of epicardial coronary blood flow according to  TIMI and CFTC scales in 71% and 67% of examined patients (p <0,001, p=0,001); increase myocardial perfusion according to MBG in 62% of patients (p=0,001); reduce the severity of thrombotic load according to TTG scale in 71% of the subjects (p=0,001).

Conclusion: in patients with ST-elevation myocardial infarction caused by massive thrombotic load and ectasia of infarct-related coronary artery, the strategy of delayed endovascular treatment with-out stent implantation is safe and effective at the hospital stage.

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:

Aim: was to determine the influence of blood plasma fibrinogen level on results of the left main coronary artery stenting.

Material and methods: clinical, laboratory and angiographic parameters of 819 patients after elective stenting of the unprotected left main coronary artery were used. The end-point was target lesion failure (TLF), including adverse events as repeated revascularization of the target lesion (TLR), myocardial infarction (MI) and death from cardiac causes.

Results: in 5 years follow-up period, end-point was achieved in 158 cases (19,3%). Independent predictors of TLF were: SyntaxScore > 32 (HR 1,089 95% CI 1,029-1,153, p = 0,003), creatinine level (HR 1,009 95% CI 1,004-1,013, p=0,001) and fibrinogen level (HR 1,4 95% CI 1,169-1698, p=0001). According to results of the Kaplan-Meier analysis, the cumulative probability of the TLF was higher in patients with fibrinogen values greater than 3,48 g/L (log-rank 0,001).

Conclusion: blood plasma fibrinogen level was an independent predictor of the TLF after left main coronary artery stenting. Increase in the level of blood fibrinogen for each 1 g/L led to an increase in the risk of TLF by 1,4 times per month.

References 

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8.     Ou Baiqing, Yang Yulian, Chen Zhimin, et al. The Effect of Lumbrokinase on the Fibrinogen Increase Following Percutaneous Coronary Intervention. Chinese Journal of new Drugs. 2004; 13(12): 1158-60.

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Abstract:

Background: clinical case of a rarely encountered pathology (0.1-3.5%) in cardiac surgery, such as the aneurysm of the left coronary artery (LCA), is presented. It was detected and analyzed by coronary angiography and coronary CT angiography

Aim: was to show possibilities of radiation research methods in identifying and evaluating of coronary artery aneurysms.

Materials and methods: a 67-year-old patient was referred to the Federation National Center of Cardiovascular Surgery (Penza) for follow-up examination (coronary angiography) and to decide on the choice of management due to the presence of critical aortic valve stenosis. Performed coronary angiography and subsequent coronary CT angiography for demonstrate the topography of the aneurysm.

Results: according to the data of coronary angiography at the region of trifurcation of the LCA or the anterior descending artery, intermediate and circumflex arteries a large-sized aneurysm is visualized. Due to coronary CT angiography data, the one is located at a distance of 1.0 cm from the entrance of the LCA in the area of trifurcation. It's presented by an aneurysmal dilatation of a rounded shape 1.3 cm in diameter with locally calcific walls.

Conclusion: coronary angiography and coronary CT angiography made it possible to identify anc examine individual morphological features of the anatomy of the coronary artery aneurysm, as well as demonstrate and take apart its topography to clearly, which in turn made it possible to rationally determine the management of the patient.

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Abstract:

Aim: was to evaluate the efficacy of MSCT in assessment of long-term graft patency after coronary artery bypass graft surgery (CABG).

Material and methods: 25 patients with multi-vessel coronary artery disease were included in the research. To assess the 5-year graft patency, MSCT arteriography was performed.

Results: a total of 96 grafts (22 left internal thoracic artery (LITA) and 74 saphenous venous grafts (SVG)) were analyzed using MSCT There were 12 venous sequential grafts and 19 venous Y-shaped grafts determined. During the assessment of graft patency, 13 occlusions of venous grafts and 1 hemodynamically significant stenosis were detected. Occlusion and hemodynamically significant stenosis of mammary grafts were not observed.

Conclusion: MSCT arteriography, allows to determine occlusive and hemodynamically significant stenoses of SVG. Results of study shows the prevalence of SVG occlusions and stenosis over arterial grafts. CT angiography can be highly informative for assessing the patency of grafts in late periods after CABG. 

