Aim      To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1–2=0.001; p1–3<0.001; p2–3=0.520). The incidence of major cardiac complications (“adverse cardiac events”, MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1–2=0.020; p1–3<0.001; p2–3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1–2=0.539; p1–3=0.001; p2–3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion      The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the “door-to-balloon” time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.

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<p><strong>Background</strong>. Main causes of very late stent thrombosis are neoatherosclerosis, late malapposition and the presence of uncovered struts. However, it remains unclear how often the above-described pathological changes are determined in stable patients without adverse cardiac events.</p><p><strong>Aim</strong>. In the present study we aimed to perform optical coherence tomography (OCT) assessment of coronary stents 5 years after implantation for ST-elevation myocardial infarction.</p><p><strong>Methods</strong>. Among 194 patients included in the hospital “Prospective PCI Registry” from October 2012 to November 2013, 25 patients were enrolled in the study. All patients received OCT, median time was 66 [63.0; 72.5] months. Only stable patients without adverse cardiac events during follow-up were included in the study. The optimal condition of the coronary stents was determined in the absence of uncovered and malapposed struts, restenosis (more than 50 % of the artery diameter), signs of neoatherosclerosis and thrombus.</p><p><strong>Results</strong>. Based on OCT results, two groups were identified. The first group consisted of 9 patients (36 %) with optimal stent condition. The comparison group included 16 patients with suboptimal condition of the coronary stents. At the same time 13 patients of this group had uncovered struts, 9 — malapposed struts, 8 had both uncovered and malapposed struts, 7 patients had neoatherosclerosis, 3 patients had restenosis of more than 50 % of the vessel diameter, 1 patient — thrombus in the stented segment, 4 patients — coronary evaginations. Uncovered struts were more often found in the proximal and middle segments of the stents, while malapposed struts in the middle segments of the stents. There was direct correlation between the percent of uncovered and malapposed struts (r = 0.544; р = 0.005), percent of uncovered struts and malapposition length (r = 0.601; р = 0.002), percent of uncovered struts and maximum distance of malposition (r = 0.574; р = 0.003). The incidence of neoatherosclerosis was associated with increase in the length stents (odds ratio = 1.15, 95% CI 1.01–1.31, p = 0.039).</p><p><strong>Conclusion</strong>. In most patients, stent condition was suboptimal 5 years after implantation for STEMI. Neoatherosclerosis, malapposition and uncoated struts were the main reasons for suboptimal stent condition.</p><p>Received 16 September 2020. Revised 9 October 2020. Accepted 12 October 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: I.S. Bessonov<br />Drafting the article: I.S. Bessonov, A.O. Dyakova, A.I. Kostousova, S.S. Sapoznikov, E.A. Gorbatenko<br />Critical revision of the article: V.A. Kuznetsov, E.A. Gorbatenko<br />Final approval of the version to be published: I.S. Bessonov, V.A. Kuznetsov, A.O. Dyakova, A.I. Kostousova, S.S. Sapoznikov, E.A. Gorbatenko</p>

