Atherosclerotic Lesions In Coronary Arteries Research Articles

Association of multiple polygenic risk scores with myocardial infarction and atherosclerotic coronary artery lesions in a Canadian population

Association of multiple polygenic risk scores with myocardial infarction and atherosclerotic coronary artery lesions in a Canadian population

Pentraxin 3 as a marker of development and severity of stable coronary artery disease

PurposeInflammation plays a crucial role in the development of atherosclerotic plaques. Pentraxin 3 (PTX3) is produced at the site of inflammation and has been identified as a specific marker of atherosclerosis, vascular inflammation, and progression of the coronary artery disease (CAD).The aim of the study was to establish if PTX3 has potential relations with classical markers of cardiovascular risk, and if PTX3 may act as an independent risk factor of CAD occurrence and advancement. Materials and methodsThe study included 98 patients with stable CAD confirmed in coronary angiography (CAD group) (median age 65 interquartile range [IQR] 61–72 years; 72 ​% men). The control group consisted of 40 patients without CAD. ResultsThe CAD group had significantly higher PTX3 concentration compared to the control group. There was a correlation with age, male gender, lipid profile and intima-media thickness. There was no correlation between PTX3 concentration and the number of coronary vessels with significant atherosclerotic lesions and the advancement of atherosclerotic lesions on the Gensini scoring scale. The cut-off point was determined for 0.89 ​ng/ml for the exclusion of angiographically significant atherosclerotic lesions. ConclusionsPatients with CAD have significantly higher concentration of PTX3. There was no correlation between PTX3 and the advancement of angiographically significant atherosclerotic lesions in coronary arteries. Low PTX3 concentration may serve as an indicator for the absence of atherosclerosis.

Impact of ethnicity on aortic root dimensions in patients without atherosclerotic lesions in coronary arteries or the ascending aorta assessed by computed tomography angiography.

Impact of ethnicity on aortic root dimensions in patients without atherosclerotic lesions in coronary arteries or the ascending aorta assessed by computed tomography angiography.

Comparison of the Effect of Kombucha and Vitamin C on Coronary Arteries in Rabbits Exposed to Lead and High-cholesterol Diet

Background: Vitamin C and kombucha contain a high amount of glucuronic acid that can prevent cholesterol accumulation and convert cholesterol to a more water-soluble compound. Objectives: The aim of this study was to compare the effects of kombucha and vitamin C on the coronary arteries and aorta of male rabbits exposed to lead acetate fed with a high-cholesterol diet. Methods: Forty male rabbits were divided randomly into four groups of 10 animals. Group 1 served as a control group. Rabbits in group 2 received water containing 547 ppm of lead acetate and a high-cholesterol diet (1%). Group 3 received water containing 547 ppm lead acetate and a high-cholesterol diet (1%) in combination with ascorbic acid (500 mg/kg), and group 4 rabbits were treated with water containing 547 ppm lead acetate and kombucha extract (10 ml/kg) for 40 days orally on a high-cholesterol diet (1%). Results: The results showed that in groups 3 and 4, no significant atherosclerotic plaques could be detected in coronary arteries, compared to the control animals. However, large atherosclerotic plaques were observed in the aortas of those treated only with kombucha. The data were analyzed using analysis of variance (ANOVA) statistical methods. The mean ± standard error of the mean (SEM) triglyceride (TG) serum levels in groups 1, 2, 3, and 4 were 122.70 ± 66.77, 280.60 ± 88.66, 120.10 ± 8.33, and 107.86 ± 8.61 mg/dL, respectively. The mean ± SEM TG serum levels in groups 1, 2, 3, and 4 were 67.80 ± 10.33, 67.90 ± 10.10, 60.80 ± 8.16, and 58.71 ± 4.78 mg/dL, respectively. The mean ± SEM TG serum levels in groups 1, 2, 3, and 4 were 194.50 ± 6.58, 182.60 ± 13.75, 178.30 ± 18.01, and 166.00 ± 7.65 mg/dL, respectively. P-values for low-density lipoprotein (LDL), high-density lipoprotein (HDL), and TG were reported as P < 0.001, P = 0.077, and P < 0.001, respectively. Conclusions: It could be concluded that kombucha, unlike vitamin C, cannot prevent the formation of large plaques in the aorta, although it seems that it can prevent atherosclerotic lesions in coronary arteries. Therefore, further studies are required to evaluate the long-term use of kombucha to assess whether higher doses are beneficial in preventing atherosclerotic events or not.