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Abstract:

Article describes a case report of successful treatment of coronary artery perforation using handmade stent-graft, ex tempore made of coronary balloon and two bare-metal stents. Article also reports results of follow-up, including control angiography and optical coherence tomography 3 months later. 

References

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2.     Shirakabe A., Takano H., Nakamura S., Kikuchi A., Sasaki A., Yamamoto E. et al. Coronary perforation during percutaneous coronary intervention. Int Heart J. 2007; 48(1):1-9.

3.     Lansky A.J., Yang YM., Khan Y, Costa R.A., Pietras C., Tsuchiya Y et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006; 98(3): 370-4.

4.     Sarli B., Baktir A.O., Saglam H., Kurtul S., Dogan Y., Aring H. Successful Treatment of Coronary Artery Perforation with Hand-Made Covered Stent. Erciyes Med J. 2013; 35(3):164-6 • DOI: 10.5152/etd.2013.20.

5.     Copeland K.A., Hopkins J.T., Weintraub W.S., Rahman E. Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation. Catheter Cardiovasc Interv. 2012; 80(1):53-7.

Abstract:

Introduction: for assessment of the significance of coronary artery stenosis, it is necessary to determine the minimum area of the residual square of the vessel lumen (VLRS) that can provide adequate blood flow to myocardial needs. This value is called «threshold» or «borderline». Numerous studies on this issue using modern intravascular and isotope techniques, randomized clinical trials have shown that the values of the «borderline» value of VLRS for proximal coronary arteries are within 3-4 mml. According to the literature, the angiographic method for assessing the severity of stenosis is not sufficiently informative and unreliable. In this article, a combination of coronary angiography with use of balloon catheter is proposed, that allows to eliminate disadvantages of the angiographic method in solving the task is shown.

Aim: was to investigate possibilities of the method of determining the VLRS of coronary artery (CA) in the stenosis region and to assess its hemodynamic significance based on coronary angiography (CG) using a balloon catheter

Materials and methods: the essence of the proposed approach is the obstruction of the artery at the site of stenosis with a balloon catheter with a known cross-sectional area; the VLRS value in this case is equal to or smaller than the area of the balloon catheter. In case of obstruction of the artery by balloon catheter with a transverse area up to 4 mm2, stenosis was considered to be hemodynamically significant and revascularization was recommended; with preserved intensive blood flow, stenosis is considered hemodynamically insignificant.

Results: angiogram evaluation was performed in 120 patients with IHD with «intermediate» stenoses of proximal coronary arteries (from 40 to 70%) using the described technique. In 84% of cases, VLRS was estimated at 3,14 mm2 or less; in 8% of the VLRL was 3,86 mm2 or less. In such areas of coronary arteries, stenosis was considered hemodynamically significant. These patients underwent revascularization of the myocardium - balloon angioplasty and stenting of the coronary artery In 8% of cases, VLRS was more than 4 mm2, coronary stenosis in such cases was recognized as hemodynamically insignificant, and endovascular treatment was not performed in these patients.

Conclusion: the proposed approach for assessment of the area of the residual square of coronary artery lumen at the site of constriction provides an opportunity for an optimal choice of treatment tactics. 

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Abstract:

Authors present results of simultaneous transluminal coronary interventions (TCI) (stenting) in coronary patients with triple vessel disease. Stenting of right coronary artery (RCA) and major branches of left coronary artery (LCA) was performed in 44 patients with coronary artery disease, having angina of III—IV functional classes. In total 1 83 coronary stents were implanted (1 66 «Cypher» and 17 «BxVelocity»). Stents «Bx Velocity» were used only coronary arteries with diameter > 3,5 mm. 3 stents were implanted in 22 cases, 4 — in 9, 5 — in 4, 6 — in 4 and 7 — in 7. TCI were successful in all patients, with restoration of coronary blood flow up to TIMI III through stented segments. Clinical effectiveneness of TCI during long-term follow-up (up to 32 months) was 100%, patient's survival — 90,9%. In 3 patients (6,8%) restenosis developed inside drug-coated stents (4,8%). Repeated stenting was performed with satisfactory clinical and angiographic results. Complete transluminal coronary revascularization is an effective method for treatment of patients with multiple coronary lesions. It provides return to high level of life quality.

