Trunk Of Left Coronary Artery Research Articles

Left coronary artery trunk stenosis in patients with acute coronary syndrome

Left coronary artery trunk stenosis in patients with acute coronary syndrome

Application of Intravascular Ultrasound During Percutaneous Coronary Interventions in Controversial Cases and Complex Atherosclerotic Lesions

The aim of the study is to present our own experience of using intravascular ultrasound (IVUS) for making a clinically informed decision to perform percutaneous coronary intervention (PCI) in a particular patient. Material and methods: A 65-year-old patient with angina pectoris and a positive exercise test, which revealed horizontal ST depression in the chest leads, underwent diagnostic coronary angiography, which diagnosed stenosis of up to 50 % of the trunk of the left coronary artery (LCA). In this connection, IVUS was performed to make a decision on the advisability of performing PCI. According to IVUS data, the area of narrowing of the LCA trunk was 60 %. There is a “torn” edge of the intima of the vessel with severe calcification in the largest segment of the narrowing, which indicates the “instability” of the atherosclerotic plaque. The patient underwent PCI with stenting of the LCA trunk with a transition to the proximal segment of the anterior descending artery (LAD) due to the spread of an atherosclerotic plaque at the mouth of the LAD. Conclusion: IVUS plays an important role in the decision to perform PCI in controversial cases and complex atherosclerotic lesions.

Endovascular rotational atherectomy for multivessel coronary calcification involving the main trunk of left coronary artery and the left anterior descending artery

The revascularization strategy for severe calcification is one of the most pressing problems of modern percutaneous coronary interventions, since it is observed more and more often and significantly complicates traditional endovascular treatment. Currently, the method of choice for severe coronary calcification is rotational atherectomy, which allows modification of atheromatous mass with an increase in the vessel lumen to allow satisfactory balloon angioplasty and stenting. This article presents a case of a patient at very high cardiovascular risk with a burdened coronary history and severe clinical symptoms of exertional angina while receiving the optimal multiagent therapy. The examination revealed a multivessel coronary calcification, but the patient was denied coronary artery bypass grafting due to high perioperative risks. SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery score) score I – 25,5 points, SYNTAX score II — 40,4% and 70,1% for percutaneous coronary intervention and coronary bypass surgery, respectively, European System for Cardiac Operative Risk Evaluation (EuroSCORE II) — 4,95%. Attempts at traditional percutaneous intervention were unsuccessful and the patient underwent endovascular rotational atherectomy followed by stenting of affected coronary segments, against the background of which there was an improvement in exercise tolerance with a decrease in angina class.

Long-term results of percutaneous coronary interventions in lesions of the left coronary artery trunk

Long-term results of percutaneous coronary interventions in lesions of the left coronary artery trunk

Еволюція тактик лікування пацієнтів зі стовбуровими ураженнями коронарних артерій

Damage to the trunk of the left coronary artery is the most dangerous manifestation of coronary atherosclerosis. Mortality with this type of lesions occurs by 3–4 times more often compared to lesions of other segments of coronary arteries. On the basis of previous clinical studies demonstrating advantages of coronary artery bypass grafting over drug therapy in terms of patient survival, coronary artery bypass grafting has long been considered the gold standard for the treatment of these lesions. The purpose of the work was to study the literature data on the evolution and peculiarities of the choice of methods of surgical treatment of coronary heart disease in patients with severe lesions of the trunk of the left coronary artery. Results and discussion. Along with the improvement of endovascular instrumentation, stenting procedures, antithrombotic agents, as well as concomitant drug therapy, percutaneous coronary interventions for lesions of the left trunk are becoming more and more widespread and show favorable clinical results in these patients. This is evidenced by the data of many randomized multicenter studies (SYNTAX, EXCEL). Based on the results of these studies, ESC/EACTS approved the following guidelines for myocardial revascularization in 2018. Percutaneous coronary interventions are indicated in the case of damage to the left trunk with scores on the SYNTAX scale less than 22 – class I, scores on the SYNTAX scale 23–32 – class IIa, and scores on the SYNTAX scale greater than 32 – class III. However, it is worth noting that both the American and the European guidelines recommend a discussion by a team of endovascular surgeons, cardiologists and cardiac surgeons (Heart Team) when choosing a treatment strategy for coronary artery disease patients with lesions of the trunk of the left coronary artery. Since the data of many studies on the treatment of patients with lesions of the trunk of the left coronary artery remain quite contradictory and ambiguous. Conclusion. Current literature data have shown that left coronary artery stenting is a fairly safe procedure, with a high rate of immediate success, low mortality, and few complications, especially in low-risk surgical patients. The use of stents with medical coating made it possible to reduce the frequency of repeated interventions to 10–12%. A number of issues remain, the solution of which would allow optimizing the application of this technique. These include: development of indications for surgical or endovascular treatment of lesions of the left coronary artery trunk, optimization of stenting techniques, assessment of the significance of concomitant pathology in the effectiveness of treatment of patients with lesions of the left coronary artery trunk

