Annotation. Markers of vascular damage constitute highly informative substances in coronary heart disease, which allows not only assessing the state of endothelial function of the arteries, but also to predict the further course of cardiovascular pathology. The purpose of the study was to analyse changes in laboratory markers of vascular lesions under the influence of different tactical, diagnostic, and interventional approaches in patients with myocardial infarction with stable elevation of the ST segment in the presence of multivascular lesions. The study included patients who were randomly divided into 4 observation groups depending on the diagnostic and treatment tactics. The obtained results were compared with similar ones in healthy people. Studies of markers of vascular endothelial function were performed on the 1st day of infarction, on day 3-4, and a year later. Statistical data processing was performed using a package of licensed software for statistical analysis “Statistica 6.0”. An odd Student’s t test (t) was used to compare quantitative parameters between independent samples, and a χ2 criterion was used for qualitative samples at a significance level of p<0.05. It turned out that patients develop a complex dysfunction of the vascular endothelium towards a substantial predominance of the concentration of thrombogenic and vasospastic substances (endothelin-1 and thromboxane A2). In the period from 3 to 4 weeks after the infarction, a partial decrease in vasospastic and thrombogenic substances was observed against the background of an increase in nitric oxide. Meanwhile, in different groups with various diagnostic and therapeutic approaches, such changes had different intensity and dynamics. The degree of balance of endothelial dysfunction depends on the time since the development of myocardial infarction and the type of diagnostic and treatment tactics. The most significant suppression of vascular function occurred with the use of regular methods (group 4), and the maximum recovery – with the use of delayed stenting after an additional study of coronary vessels. But even with the most optimal approaches, endothelial dysfunction could not be completely corrected. It is possible that for better results it is advisable to monitor the results of treatment over a longer period of time, when on the one hand the scar tissue has finally formed, and on the other hand, the pharmacological effects of antiplatelet agents and statins will be fully involved.