The Gensini Score System is a Useful Tool in Assessing the Burden and Severity of Coronary Artery Atherosclerotic Lesions [Letter

The Gensini Score System is a Useful Tool in Assessing the Burden and Severity of Coronary Artery Atherosclerotic Lesions [Letter

Correlation of Serum Endocan Level With Apoptosis Indicators and Severity of Atherosclerotic Lesions of Coronary Arteries in Patients With Coronary Heart Disease.

Aim To study the relationship of blood serum concentration of endocan with indexes of apoptosis and clinical and instrumental characteristics of patients with ischemic heart disease (IHD).Material and methods The study included 176 subjects (105 men and 71 women). 150 of them were diagnosed with IHD and 26 were healthy volunteers. Anthropometric measurements, coronary angiography, echocardiography, duplex ultrasound scanning of extracranial parts of the brachiocephalic arteries were performed for all patients. Concentrations of endocan (ng / ml), glucose (mmol / l), and apoptotic markers Bcl-2 (ng / ml), Bax (ng / ml), Bcl-2 / Bax, TRAIL (pg / ml), and p53 (ng / ml) were measured in blood serum. Patients were divided into groups based on their SYNTAX scores: group 1 with moderate atherosclerotic lesions of the coronary arteries (CA) (score < 22, 78 patients); group 2 with severe CA atherosclerosis (score 23-32, 37 patients); and group 3 with extremely severe CA lesions (score >33, 35 patients). The control group consisted of healthy volunteers (26 subjects). All groups were age- and sex-matched. Differences were considered statistically significant at p<0.05.Results A correlation was found between endocan concentration and IHD severity (r=0.32, p<0.001). In group 1, the median endocan concentration was 14.57 ng / ml [8.21; 23.66], in group 2, 19.34 ng / ml [8.425; 26.645], in group 3, 32.13 ng / ml [18.2; 39.12], and in the control group, 6.92 ng / ml [4.62; 9.18]. Correlations of varying strength and significance were observed between the endocan concentration and a number of clinical and instrumental characteristics. Endocan concentrations significantly differed in groups of patients with multifocal atherosclerosis (p<0.01), angina pectoris (p<0.01), a history of myocardial infarction (p<0.001), and obesity (p<0.05) from patients without these signs. Also, a correlation was found between serum endocan concentration and apoptotic markers: TRAIL (r= -0.448, p<0.001); BCL-2 (r= -0.552, p<0.001), Bax (r= -0.519, p<0.001), Bcl-2 / Bax (r= -0.576, p<0.001) and p53 (r= -0.520, p <0.001).Conclusion The study demonstrated a potential role of endocan as a promising biomarker for risk stratification, prognosis and therapeutic monitoring of IHD patients.

Correlation analysis of central arterial pressure parameters and the severity of atherosclerotic lesions in coronary arteries: A retrospective study.

To investigate the correlation between central arterial pressure (CAP) parameters and the severity of atherosclerotic lesions in the coronary arteries, understand the value of CAP in assessing the risk of coronary heart disease (CHD), and provide a theoretical basis for the prevention and treatment of CHD. Between January 2021 and January 2022, 224 patients admitted to our hospital for complete coronary angiography (CAG) were included in this retrospective study. CAP parameters, including central systolic pressure (CSP), diastolic pressure (CDP), and pulse pressure (CPP), and Gensini scores were collected; the association between CAP parameters and the severity of coronary lesions was analyzed using the Pearson correlation coefficient (r) and multivariate regression analysis. CPP was significantly higher in the coronary multi-branch lesion group than in the single-branch lesion group in patients with CHD (P < .05). CSP, CDP, and CPP were significantly higher in the high Gensini score group than in the low Gensini score group for coronary vascular lesions; furthermore, CSP and CPP were significantly higher in the high Gensini score group than in the medium Gensini score group (P < .05). Pearson correlation analysis showed that CSP and CPP were positively and CDP was negatively correlated with the severity of coronary artery lesions in patients with CHD (P < .05). Logistic regression analysis showed that a history of diabetes, CSP, CDP, and CPP were independent risk factors for severe atherosclerotic lesions in the coronary arteries (P < .05). noninvasive CAP-related indices, such as CSP, CDP, and CPP, are independently correlated with and can be used to predict the severity of coronary lesions in patients with CHD, which may be beneficial for guiding clinical diagnosis and treatment.