Features of Prediction of Heart Failure in Patients with Peripheral Atherosclerosis During a Three-Year Prospective Follow-Up

Aim : To assess the likelihood of developing heart failure during a three-year prospective follow-up and develop a method for its comprehensive assessment in individuals with atherosclerotic lesions of various vascular beds. Materials and methods : The study included 519 patients with atherosclerotic lesions of various vascular regions, of which 360 (69.4 %) were men, 159 (30.6 %) were women (mean age 60.0±8.7 years). Results : Analysis of the likelihood of developing heart failure clearly demonstrated that factors such as the value of the ejection fraction, % (p = 0.040), the value of the base of the aorta, mm. (p = 0.049), the degree of atherosclerotic lesions of the left coronary artery trunk,% (p = 0.013) and the severity of posterior lateral branch stenosis,% (p = 0.048) influenced the risk of developing the discussed endpoint in the long-term period in patients with peripheral atherosclerosis. Conclusions : The probability of developing vascular events and adverse outcomes during a three-year prospective followup was assessed. It was found that hospitalization for heart failure over a three-year period occurred in 3.4 % of patients with atherosclerotic lesions of various vascular beds and their combinations. It is noted that such groups of factors as “the value of the ejection fraction% + the value of the base of the aorta, mm.” (p=0.025), “the degree of atherosclerotic lesions of the posterior lateral branch, % + the value of the ejection fraction, %” (p=0.046), influenced the risk of developing heart failure in the long-term period in the subjects of the survey group. Using logistic regression equations, original prognosis tables have been developed that provide information on the likelihood of developing heart failure, which can be used in real clinical practice in patients with peripheral atherosclerosis.

ACUTE CORONARY SYNDROME WITH THROMBOTIC OCCLUSION OF THE LEFT CORONARY ARTERY TRUNK AFTER COVID-19-ASSOCIATED BILATERAL MULTISEGMENTED PNEUMONIA: A CLINICAL CASE

Here we describe the course and specific aspects of the treatment for myocardial infarction with left coronary artery occlusion after bilateral multisegmental pneumonia. Acute left coronary artery trunk occlusion is a life-threatening condition with high mortality. The paper describes the most probable mechanisms of myocardial injury after COVID-19, and shows how percutaneous intervention, mechanical circulatory support and the correct choice of drug therapy can improve clinical outcome.