<p><strong>Aim.</strong> To examine the process of neointimal formation after bioresorbable scaffolds (BRS) implantation using optical coherence tomography (OCT) in patients with stable coronary artery disease (SCAD) and to determine relationship between neointimal healing and biochemical parameters of inflammation.<br /><strong>Methods.</strong> Patients with SCAD (n = 20) who were indicated for percutaneous coronary intervention (PCI) were enrolled. Patients were randomised into two groups as per the stent type. The treatment group comprised 10 patients who were implanted with BRS ABSORB (Abbott Laboratories, Abbott Park, USA) during PCI. The comparison group comprised 10 patients who were implanted with DES XIENCE (Abbott Laboratories, Abbott Park, USA) during PCI. All the patients underwent OCT imaging during PCI. Subsequently, 18 patients were subjected to coronary angiography with OCT imaging in 12 mon. The primary endpoint was the 12-month neointimal healing (NIH) score. Secondary endpoints were clinical outcomes (all-cause hospitalisation, myocardial infarction, probable stent thrombosis and death), OCT parameters at the 12-month follow-up and biochemical markers dynamics.<br /><strong>Results.</strong> Initial angiographic data analysis indicated a higher rate of balloon pre-dilatation (100% vs. 30%; р = 0,003) and post-dilatation (100% vs. 20% р = 0,001) in patients of the treatment group. According to OCT, the NIH score was significantly higher in the XIENCE group [0 versus 9,14 (1,63–17,55); р = 0,008] at 12 mon. There was no significant difference in the clinical outcomes between the two groups. However, the ABSORB group had an increased CD40 level after 4–5 d of PCI. In agreement with the results of correlation analysis, there was an inverse correlation between the NIH score and CD40 level at 4–5 d after PCI (r = −0,576; р = 0,016). The cut-off value of CD40 level at 4–5 d after PCI was 47,5 ng/mL for the detection of optimal neointimal healing.<br /><strong>Conclusion.</strong> In patients with SCAD, BRS demonstrated higher rate of neointimal healing than everolimus-coated stents. There was a registered inverse correlation of the NIH score with the CD40 level at 4–5 days after PCI. CD40 level &gt; 47,5 ng/mL at 4–5 d after PCI increases the likelihood of optimal neointimal healing as per OCT data.</p><p>Received 19 February 2021. Revised 7 June 2021. Accepted 16 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: I.S. Bessonov, N.A. Musikhina, T.I. Petelina<br />Data collection and analysis: S.S. Sapoznikov, I.S. Bessonov, N.А. Galeeva, A.O. Dyakova<br />Statistical analysis: S.S. Sapoznikov, E.A. Gorbatenko<br />Drafting the article: S.S. Sapoznikov, N.А. Galeeva, A.O. Dyakova<br />Critical revision of the article: I.S. Bessonov, S.S. Sapoznikov, E.A. Gorbatenko, N.A. Musikhina<br />Final approval of the version to be published: S.S. Sapoznikov, N.А. Galeeva, I.S. Bessonov, N.A. Musikhina, T.I. Petelina, A.O. Dyakova, E.A. Gorbatenko</p>

Aim      To study long-term results and to identify predictors of death in patients with ST-segment elevation acute myocardial infarction (STEMI) who underwent endovascular revascularization.Materials and methods This study included 283 patients registered in the hospital registry of percutaneous coronary interventions (PCI) for STEMI from 2006 through 2009. Analysis of 10-year results included all-cause and cardiovascular death rate, incidence of recurrent myocardial infarction (MI), repeated revascularization, stroke, stent restenosis and thrombosis. Also, a composite endpoint МАССЕ (Major Adverse Cardiovascular and Cerebrovascular Events) was evaluated, which included death, recurrent MI, repeated PCI, stent restenosis and thrombosis, coronary bypass, and stroke.Results Information about the health condition was provided by 204 (72.1 %) patients. Mean follow-up period was 120.1±9.5 months. All-cause mortality was 25.5 % with cardiovascular death determined in 19.1 % of cases. Recurrent MI developed in 21.6 % of patients; in 1.5 % of cases, recurrent MI resulted from thrombosis of previously implanted stents. Repeated PCI was performed for 31.9 % of patients; in 13.7 % of cases, the PCI was performed for stent restenosis. Coronary bypass was performed for 5.4 % of patients. Incidence of stroke was 10.3 %. Major cardiovascular and cerebrovascular complications (МАССЕ) during the follow-up period were determined in 60.3 % patients. According to the Cox proportional hazards regression model, age ≥65 years (odds ratio (OR), 3.75 at 95 % confidence interval (CI) from 1.75 to 8.03; р=0.001) and incomplete coronary revascularization (OR, 3.09 at 95 % CI from 1.52 to 6.30; р=0.002) were independent predictors of death based on data of the 10-year observation.Conclusion      Therefore, at 10 years following endovascular revascularization, STEMI patients showed a moderate death rate with a high incidence of major cardiovascular and cerebrovascular complications. The leading causes for fatal outcomes were recurrent cardiovascular complications. The major predictors of death for the coming 10-year period included age ≥65 years and incomplete myocardial revascularization.