Reference 

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2.     Daemen S., Serruys P.W. Optimal revascularization strategies for multivessel coronary artery disease. Curr. Opin. Cardiol. 2006; 21(6): 595-601.

3.     Vaina S., Touchida K., Serruys P.W Treatment options for multivessel coronary artery desease. Expert Rev. Cardiovasc. Ther. 2006; 4(2): 143-147.

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5.     Legrand VH., Serruys P.W, Unger E et al. Three-year outcome after coronary stenting versus bypass surgery for the treatment of multivessel disease. Circulation. 2004; 109(9): 1079-1081.

6.     Алекян Б.Г., Бузиашвили Ю.И., Стаферов А.В. Ангиопластика при множественном поражении коронарных артерий. М.: НЦССХ им. А.Н. Бакулева РАМН. 2002; 146-178.

7.     Меркулов Е.В., Ширяев А.А., Самко А.Н. и др. Сравнительная оценка результатов ангиопластики и коронарного шунтирования у больных ИБС с многососудистым поражением коронарного русла. Материалы 1-й межрегиональной конференции по проблемам кардиологии. Ханты-Мансийск. 2003; 65. 

8.     Babunashvili A.M., Iudin I.E., Dundua D.P., Kartashov D.S., Kavteladze Z.A. Efficacy of the use of sirolimus covered stents in the treatment of diffuse atherosclerotic lesions of coronary arteries. Cardiology. 2006; 46 (11): 21- 29.

Abstract:

Lesions of the LCA stem are found in 2,5-4 % of patients with coronary heart disease who endured coronography, and are accompanied by more severe symptomatology, higher morbidity and mortality rates, and difficulty of radical correction. According to the generally accepted guidelines, the operation of coronary artery bypass has up to now been a method of choice in treatment of the LCA stem. Nevertheless, endovascular methods of treatment for LCA stem lesions have relatively long been used, while implementation into clinical practice of drug-eluding stents has considerably improved the remote outcomes, which made it possible to consider LCA stem stenting as a real alternative to ACB. Hence, the problem concerning indications for and contraindications to LCA stem stenting remains unsolved today. We retrospectively analysed a total of 75 endovascular interventions on the LCA stem in 67 patients, with an isolated lesion of the LCA stem being found only in 7,4 % of the patients. The remaining subjects had lesions of the LCA stem on the background of a multivascular lesion of the coronary bed, including occlusion of the RCA observed in 16,4 % of cases. Successive revascularization was performed in 98,64 % of cases, with no lethal outcomes. One patient required urgent ACB due to development of occluding dissection of the circumflex branch. Complications in the immediate postoperative period were observed in two patients and were represented by non-Q myocardial infarction and stroke. LCA stem stenting proved an efficient and safe method of treatment for coronary heart disease. A comparative analysis of the immediate results of LCA stem stenting and ACB revealed advantages of stenting, consisting in no lethal outcomes (in our series) and a lower short-term rate of postoperative complications.

Reference

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12.   TakagiT, Stankovic G, Finci L, Toutouzas K, Chieffo A, Spanos У Liis-tro F, Briguori C, Corvaja N, Albero R, Sivieri G, Paloschi R, Di Mario C, Colombo A. Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery. Circulation. 2002; 106: 698 - 702.

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16.   Бокерия Л. А., Алекян Б. Г., Бузиашвили Ю. И. и др

Abstract: 

Aim: was to give a literature review normal coronary anatomy, described patterns of anomalous coronary arteries by using multislice computed tomography (MSCT).

Materials and methods: 1104 computed tomography coronary angiography (CCTA) was made in «Fedorovich Clinikasi» for the period of 2011-2016. The age of patients ranged from 7 to 82 years. Men were 790 (71.5%), women - 314 (28.5%). The study was carried out on the multislice spiral CT scanners Brilliance 64 and Brilliance i-CT 256 (PHILIPS).