Relationship of plasma ST2 level with anatomical features of coronary artery lesion in patients with NSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Objective Relationship determining of ST2 plasma level and comparing it in patients with NSTEMI, determining of ST2 plasma level gradations. Methods We studied 90 patients with NSTEMI aged of 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Plasma ST2 level was determined and analyzed in the NSTEMI group of patients, the gradations of the stimulating growth factor level (ST2) and the correlation with the character of coronary artery lesions were highlighted. The degree of damage to the coronary arteries was determined by the SYNTAX score. All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association. Results Using the variational statistics method, the ST2 level gradations group were selected. Thus, the relatively low level (RL) corresponded to less than 25, and the relatively high (RH) level of ST2 to more than 75 persons in the group, respectively. For patients in the main group, these levels were < 26 and > 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng/ml (Fig. 1). Analysis of the anatomical damage of the coronary arteries showed a reliable relationship of a relatively high level of ST2 with atherosclerotic lesion of the left coronary artery (LCA) trunk, while a relatively moderate level of ST2 was determined in the case of lesions of the circumlex branch (CB) of LCA (Fig. 2). The highest degree of coronary artery stenosis was determined in patients with relatively high ST2 levels, while relatively low ST2 levels were observed in the absence of hemodynamically significant stenosis (Fig. 2). Conclusion 1. There are 3 groups of levels of stimulating growth factor in patients with NSTEMI: relatively low level (<26 ng / ml), relatively moderate level (26-56 ng / ml), relatively high level (> 56 ng / ml). 2. A relatively high level of ST2 was observed in the lesion of the LСA trunk, while a relatively moderate level of ST2 was determined in the case of the CB LCA lesion. 3. The level of ST2 with high probability allows to predict the severity and character of the lesion of the coronary arteries.

LEFT VENTRICLE REARRANGEMENT IN PATIENTS WITH CRITICAL OSTIAL STENOSIS OF THE LEFT MAIN TRUNK COMPLICATED WITH ISCHEMIC MITRAL REGURGITATION

In this work, we studied the possibility of stenting the left coronary artery trunk in patients with subacute myocardial infarction on a background of critical stenosis of the left coronary artery trunk, reduced left ventricular ejection fraction and surgically significant mitral regurgitation. We analyzed treatment outcomes of 97 patients who underwent stenting of left main trunk for subacute stage of myocardial infarction. All patients had mitral insufficiency of II–III degree. The echocardiography data were analyzed before surgery, 7 days, 30 days and 12 months after surgical treatment. Direct stenting of the left coronary artery trunk was performed in 38 (39.2%) patients. 59 (60.8%) patients underwent Culotte bifurcation stenting. A good treatment effect was achieved in 89 (91.2%) patients. As a result of the LV myocardial remodeling, EF increased by 1.44 times (p < 0.05). There was a significant decrease in the degree of mitral insufficiency by 39% to surgically insignificant from 5.9 to 3.6 mm (p < 0.05). Stent placement as an initial treatment in elderly patients with more than 24 hours after the onset of acute myocardial infarction (AMI) originated from a critical lesion of the left coronary artery trunk and concomitant pronounced mitral insufficiency proved as fully justified and safe. We assume that this treatment enables to improve ejection fraction and reduce severity of mitral regurgitation in elderly AMI patients.

A clinical case of a successful step-by-step treatment of a patient with a dissecting aneurysm of the ascending aorta involving the trunk of the left coronary artery

Background: The presented clinical case shows a version of successful step-by-step medical care for a patient with a dissecting aneurysm of the ascending aorta involving the trunk of the left coronary artery in a vascular center without a cardiac surgical support. Clinical case description: The patient was admitted to the Kostroma Regional Vascular Center with the symptoms of Acute Coronary Syndrome. During the examination in the clinic, the diagnosis of acute coronary syndrome with ST segment elevation was confirmed, and a dissecting aneurysm of the ascending aorta was also revealed. According to emergency coronary angiography, the dissection of the left coronary artery trunk was visualized, and the left coronary artery trunk was successfully stented with a bare metal stent. Later, the patient was transferred to a federal center, where aortic prosthetic reconstruction was performed. Conclusion: In patients with a dissecting thoracic aortic aneurysm involving the trunk of the left coronary artery and acute myocardial damage, who are admitted to a vascular center without a cardiac surgery support, the following step-by-step treatment strategy is likely to be effective: stenting the trunk of the left coronary artery with a bare metal stent and a further transfer to a center of cardiac surgery for a surgical treatment.