The relationship between mechanical dyssynchrony of the left ventricular myocardium and the degree of coronary artery occlusion in patients with coronary artery disease

Background. The prevalence of chronic heart failure in the world is increasing; however, it is stabilizing in developed countries. One of the reasons for this stabilization is an improvement of acute coronary syndrome treatment and revascularization. Revascularization in patients with chronic coronary syndromes without signs of the left ventricular dysfunction is less effective. One of the promising methods for assessing left ventricular dysfunction is the detection of electrical and mechanical dyssynchrony of the myocardium (DM). However, mechanical dyssynchrony of the myocardium has not been sufficiently studied in patients with coronary artery (CA) disease. The purpose was to assess the relationship between mechanical myocardial dyssynchrony and the degree of coronary artery occlusion in patients with coronary artery disease who underwent revascularization. Materials and methods. One hundred and thirty-four patients with coronary artery disease (35 with myocardial infarction and 99 with chronic coronary syndromes) who underwent coronary angiography and revascularization of coronary arteries were included in the study. According to the results of coronary angiography, patients were divided into 3 groups: 12 had unchanged CA (group 1), 17 had atherosclerotic lesions of CA without signs of occlusion (group 2), and 105 patients were with CA occlusion. Among those with CA occlusion, 10 people had an occlusion of less than 50 %, 26 patients had occlusion from 50 to 80 %, 36 had more than 80 %, and 33 patients had complete occlusion of at least one coronary artery. In all patients, parameters of mechanical DM were determined by ultrasound method. Results. In the first group, 3 patients (25 %) had mechanical DM, in the second — 4 patients (23.5 %), in the group with coronary artery occlusion, 42 patients (40 %) had mechanical DM. In the group with complete CA occlusion, mechanical DM was detected in 18 (53 %) cases. Septal to posterior wall motion delay (SPWMD) did not differ significantly in the comparison groups; however, it increased significantly to 64.8 ± 43.2 ms in patients with complete CA occlusion compared with 40.8 ± 13.1 ms in the group with unchanged CA (p &lt; 0.05). SPWMD had a significant correlation with the degree of CA occlusion (r = 0.254, p = 0.009). The interventricular mechanical delay increased significantly, to 61.3 ± 40.5 ms compared with 33.4 ± 3.4 ms in patients with unchanged CA (p &lt; 0.05). Left ventricular filling time was significantly shorter in the group with complete CA occlusion compared to the patients with incomplete CA occlusion and those with unchanged CA (47.3 ± 10.4 ms vs. 54.2 ± 5.7 ms, respectively; p &lt; 0.05). Left ventricular ejection time was not significantly different between comparison groups, but correlated significantly with the degree of CA occlusion (r = 0.241, p = 0.013). The early ventricular time deceleration, the time from the beginning of the QRS complex to the beginning of the peak systolic velocity did not differ significantly. The time to the peak systolic velocity was significantly longer in the group with complete CA occlusion (32.6 ± 8.5 ms), and had a significant correlation with the degree of CA occlusion (r = 0.26, p = 0.007). Conclusions. A third of patients with chronic coronary syndrome included in the study had DM. In the group with complete CA occlusion, the frequency of DM detection increased significantly and was diagnosed in half of cases. In patients with complete CA occlusion, DM manifested itself in a significant SPWMD, an increase in the period of pre-ejection into the aorta and, as a result, a significant increase in the interventricular mechanical delay. An increase in the time to peak systolic velocity was also found in the group of patients with complete CA occlusion. DM associated with left ventricular diastolic dysfunction was detected in a group of patients with complete CA occlusion and manifested itself in a reduced left ventricular filling time.