Results. In 32 (2,9%) cases we detected anatomical variations as conus artery high take-off of a coronary ostium, myocardial bridging, shepherd's crook deformation of right coronary artery 23 (2%) patients had coronary artery anomaly (CAA) as a single coronary artery, absence of circumflex artery, hypoplasia of coronary artery, intra-atrial location, origin from the opposite coronary sinus of Valsalva, separate discharge of the LAD and circumflex from aorta, Blunt-White-Garland syndrome, coronary fistulas, aneurysms of coronary arteries. When a CAA is found, the exact origin, course and its position with other cardiac structures must be described in detail.   

References

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Abstract:

Choice of treatment strategy in patients with recurrent angina after coronary artery bypass graft surgery (CABG) is still an actual question. Repeat CABG is associated with an increased risk of mortality and large cardiovascular events, so percutaneous coronary intervention (PCI) is the main strategy in these patients. Criteria for choosing between the bypass and the native vessel stenting are not fully understood, as well as not resolved the question of the differentiated approach to the choice of defeat for stenting

Aim: was to compare long-term results of stenting of bypass and native coronary arteries in patients with recurrent angina after CABG using the algorithm proposed in the study.

Materials and methods: study was conducted in 2010-2014 years. in «3rd Central Military Clinical Hospital named after A.A.Vishnevsky of Ministry of Military Defence». A total of 168 patients with the defeat of coronary bypass graft were operated: revascularization of the native vessel - 80 patients, stenting of coronary bypass graft was performed in 88 patients.

Treatment groups were comparable in all major clinical characteristics of patients, as well as on the number of affected arteries, the total number of bypasses, the number of working bypasses, and diffuse lesion of the native channel.

The degree of stenosis of the native vessel was significantly higher in the second group, and the degree of stenosis of bypasses was significantly higher in the first group. Diffuse lesions of coronary bypasses were significantly more frequent in the first group.

Long-term results of the study were followed up in patients in the observation period of 3 to 36 months (mean follow-up was 21(14-27) months). The average duration was not significantly different between treatment groups.

Results: the incidence of myocardial infarction was comparable between groups. In group of coronary bypass graft stenting, revascularization procedures frequency was higher than in the native vessel revascularization (20,45% and 16,25%, respectively, p = 0,0045), and also had a higher incidence of target lesion revascularization (11.36% and 6.25%, respectively, p = 0,0045).

The cumulative rate of major cardiovascular events did not differ significantly, but there was a certain tendency toward a lower incidence of major cardiovascular events in the group of revascularization of the native vessel. 

References 

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4.    Brilakis E.S., Wang T.Y, Rao S.V., et al. Frequency and predictors of drug-eluting stent use in saphenous vein bypass graft percutaneous coronary interventions: a report from the American College of Cardiology National Cardiovascular Data CathPCI registry. JACC Cardiovasc Interv. 2010; 3:1068-73.

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6.    Brilakis E.S1, Rao S.V., Ba

Abstract:

Purpose. To assess the effectiveness of palliative endovascular interventions in patients with CTO anatomy infavorable for recanalisation.

Material and methods. The authors analyzed the results of interventions in 60 patients (50 male (83,3%), 10 female (16,7%)) aged 38 – 75 years (mean age 53,9±3,2), with occlusive coronary disease. Palliative revascularizations were performed in 30 patients, and CTO recanalization was done in 30 cases. The LV function was assessed echocardiographically in both groups before and after the intervention.

Results. 12 month follow-up showed significant improvement or normalization of LV function in both groups. Results of palliative interventions were shown to be as effective as recanalization of CTO.

Conclusions. Endovascular palliation is effective in treatment of patients with coronary CTO. It results in myocardial function improvement comparable to that in patients with complete coronary revascularization.   

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7.        Араблинский А.В. Степень реваскуляризации миокарда с помощью транслюминальной баллонной ангиопластики у больных с многососудистым поражением коронарного русла. Международный медицинский журнал. 2000; 1: 2–6.

8.        Ott R.A., Tobis J.M., Mills T.C., Allen B.J., Dwyer M.L. ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. Department of Cardiothoracic Surgery, University of California. Irvine Medical Center. 2006.  