Middle and long-term follow-up of 101 children with giant coronary artery aneurysm of Kawasaki disease

Objective: To summarize the clinical features, middle-and long-term prognosis of Kawasaki disease (KD) with giant coronary artery aneurysm (GCAA). Methods: In this retrospective cohort study, a cross-sectional analysis was conducted on 101 KD children with GCAA in the KD with GCAA database established by Beijing Children's Hospital, Capital Medical University in 2004. GCAA was diagnosed as coronary artery absolute lumen diameter ≥8.0 mm. All patients were followed up regularly. The endpoint was the time of last follow-up or the death time. T test or χ2 test was used for comparison between groups. Results: A total of 101 KD children with GCAA were enrolled, including 82 males (81.2%) and 19 females (18.8%). The age of disease onset was 2.5 (1.0, 4.5) years. The follow-up duration was 4.5 (2.7, 7.5) years, with a longest of 19 years. All children received routine treatment with aspirin and warfarin, and clopidogrel was added in severe cases. At the end of follow-up, 13 cases (12.9%) had cardiac enlargement, 11 cases (10.9%) developed heart failure, 13 cases (12.9%) experienced myocardial infarction, 2 cases (2.0%) underwent coronary artery bypass graft and 6 cases (5.9%) died. A total of 170 coronary arteries were involved, including 24 (14.1%) GCAAs on the main trunk of left coronary artery, 10 (5.9%) GCAAs on left circumflex, 57 (33.5%) GCAAs on left anterior descending, 78 (45.9%) GCAAs on the middle segments of right coronary artery, and 1 (0.6%) GCAA in the distal segments of right coronary artery. Eleven cases (10.9%) recovered with the coronary artery absolute lumen diameter of all GCAAs below 4.0 mm. Among 170 branches with GCAAs, 28 (16.5%) regressed below 4.0 mm. No significant difference was found in the regression rates between right and left GCAA (18.7% (17/91) vs. 13.9% (11/79), χ²=2.473, P=0.116). There was no statistically significant difference in retraction between unilateral GCAA and bilateral GCAA (16.1% (9/56) vs. 4.4% (2/45), χ2=2.381, P=0.123). Conclusions: GCAA of KD occurred more common in the middle segments of right and left anterior descending coronary arteries. The incidence of adverse cardiac events and the mortality rate in children with GCAA complicated with KD was high. Their long-term prognosis was poor.

Is left main percutaneous coronary intervention justified in the presence of concomitant complex coronary artery disease – immediate and remote results – single Bulgarian center experience

Revascularization in patients with severe stenosis of left coronary artery (LCAS) trunk signifi cantly improves their prognosis. Modern clinical studies, registries and meta-analyses have identifi ed percutaneous coronary intervention (PCI) of LCAS as a safe alternative to aorto-coronary bypass (ACB) in patients with low and intermediate lesion complexity. Aims: To confi rm the safety and effectiveness of PCI and implantation of second generation drug eluting stent (DES) in patients with unprotected LCAS and concomitant complex coronary pathology. Material and Methods: For the period March 2013–October 2018 we performed 225 PCIs of patients with LCAS. 170 of patients who received PCI were divided into 2 groups, according to their SS-1 (ST elevation excluded). We analyzed the major adverse cardio-vascular events (MACE – all-cause mortality, cardiac mortality, stroke and ischemia driven TLR) rate and time-to-fi rst MACE during follow up. Results: 103 patients had SS-I < 32 and 67 patients had SS-I ≥ 32 and their mean age was 67,25 ± 11,03. The median follow-up was 26,6 ± 19,1 months. MACE rate was 12,4% and there was no signifi cance between groups (p = 0,118). Conclusions: PCI of unprotected LCAS has high procedural success rate and good mid-term results, even in pts with complex anatomy. High anatomical complexity of coronary lesions defi ned by SS-I ≥ 32 is not predictive for poor clinical outcome after PCI.