EAGMN: Coronary artery semantic labeling using edge attention graph matching network

Coronary artery disease (CAD) is one of the primary causes leading deaths worldwide. The presence of atherosclerotic lesions in coronary arteries is the underlying pathophysiological basis of CAD, and accurate extraction of individual arterial branches using invasive coronary angiography (ICA) is crucial for stenosis detection and CAD diagnosis. However, deep-learning-based models face challenges in generating semantic segmentation for coronary arteries due to the morphological similarity among different types of arteries. To address this challenge, we propose an innovative approach called the Edge Attention Graph Matching Network (EAGMN) for coronary artery semantic labeling. Inspired by the learning process of interventional cardiologists in interpreting ICA images, our model compares arterial branches between two individual graphs generated from different ICAs. We begin with extracting individual graphs based on the vascular tree obtained from the ICA. Each node in the individual graph represents an arterial segment, and the EAGMN aims to learn the similarity between nodes from the two individual graphs. By converting the coronary artery semantic segmentation task into a graph node similarity comparison task, identifying the node-to-node correspondence would assign semantic labels for each arterial branch. More specifically, the EAGMN utilizes the association graph constructed from the two individual graphs as input. A graph attention module is employed for feature embedding and aggregation, while a decoder generates the linear assignment for node-to-node semantic mapping. Based on the learned node-to-node relationships, unlabeled coronary arterial segments are classified using the labeled coronary arterial segments, thereby achieving semantic labeling. A dataset with 263 labeled ICAs is used to train and validate the EAGMN. Experimental results indicate the EAGMN achieved a weighted accuracy of 0.8653, a weighted precision of 0.8656, a weighted recall of 0.8653 and a weighted F1-score of 0.8643. Furthermore, we employ ZORRO to provide interpretability and explainability of the graph matching for artery semantic labeling. These findings highlight the potential of the EAGMN for accurate and efficient coronary artery semantic labeling using ICAs. By leveraging the inherent characteristics of ICAs and incorporating graph matching techniques, our proposed model provides a promising solution for improving CAD diagnosis and treatment.

The Comparison of Coronary Angiographic Profile between Diabetic and Non-Diabetic Patients with Coronary Artery Disease in a Nepalese Population

Background: Diabetes mellitus is associated with an increase in cardiovascular morbidity and mortality. As the prevalence of diabetes mellitus is increasing globally the burden of death related to cardiovascular disease including myocardial infarction will be a great burden to countries like Nepal. The aim is to compare the extent and severity of coronary artery disease between diabetic and non-diabetic patients referred for coronary angiography.&#x0D; Materials and methods: It was a Hospital-based, cross-sectional study conducted in the Department of Internal medicine, BPKIHS Dharan, Nepal. All consecutive patients undergoing coronary angiography with a clinical indication for the procedure during the study period of one year were included in the study. 61 subjects with diabetes were compared with 147 subjects without diabetes for assessing the severity and extent of coronary artery disease. The coronary atherosclerosis score was used to grade the severity of lesions visualized by coronary angiography.&#x0D; Results: The mean coronary atherosclerosis score was 6.64±4.18 among diabetes and 4.97±4.07 among the non-diabetic group with p-value of 0.008 which was statistically significant. The left anterior descending coronary artery was significantly more frequently involved in diabetics than nondiabetic patients 88.52% vs. 66.67% (p&lt;0.002).&#x0D; Conclusion: Diabetic patients had more severe and extensive atherosclerotic lesions in coronary arteries than the non-diabetic patients on coronary angiography suggesting atherosclerotic burden in the diabetes population is higher in our population.

The influence of hypothyroidism on the course of coronary artery disease in patients with reduced left ventricular ejection fraction