9.        Gaudino M., Santarelli P., Bruno P., Piancone F.L., Possati G. Palliative coronary artery surgery in patients with severe noncardiac diseases. Department of Cardiac Surgery, Catholic University. Rome. Italy. 2006.  

10.      Гринхальх Т. Основы доказательной медицины. Учебное пособие. М. 2004; 58.  

11.      Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Кардиология. 1976; 12 (16): 41–46.

12.      Петросян Ю.С., Шахов Б.Е. Коронарное русло у больных с постинфарктной аневризмой левого желудочка сердца. Горький. 1983; 17–37.

13.      Rahimtoola S.H. The hibernating myocardium. Ibid. 1989; 117: 211–221.

Abstract:

Aim: was to investigate possibilities of multislice computed tomography in estimation of stenosis degree in coronary arteries in patients with ischemic heart disease (IHD).

Materials and methods: we examined 64 patients (18 female, 46 male, mean age 62,4± 9,5 years), who primary had been admitted to hospital and had high risk of IHD; and those who had early diagnosed IHD of 1,2,3 and 4 functional class, they were hospitalized for condition correction. Mainly spreaded risk factor was arterial hypertention in 55 patients - (85,9%) with highest level 200/100 mm hg and minimal 140/80 mm hg. All patients underwent multislice computed tomography (MSCT) on the 256-slice tomography station «Somatom definition flash (Siemens, Germany)»: collimation 128 x 0,6, the temporal resolution of 75 ms and a spatial resolution of 0.33 mm, slice thickness of 0.6 mm, with simultaneous use of two tubes with different voltage (kV 120/100), the current mAs - with programs to reduce radiation exposure Care Dose - is calculated automatically according to the constitution of man.

Post-processing of obtained data was performed on a workstation Syngo Via, in the application of CT-Soronary with automatic longitudinal separation of each coronary artery In view of image quality was analyzed data from end-diastolic phase of the cardiac cycle (80% R-R), or evaluated complex of multiphase images. We analyze the state of the main arteries of the main coronary: left anterior descending artery, the circumflex artery and the right coronary artery (LAD, CA, RCA). We performed estimation of coronary artery stenosis of segments according to the American Heart Association (AHA). Results were displayed in percentage. Obtained data was compared with those obtained using the reference method - X-ray coronary angiography, which was performed according to standard protocol

Results: comparison of results of coronary angiography and MSCT using correlation analysis showed the presence of strong direct significant correlation coefficients in the evaluation of coronary artery disease according to two methods. It was demonstrated a high inter-operator and intraoperator reproducibility of MSCT in the study of vessels conditions. Following characteristics of the method related to the identification of coronary artery stenosis segments: sensitivity - 95.8%, specificity - 92.8%, diagnostic accuracy - 95.1%, positive predictive value - 97.9%, negative predictive value - 86.6 %.

It was concluded that the high importance of the method of MSCT in the diagnosis of cardiovascular diseases and the need for its widespread use in cardiology practice.  

References 

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3.    Sun Z., Choo G.H., Ng K.H. Coronary CT angiography: current status and continuing challenges. Br. J. Radiol. 2012; 85: 495-510.

4.    Sun Z., Aziz YF., Ng K.H. Coronary CT angiography: how should physicians use it wisely and when do physicians request it appropriately. Eur. J. Radiol. 2012; 81: 684-687.

5.    Haberl R., Tittus J., Bohme E. et al. Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: an effective filter before catheter angiography. Am. Heart J. 2005; 149: 1112-1119.

6.    Steigner M.L., Otero H.J., Cai T. et al. Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography. Int. J. Cardiovasc. Imaging. 2009; 25: 85-90.

7.    Achenbach S., Marwan M., Schepis T. et al. High-pitch spiral acquisition: a new scan mode for coronary CT angiography. J. Cardiovasc. Comput. Tomogr. 2009; 3: 117-121.

8.    Budoff M.J., Dowe D., Jollis J.G. et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J. Am. Coll. Cardiol. 2008; 52: 1724-1732.

9.    Petcherski O., Gaspar T., Halon D. et al. Diagnostic accuracy of 256-row computed tomographic angiography for detection of obstructive coronary artery disease using invasive quantitative coronary angiography as reference standard. Am. J. Cardiol. 2013; 111: 510-515.