Morphological Variations in the Branching Pattern of Left Coronary Artery in Adult Human Hearts using Silicon Cast Method

The knowledge of variations in the branching pattern of Left Coronary artery is an important factor in the study of coronary heart disease and mostly it is the left which is commonly involved. With the adaptation of sedentary life style and increasing stress, Coronary artery disease has become the major cause of death and coronary angiography is has become a routine for cardiologists & radiologists. This study is done to determine the branching pattern, mean length and mean outer diameter of the trunk of the Left Coronary artery using Silicon Cast technique. A Plastinate material that is Silicon is used in this study for luminal casts, this is first of its kind in India and it’s a new innovative technique for studying the arterial patterns. The present study was carried out in 110 fresh hearts, 90 males and 20 females with a mean age of 66.0 years, which were collected from the mortuary of the Forensic department of Mysore Medical College and JSS Medical College, Mysore, South India for a period of 2 years. The Silicone material was injected into the Coronary arteries; the cast was removed and the fine branching pattern of the left Coronary artery was studied and measured using Vernier digital calipers. The left Coronary artery arose from the left posterior aortic sinus in most number of cases. The mean outer diameter of the trunk at the point of origin was 3.51±0.71 (range 2 – 5.8mm). The mean length of the trunk of left Coronary artery was 10.04 ± 3.27 mm (range 4-18.5mm). Most of the branching pattern was bifurcation (62.72 %) and trifurcation (33.63%) was observed, tetrafurcation was found to be in 3.63% of cases only, no cases of pentafurcation was seen .This study will help in interventional studies by cardiologist and radiologists during diagnostic and therapeutic approach in Coronary vascular diseases.

A modern view on revascularisation of brain and myocardium in patients with multifocal atherosclerosis: A review

Among cardiovascular diseases, multifocal atherosclerosis has begun occurring more frequently in the recent years; its manifestations such as coronary heart disease and acute cerebrovascular disease are the primary cause of death and disability worldwide. Both open and endovascular methods of surgical revascularisation of the brain and myocardium are presently used for addressing this global epidemic. Therefore, the outcomes and disease course during both the early postoperative and long-term periods in patients with multifocal atherosclerosis depend on the choice of appropriate surgical strategies. However, there is no consensus on the optimal strategies for the combined treatment of lesions in the coronary and cerebral basins. Consequently, there are no clinical recommendations or randomised trials that provide recommendations on the choice of treatment approaches in this cohort of patients. The specific treatment options are based on the personal experience of the clinic and the decision of the multidisciplinary team.Nevertheless, it is certain that carotid endarterectomy remains the gold standard for the treatment of significant stenosis of internal carotid artery, including that with complex anatomical characteristics and severe calcification; carotid endarterectomy is also the most important preventative measure for the acute violation of cerebral circulation. In addition, given the emergence of new coronary stents and the spread of intravascular imaging methods, percutaneous coronary intervention is increasing its evidence base by the year by demonstrating efficacy even in patients with concomitant left coronary artery trunk and multi-vascular coronary bed lesions.The use of carotid endarterectomy in combination with percutaneous coronary intervention in patients with lesions in both vascular basins for achieving hybrid revascularisation is promising although studied minimally.Therefore, in the present review, we aimed to present the current understanding of the methods utilised for revascularisation of the brain and myocardium as well as the hybrid revascularisation approach for the treatment of patients with multifocal atherosclerosis, with consideration given to its advantages and prospects.Received 12 April 2019. Revised 17 December 2019. Accepted 24 December 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