Background. Thyroid hormones play a fundamental role in the homeostasis of the cardiovascular system. Cardiovascular diseases are among the most common diseases worldwide, causing a significant percentage of mortality, hospitalizations, and disability. The purpose of the study is to evaluate the impact of hypothyroidism on the course of atherosclerotic lesions of coronary arteries and major cardiovascular events in patients with heart failure with reduced left ventricular ejection fraction after myocardial revascularization using percutaneous coronary intervention (PCI). Materials and methods. This prospective observational one-center study included 103 patients with ischemic cardiomyopathy, heart failure with reduced left ventricular ejection fraction, with and without hypothyroidism who underwent PCI. The result of revascularization was evaluated within 2 years. Inclusion criteria: age over 18 years, coronary artery disease, left ventricular ejection fraction less than 40%. Results. Patients with hypothyroidism had a worse lipid profile and, as expected, a higher baseline thyroid-stimulating hormone (TSH). According to echocardiography, patients with hypothyroidism had thickening of the left ventricular myocardium walls, which is indicated by a probable increase in the dimensions of the left ventricular posterior wall (11.40±0.98 mm; p&lt;0.001). In the first group, patients had higher myocardial mass indicators as one of the criteria for left ventricular hypertrophy (172.73±12.72g/m2; p&lt;0.001). After multivariate analysis using Cox proportional hazards regression, an elevated TSH level was still associated with significantly higher rates of cardiovascular mortality (risk ratio (RR) 0.85; 95% confidence interval (CI) 0.75–0.95; p&lt;0.001), repeat PCI (RR 0.75; 95% CI 0.65–0.85; p&lt;0.05) and decompensation due to heart failure (RR 0.88; 95% CI 0.78–0.96; p&lt;0.05). Conclusions. Hypothyroidism is associated with a higher incidence of the primary composite endpoint of repeat PCI, hospitalizations for decompensated heart failure, and the secondary endpoint of cardiovascular mortality compared to euthyroid patients over two years of follow-up. Maintaining adequate control of TSH in patients with coronary artery disease and heart failure with reduced ejection fraction is prognostically important for preventing cardiovascular events.

Various mechanisms of myocardial necrosis development due to combat injury as a reason for discussion: a case series

The real clinical practice of the last 8 years in Ukraine indicates the possibility of myocardial injury developing in wounded with combat trauma, including those meeting the criteria for myocardial infarction (predominantly type 2), which differs significantly in the mechanism of development, resulting in numerous difficulties for doctors in providing medical care to such patients (formulation of the diagnosis, choice of treatment tactics). The current recommendations of the European Society of Cardiology for the management of patients with acute coronary syndromes after the adoption of the Fourth Universal Definition of Myocardial Infarction do not consider special approaches to the treatment of patients with myocardial necrosis associated with trauma. The aim of this publication was to demonstrate, using the example of a case series, the relevance of the problem of terminology, diagnosis, and treatment of myocardial infarction caused by a combat injury. In all three clinical cases presented, young and middle-aged patients were diagnosed with myocardial infarction in accordance with the Fourth Universal Definition. In all these cases, there were no atherosclerotic coronary artery lesions, and a type 2 myocardial infarction was assumed due to acute myocardial ischemia as a consequence of the injured coronary artery ligation (case 1); microcirculation disorders in the area of myocardial contusion (case 2); anatomical feature of the coronary artery in the form of its intramural course in the presence of severe sympathicotonia and sinus tachycardia (case 3). Because all three patients had myocardial necrosis associated with trauma of the chest and heart, the question arose of the preference for coding such pathology through ICD-10 as section S00-T88 (injury, poisoning and certain other consequences of external causes), namely S26 (injury of heart), but not as I21 (acute myocardial infarction) from the section I00-I99 (diseases of the circulatory system). Thus, the developed pathology in such patients will be clearly associated with the combat trauma, and their treatment will not be tied to the current Ukrainian Unified Protocol for the Management of Patients with ST-segment Elevation Acute Coronary Syndrome. Conclusions. The presented clinical cases substantiate the planning of clinical trials and the development of recommendations for the management of patients with acute myocardial injury (including myocardial necrosis) and trauma of the heart and coronary arteries, depending on the mechanism of damage development.

Decreased low-density lipoprotein receptor-related protein 1 expression in pro-inflammatory monocytes is associated with subclinical atherosclerosis.