10.  De Graaf F.R., Schuijf J.D., Van Velzen J.E. et al. Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur. Heart J. 2010; 31: 1908-1915.

Abstract:

In present time coronary angiography remains the "gold standart" in ischemic heart disease diagnostics. The correlation between angiographic or intravascular ultrasound (IVUS) variables and fractional flow reserve (FFR) in patients with intermittent lesion remain unclear. The aim of this article is to demonstrate complimentary use of fractional flow reserve evaluation and intravascular ultrasound for achieving optimal results during PCI.

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 

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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).

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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.

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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:

We had analyzed percutaneous coronary intervention (PCI) of non-standard complications - coronary artery dissection with extension on the eft main coronary artery (LMCA) and aorta. There was the coronary dissection of LMCA and aorta after left internal thoracic arteries and left anterior descending anastomosis (LIMA-LAD) balloon predilatation. Satisfactory angiographic result was achieved with blood flow TIMI III after stent implantation. In connection with the stable condition of the patient there was no endovascular or surgical treatment. The patient had stable hemodynamics in hospital period. The angiografic control was performed after 8 days. There was no coronary and aorta dissection and stent-thrombosis.

In conclusion in can be said that conservative tactics may be useful in a case of retrograde coronary and aorta dissection after LIMA-LAD stent mplantation.

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11.  Moussa I. et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation. 1999; 99:

Abstract:

Purpose. Оf the study was to determine abilities of multislice spiral tomography (MSCT) in detection coronary artery disease (CAD) in patients with atypical angina..

Material and methods. Sixty patients (39 men) with atypical chest pain and suspected ischemic heart disease underwent complex diagnostic strategy. Value of MSCT in detection of significant (more than 50%) coronary artery stenoses was assessed by segmental analysis, vascular bed involvement, and patient analysis.

Results. Significant CAD in 8% of patients with atypical angina was revealed. In 98,7% (58 of 60 cases) MSCT allowed to specify coronary anatomy. In 53 (88,3%) of patients no significant CAD was found, in 5 cases (8,3%) MSCT confirmed significant coronary artery stenoses. Sensitivity, specificity, positive and negative prognostic value of MSCT were correspondingly 100%, 99,3%, 71,4%, 100% in segmental analysis (n = 295). Vascular territory involvement analysis (n = 91) showed 100% sensitivity, 97,7% specificity, positive prognostic value 71,4% and negative prognostic value 100%.

Conclusions. High prognostic value, as well as high sensitivity and specificity of MSCT allow us to include this method into the CAD diagnostic algorithm in patients with atypical chest pain. This method is highly reliable in eliminating of significant CAD and detecting coronary artery stenoses.

References 

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3.      Hoffman M.H. et al. Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005; 293: 2471-2478.

4.      Leber A.W. et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography. A comparative study with quantitative coronary angiography and intravascular ultrasound. J. Am. Coll. Cardiol. 2005; 46: 147-154.

5.      Leschka S. et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur. Heart. J. 2005; 26: 1482-1487.

6.      Mollet N.R. et al. Highresolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 2005; 112: 2318 -2323.

7.      Raff G.L. et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J. Am. Coll. Cardiol. 2005; 46: 552-557.

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10.    Patel M.R. et al. Low diagnostic yield of elective coronary angiography. N. Engl.J. Med. 2010; 362: 886-895.

11.    Leber A.W. et al. Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur. Heart. J. 2007; 28: 2354-2360.

12.    Hausleiter J. et al. Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease. Тhe Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial. Eur. Heart. J. 2007; 28: 3034-3041.

13.    Goldstein J.A. et al. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J. Am. Coll. Cardiol. 2007; 49: 863-871.

14.    Hoffmann U. et al. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease. Patient-versus segment-based analysis. Circulation. 2004; 110: 2638-2643.