Association of Atrial Fibrillation with Coronary Lesion in Ischemic Heart Disease Patients

to find out whether atrial fibrillation (AF) in patients with ischemic heart disease (IHD) is related to some definite localization or extentof coronary artery lesions or type of coronary circulation. We compared data of clinical, laboratory, and instrumentalexamination of 178 IHD patients from the Registry of coronary angiography of patients with AF (main group) and 331 patients(comparison group) selected according to propensity score matching with balancing by sex, age, body mass index, severity of chronic heartfailure, frequency of myocardial infarctions, detection of arterial hypertension, and thyroid diseases. The groups did not differ in termsof alcohol use, frequency of smoking, and detection of diabetes. Patients with AF compared with those without had higher mean heart rate(105±32 vs. 70±13 bpm, р<0.001), lower level of triglycerides (1.74±1.08 vs. 1.94±1.17 mmol / l, р=0.019). AF patients more rarely hadclass III-IV effort angina (52.9 % vs. 66.5 %, р=0.041). Rate of detection of left ventricular (LV) dilatation and index of LV asynergy in bothgroups were similar, but absolute dimensions and indexes of LV, left atrium, right ventricle, LV myocardial mass were higher in the AF group.Hemodynamically significant mitral regurgitation and lowering of LV contractility were more often detected in patients with AF (49.1 %vs. 18.4 %, р<0.001, and 56.2 % vs. 39.5 %, р<0.001, in main and comparison groups, respectively). Analysis of coronary angiography datashowed that patients with compared with those without AF more often had right type of coronary circulation (87.5 % vs. 80.4 %, р=0.043) aswell as lesions of the right coronary artery (92.1 % vs. 85.8 %, р=0.037), and less often lesions of left coronary artery trunk (16.3 % vs. 24.8 %,р=0.027). AF in patients with IHD is associated with right coronary artery lesions and right type of coronary circulation.

Immediate and Long-term Results of Stenting of the Unprotected Left Coronary Artery Trunk in Patients with Stable Coronary Heart Disease

Objective. To assess the immediate and long-term results of stenting of the unprotected left coronary artery (LCA) trunk in patients, by using different types of drug-eluting stents.Material and methods. The follow-up covered 282 patients who had undergone stenting of the unprotected LCA trunk. The mean follow-up was 34.6 [33.9; 35.3] months. The patients were divided into groups according to the type of a first-, second-, and third-generation implanted stent.Results. The incidence of adverse cardiovascular events in the patients of Group 1 was significantly higher than in those in Groups 2 and 3 (29 and 7.6%, p<0.0001). The incidence of thrombosis of first-generation stents (7.0%) was significantly higher than that of second- and third-generation ones (1.6%) (p=0.02). The incidence of adverse cardiovascular events was comparable between Groups 2 and 3, despite a shorter duration of dual antiplatelet therapy in the third-generation stent group. The absence of stent postdilatation in the LCA trunk is an independent risk factor for adverse prognosis.Conclusion. The use of second- and third-generation stents along with changes in the technical aspects of stenting of the unprotected LCA trunk leads to a substantial reduction in the risk of adverse cardiovascular events and allows the indications for intervention to be expanded in this patient category.

Regional aspects of associations of the CYP2C19 gene polymorphism with coronary atherosclerosis in acute coronary syndrome

Aim . To study the associations of allelic variants of the CYP2C19 gene with atherosclerotic lesions of the coronary arteries in patients with acute coronary syndrome (ACS) in the North of Siberia (Surgut) and in large cities of the Siberian Federal Okrug (SFO). Material and methods . During the study 296 patients with ACS were examined at admission to cardiology hospitals in large cities of the North (Surgut, 114 patients) and SFO (Irkutsk and Kemerovo, 182 patients). All patients underwent coronary angiography and genetic research (identification of CYP2C19*2, CYP2C19*3 and CYP2C19*17 alleles). Results . In patients with ACS living in the North of Russia allelic variant CYP2C19*17 (*17/*17) is positively associated with the severity of lesion of left coronary artery (LCA) ( χ 2 =9,81; p=0,002), as well as with at least 50% stenosis, more than 70% lesion of the proximal or middle part of the three main arteries, or more than 50% lesion of LCA trunk ( χ 2 =6,52; p=0,011), and previous myocardial infarction ( χ 2 =8,15; p=0,004). Among patients with ACS living in cities of the Siberian Federal Okrug, the allelic variant CYP2C19*17 (*17/*17) is directly associated with diabetes mellitus ( χ 2 =5,48; p=0,019) and less than 45% left ventricular ejection fraction ( χ 2 =4,20; p=0,040). Regression analysis showed that in patients with ACS living in the northern region of Russia, only the allelic variant CYP2C19*17 (*17/*17) correlated with at least 50% stenosis of LCA trunk (Exp (B): 11,623, 95% CI: 1,893; 71,342; p=0,008). It did not correlate with the male sex, age, smoking and diabetes (p>0,05). Conclusion . The results show the presence of direct associations of CYP2C19*17 alleles with prognostically unfavorable coronary atherosclerosis in ACS patients living in the North of Siberia.