Subclinical atherosclerosis (SCA) occurs in asymptomatic individuals. Blood peripheral monocytes are involved in the development of atherosclerosis. Circulating monocytes acquire pro-inflammatory profiles, and they are involved in the early stages of atherosclerosis development. Low-density lipoprotein Receptor-related Protein 1 (LRP1) is expressed in monocytes, mainly in classical and intermediate subsets. Although LRP1 is highly expressed in macrophages and vascular smooth muscle cells (VSMCs) in atherosclerotic plaque formation, its expression in circulating monocytes has not been studied in SCA. The aim of this study was to characterize the LRP1 expression level in circulating monocytes of individuals with SCA and compared with individuals with low (LR) and intermediate (IR) risk of cardiovascular diseases, both without evidence of atherosclerotic lesions in carotid and coronary arteries. LRP1 and additional markers (CD11b, CD11c, and CD36) at cell surface of monocytes were analyzed by flow cytometry assays, whereas LRP1 and pro-inflammatory factors gene expressions were measured in isolated monocytes by quantitative RT-PCRs. Both LRP1 protein and LRP1 mRNA were significantly reduced in monocytes in SCA and IR respect to LR. Conversely, CD36, CD11b, and CD11c monocytic markers showed no significant changes between the different study groups. Finally, increased gene expressions of TNF-α and IL-1β were detected in monocytes of SCA, which were associated with decreased LRP1 expression at the cell surface in total monocytes. In summary, we propose that the decreased LRP1 expression at cell surface in total monocytes with pro-inflammatory profile is associated with the development of atherosclerosis in asymptomatic individuals.

Age-related Changes in Renal Arterio-Arteriolosclerosis in Kidney Disease: Renal Biopsy-based Study

Age-related Changes in Renal Arterio-Arteriolosclerosis in Kidney Disease: Renal Biopsy-based Study

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p&lt;0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p&lt;0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p&lt;0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p&lt;0,0001) were significantly more often recorded in patients with type 2 diabetes.Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p&lt;0,0001, respectively).Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period.

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p&lt;0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p&lt;0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p&lt;0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p&lt;0,0001) were significantly more often recorded in patients with type 2 diabetes.Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p&lt;0,0001, respectively).Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period.

Clinical case of endovascular repair of abdominal aortic aneurysm in patient with multifocal atherosclerosis

Background. Until now, the issue of surgical treatment staging in patients with aortic pathology coexisting with coronary artery disease and atherosclerosis of the peripheral arteries remains controversial because of features of each clinical situation and association with the risk of periprocedural life-threatening complications (ruptured aortic aneurysm, myocardial infarction, stroke).Objective. Present a clinical case of successful treatment of a patient with an abdominal aortic aneurysm, clinically significant lesions of the coronary and carotid arteries.Design and methods. Diagnosis was carried out using computed tomography of the aorta with intravenous contrast. Instrumental examination included electrocardiography, echocardiography (EchoCG), ultrasound dopplerography of the BCA. Coronary angiography with BCA angiography was also performed.Results. Clinical diagnosis is an ischemic heart disease, angina pectoris III FC, chronic heart failure II FC and atherosclerosis of the aorta. Aneurysm of the abdominal aorta (diameter 96 mm), stenosing atherosclerosis of the BCA, PVCA stenosis 80 % and occlusion of the LVCA were observed. Patient had hypertension stage III and risk of CVE 4. Firstly, the patient was underwent stenting of the right internal carotid artery, than coronary artery bypass grafting and on the last stage he was performed — endovascular aotric repair. There were no complications in the perioperative period.Conclusions. Endovascular repair of abdominal aotric aneurysm is an effective method of treating patients with comorbid conditions. However, it is possible the development of fatal cardiovascular complications in patients with combined atherosclerotic lesions of brachiocephalic and coronary arteries that is why they are required a multidisciplinary approach for choosing a safe treatment strategy.

Early and late outcomes of combined and staged surgeries in patients with concomitant atherosclerotic lesions of the coronary and brachiocephalic arteries