Abstract:

For long time the only method of postinfarction myocardial «scars» topical diagnostics was ECG. Contrast-enhanced magnetic resonance (CE-CMR) is considered to be a highly informative technique for location and quantification of myocardial necrotic areas, but there are few studies comparing the method with conventional ECG. CE-MR/ECG correlation was studied in 59 patients with postinfarction changes. The global concordance between CE-MR and ECG was of 80%. In 5 cases (1 - anterolateral, 2 - inferior and 2 - inferolateral). ECG-pattern was misleading.

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15 .  Беленков Ю.Н., Терновой С.К. Функциональные методы диагностики сердечно-сосудистых заболеваний. М.: «ГЭОТАР-МЕДИА». 2007.

Abstract:

Importance: despite generally promising outcomes after stenting for unprotected left main coronary artery (ULMCA) disease, the ULMCA bifurcation lesions remain challenging, and their restenosis rate is still relatively high.

Objective: aim of the current study was to analyze possible factors influencing one year MACE rate in distal ULMCA patients.

Design, setting and patients: from year 2002 until end of year 2011 at Latvian Centre of Cardiology Pauls Stradins Clinical University hospital in ULMCA registry 1052 patients were enrolled. Interventions: In 723 patients distal bifurcations were treated, out of them in 449 patients one year follow-up were completed and those patients were included in current analyses Main outcome measures: cardiac death, target vessel revascularization (TVR), target lesion revascularization (TLR), major cardiac adverse events (MACE) were assessed at one year.

Results: two stent technique was used in 8,5% of cases. MACE, cardiac death, TVR and TLR rates at one year was 15,6%, 2,9%, 4,7% and 12,9%, respectively Cardiac death was associated with diabetes mellitus and NSTEMI, however, TLR was associated with SYNTAX score >30. MACE was associated with NSTEMI and 2 stent technique. True bifurcation was not associated with adverse cardiovascular outcomes.

Conclusions: Use of two stent technique and NSTEMI at presentation were associated of MACE at one year in distal ULMCA patients. 

References

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2.     Wijns W., Kolh P, Danchin N. et al. 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. 2010;31 (20):2501-55.

3.     Chieffo A., Stankovic G., Bonizzoni E. et al. Early and mid-term results of drug-eluting stent implantation in unprotected left main. Circulation. 2005;111(6):791-5.

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7.     Park S.J., Kim YH., Lee B.K. et al. Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation. J. Am. Coll.Cardiol. 2005; 45(3):351-6.

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22.   Meliga E., Garcia-Garcia H.M., Valgimigli M. et al. Diabetic patients treated for unprotected left main coronary artery disease with drug eluting stents: a 3-year clinical outcome study. The diabetes and drug eluting stent for LeFT main registry (D-DELFT). Eurolntervention. 2008; 4(1):77-83. 

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.

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Abstract:

Aim: was to study properties of nanostructured carbon coating stents in coronary arteries with the help of intravascular ultrasonic visualization.

Materials and Methods: experimental implantation of stents in coronary artery was performed on 8 yearling sheep. Estimation of bioinertness properties of stents was made by intravascular ultrasonic method on the 14, 28, 180 day. Bioinertness properties were estimated in comparison with analogical bare-metal stents.

Results: The analysis of results showed that in early stages (up to 28 days) experimental samples of stents cause less formation of trombus than simple balloon-extendable stents. In the period of late outcomes, coronary nanostructured carbon coating stents have lower level of «in-stent stenosis».

Conclusion: stent implantation with nanostructured carbon coating does not prevent the natural reparative processes taking place in the artery wall, does not cause the formation of thrombotic masses under standard doses of antiaggregants. Experimental stents significantly less affected in-stent stenosis, than stents without surface modification, indicating their higher bioinertness. 

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Abstract:

Aim: was to show capabilities of MDCT-angiography of coronary arteries in the detection and characterization of rare forms of anomalous coronary arteries from the pulmonary artery in adult patients

Materials and methods: we made retrospective study of anomalous coronary arteries from pulmonary arteries in patients who have been examined and operated in our Center for the period of 2008-2013. All patients on admission underwent: echocardiography, selective coronary angiography and MDCT coronarography Postoperatively - echocardiography and MDCT coronarography.