Anatomical study of length and branching pattern of main trunk of the left coronary artery

The left coronary artery is responsible for the irrigation of important heart structures. The objective of this study was to analyze the morphological characteristics of the main trunk of left coronary artery in the Brazilian population and its clinical implications. The study was carried out by using 63 adult human hearts of the human anatomy laboratory of the Federal university of Ceará, Brazil. The hearts were dissected for exposure and analysis of the left coronary artery and its branches. The data collected were statistically analyzed. The main trunk arose from the left aortic sinus under the left atrial auricle in all the 63 hearts. The mean length of the main trunk was 8.53±4.03mm. According to the criteria for the classification of the main trunk length, about 78% were medium-sized. The majority of the hearts (52.38%) showed trifurcation of the main trunk. Anova test followed by the Tukey's post hoc test showed that the main trunk length of hearts with trifurcation was significantly longer when compared with hearts with bifurcation (9.77±4.31mm vs. 6.44±3.01mm; P=0.0029). Similar findings were observed in the main trunk length of the hearts with tetrafurcation in comparison with hearts with bifurcation (10.78±1.4mm vs. 6.44±3.01mm; P=0.0387). This study showed that there is a correlation between the branching pattern and the length of the main trunk. Additionally, we showed that the most common branching pattern of the main trunk is the trifurcation, differing from other Brazilian studies and providing additional information to professionals of cardiology, cardiovascular surgery, and radiology.

THE DEVELOPMENT OF ACUTE MYOCARDIAL INFARCTION DUE TO COMPRESSION OF THE LEFT CORONARY ARTERY TRUNK BY THE CARDIAC TUMOR

We report the clinical observation of acute myocardial infarction development associated with the compression of the left coronary artery trunk and discuss etiological role of primary and secondary cardiac tumors in the development of acute coronary syndrome.

Factors of the complicated course of the myocardial infarction in men and women

The coronary heart disease (CHD) and myocardial infarction (MI) are among the leading causes of death throughout the World. The purpose of the research wasto study the features of a myocardial infarction course in men and women and to develop ways of predicting lethal outcome and complicated course of a disease. Research was based on 121 patients (86 men and 35 women) with the confirmed diagnosis of MI. During hospitalization, men were tested for coronary angiography more often, than women. Coronary arteries disease was caused in men by damage of one vessel, whereas in women it was damage of one, two or three vessels and the left coronary artery (LCA) trunk. The hospital lethality for women was 2.5 times higher than in men and the most frequent cause of death both in men and women was acute cardiovascular insufficiency (ACVI), while men more often suffered from thromboembolia. Rhythm and patency disturbances affected the lethality in both men and women equally, but men were also influenced by age, MI localization and atherosclerosis intensity, while women had an acute heart failure, metabolic and electrolytic frustration. The data showed that the factors influencing the complicated course of MI in men and women are different. Acute heart failure, MI localization and coronary artery disease are more common for men. In women such factors are ST elevation myocardial infarction, ventricular rhythm disturbances during breakthrough, anemia and hypercreatininemia at admission.