Objective. To study the early and late outcomes of surgical treatment of patients with concomitant atherosclerotic lesions of coronary and brachiocephalic arteries while choosing a treatment strategy based on the developed diff erentiated approach algorithm.Material and Methods. The study comprised 243 patients with combined atherosclerotic lesions of the coronary and carotid arteries examined during the period from 01.07.2014 to 01.01.2021. Patients underwent revascularization surgeries based on the algorithm for choosing the volume and stages of surgical intervention, which was previously developed in the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov. A single-stage combined surgery of coronary artery bypass grafting (CABG) and carotid endarterectomy (CEE) was performed in 104 patients (42.8%); 139 patients (57.2%) received staged revascularization including 102 patients (73.4%) who received CABG as the fi rst step and 37 patients (26.6%) who received CEE as the fi rst step of surgery. The endpoints for both early and late results were death from all causes, stroke, transient ischemic attack (TIA), acute myocardial infarction (AMI), and combined endpoint that included all of the above. Average follow-up time was 41.1 ± 21.8 months.Results. No fatal outcomes were in any group during the early postoperative period. At the hospital stage, there were 5 cases (2.1%) of stroke, 1 case (0.4%) of TIA, and 3 cases (1.2%) of acute MI. Long-term results were evaluated in 225 patients (92.3%). The overall survival rate was 93.8%. There were 5 cases (2.4%) of MI, 11 cases (4.9%) of stroke, and 1 case (1.0%) of TIA. No signifi cant diff erences were observed in immediate and long-term endpoints between the groups of staged and combined interventions as compared to immediate (AMI: p = 0.680; TIA: p = 0.500; acute cerebrovascular events: p = 0.567; combined: p = 0.940) and long-term results (deaths: 0.860; AMI: p = 0.906; TIA: p = 0.528; acute cerebrovascular events: p = 0.378; combined: p = 0.669).Conclusion. Based on successful experience with treating the concomitant atherosclerotic lesions of the coronary and brachiocephalic arteries, the proposed algorithm allowed to perform safe procedures in both arterial basins and to achieve satisfactory results in in-hospital and long-term periods in the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov (Perm).

Off-pump coronary artery bypass grafting in simultaneous surgical treatment of patients with concomitant atherosclerotic lesion of coronary and supra-aortic arteries

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ ближайших послеоперационных результатов реваскуляризации миокарда без искусственного кровообращения (ИК) при одномоментном хирургическом лечении больных с сочетанным атеросклеротическим поражением коронарных и брахиоцефальных артерий. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Работа основана на ретро- и проспективном анализе результатов хирургического лечения 143 пациентов, которым выполнили комбинированное вмешательство — коронарное шунтирование (КШ) и каротидную эндартерэктомию (КЭАЭ). Больных разделили на две группы в зависимости от типа вмешательства: 74 (51,7%) пациента, оперированных на работающем сердце без ИК, и 69 (48,3%) больных, оперированных в условиях ИК. <h3>РЕЗУЛЬТАТЫ</h3> КШ без ИК в сочетании с КЭАЭ было менее продолжительным (243,3±50,3 и 280,5±63,9 мин, <i>p</i>&lt;0,05) и сопровождалось меньшей кровопотерей (245,3±119,5 и 378,1±108,5 мл, <i>p</i>&lt;0,05) и более высоким уровнем гемоглобина в конце операции (11,1±1,1 и 10,1±1,3 г/л, <i>p</i>&lt;0,05). Частота осложнений после операции была низкой. Госпитальная летальность отсутствует. Периоперационных инфарктов миокарда в обеих группах не было. <h3>ВЫВОД</h3> КШ без ИК и одномоментная КЭАЭ могут безопасно выполняться с низкой частотой периоперационных осложнений и минимальной госпитальной летальностью.

Histomorphological Study of Atherosclerotic Lesions of Coronary Artery and Aorta: An Autopsy Study

Background: Cardiovascular diseases leading to atherosclerosis are rapidly increasing in Indian population. This study was formulated to assess histomorphological atherosclerotic changes in aorta and coronary arteries and grading of lesions according to American Heart Association Classification (AHA). Materials and Methods: 57 heart specimens received for autopsy study were included in the study. Hearts were fixed in 10% formalin and dissected. They were examined grossly for atherosclerotic lesions in aorta and coronary arteries and subsequent microscopic sections were studied and graded according to AHA classification. Results: 44(77%) cases belonged to male and 13(23%) cases belonged to female. 16(28%) cases were seen in third decade followed by 14(24.6%) and 9(15.8%) in second and fourth decades respectively. Majority of atherosclerotic lesions were noted in aorta (25) followed by LAD (10). Maximum number of lesions were in grade II with 15(26.3%) cases followed by grade IV and grade III with 13(22.8%) and 10(17.5%) cases each respectively. Conclusion: Atherosclerotic lesions are rapidly increasing among younger population. Screening programs and preventive measures if implemented early can prevent these lesions and it’s complications