Results: for the period of 5 years about 30,000 patients underwent examination in our center, and congenital anomalous coronary arteries from the pulmonary artery was identified only in 6(0,02 %) cases. 4( 0,013%) of them had «infantile» type - ALCAPA. In adults, anomalous coronary arteries from the pulmonary artery revealed in 2 cases: a 31 year woman had «adult» type ALCAPA (0,003%) and 17-year boy - isolated form ARCAPA (0,003%). Preoperative MDCT provided direct visualization of anomalous coronary arteries from the pulmonary artery, displayed the spatial relationship of coronary vessels in the three-dimensional image that helped to clarify and demonstrate for cardiac surgeons individual characteristics of congenital disorder. Marked dilatation and tortuous course of trunks and branches of coronary arteries, the severity of which declined after surgical correction. Adult patients successfully underwent surgical correction: reimplantation of anomalous coronary arteries in orthotopic position in cardiopulmonary bypass with the creation of two-coronary blood supply of the heart

Conclusions: Even in cases where a definitive diagnosis of anomalous coronary arteries from the pulmonary artery can be diagnosed by echocardiography and coronary angiography, before surgery is recommended to perform MDCT angiography to clarify the anatomy and more specific spatial representation of the topography of the anomalous vessel. In the late postoperative period this method allows to assess in details the condition of coronary flow and effectiveness of coronary intervention. 

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Abstract:

Aim: was to study possibilities of using thermographic equipment (TE) in coronary surgery (for evaluating coronary arteries' condition, quality of formed anastomosis and revascularization efficiency).

We examined 38 patients who underwent myocardial revascularization in condition of extracorporeal circulation.

Intraoperatively investigated 164 distal anastomosis of autotransplants with coronary artery (CA): 126 of which were vein autotransplant (great saphenous vein (GSV)), 38 - arterial autotransplant (left internal mammary artery (LIMA) - anterior interventricular branch (AIB)).

Absence of rough technical variations has been confirmed in all cases but one, when the leak as a thermal spot of extravasation was found.

In all 38 patients absence of thermal gradients on the surface of various myocardium area after reperfusion of myocardium was noted, which is perhaps (in our opinion) the sign of complete revascularization of myocardium.

Using of the TE was especially effective in detection of coronary arteries in cases when it was impossible by the conventional visual examination and epicardium palpation in patients with postinfarction adhesive process in pericardium (Dressler syndrome) or thick epicardium fat layer. In 2 patients with postinfarction in left ventricular aneurism the TE helped to distinguish viable myocardium from the scar.

Conclusion: the usage of the TE during a surgery is quite effective in examination of coronary arteries condition on a real-time basis, quality of distal anastomosis made, and adequacy of myocardial perfusion after its revascularization. 

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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.

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Abstract:

Aim: was to improve the efficiency of diagnosis of patients with coronary heart disease, by estimating of possibilities of cardiac multislice computed tomography in comparison with coronary angiography.

Materials and methods: study included 64 patients (18 women and 46 men, mean age 62,4 ± 9,5 years) with a high risk of developing coronary heart disease. In 34 patients - myocardial infarction in anamnesis (18 patients - in pool right coronary artery in 16 patients - in left anterior descending artery). Clinics of angina pectoris - in 40 patients (functional class (FC) I - 10; FC II - 22, FC III - in 6, FC IV - 2 patients). Selection criteria: the absence of disease progression for at least 6 weeks, and at least 3 months of optimal treatment. All patients underwent cardiac MSCT at 256-slice CT scanner. Obtained data was compared with data of reference method - x-ray coronary angiography.

Results: comparison of MSCT coronary angiography with invasive data showed a high comparability of results of two methods in the evaluation of coronary artery disease. It was revealed that discrepancies between cardiac MSCT and CAG in detection of hemodynamically insignificant stenoses ranging from 0 to 4%, hemodynamically significant stenoses - from 0 to 2.6%, subtotal stenosis - from 0 to 1%, occlusions - 0%. The presence of strong correlations between data of cardiac MSCT and coronary angiography of stenosis, demonstrated the high quality of MSCT imaging of coronary artery segments in the examination with a variety of modes of application method.

Conclusion: multislice computed tomography is a highly effective method for diagnosing of structural and anatomic changes of coronary arteries in patients with coronary heart disease.

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