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Aim. To evaluate the effect of 5-hydroxymethyluracil on the dynamics of angiogenic growth factors in the perioperative period of surgical myocardial revascularization.Material and methods. This prospective, randomized, single-center study included two following groups: experimental group — 25 patients in the perioperative period of coronary artery bypass grafting (5 days before and 14 days after surgery) receiving 5-hydroxymethyluracil (at a dose of 500 mg 3 times a day) in addition to standard therapy; control group — 25 patients receiving standard therapy. The groups were comparable in terms of sex, age, main clinical and functional characteristics and features of surgical intervention. In patients, quantitative indicators of angiogenic growth factors in peripheral blood taken 5 days before and 14 days after surgery were studied by enzyme immunoassay: human vascular endothelial growth factor A (VEGF-A), human hepatocyte growth factor (hHGF), insulin-like factor growth 1 (IGF-1) and basic fibroblast growth factor (bFGF).Results. In the experimental group of patients, while taking 5-hydroxymethyluracil, there was a significant increase in the peripheral blood concentration of following growth factors compared with the control group: VEGF-A by 26,90% (p=0,0246), IGF-1 by 44,89% (p=0,0011), bFGF by 60,0% (p=0,0006). The hHGF concentration also turned out to be higher by 19,90%, but did not reach the level of statistical significance (p=0,2836).Conclusion. The use of 5-hydroxymethyluracil, a representative of pyrimidines, in the perioperative period of surgical myocardial revascularization leads to a significant increase in peripheral blood of such angiogenic growth factors as VEGF-A, IGF-1, and bFGF.

Highlights. This review systematizes the results of experimental and clinical studies on the impact of coronary artery bypass grafting on angiogenesis and potential use of pyrimidine derivatives for therapeutic angiogenesis.Abstract. Coronary artery bypass grafting is the preferred treatment modality for multivessel coronary artery disease. However, the clinical efficacy of the procedure decreases over time due to the progression of atherosclerosis in the bypass grafts and native coronary arteries. In this regard, it is of great scientific and practical interest to disclose the mechanisms affecting the development of the microvasculature during myocardial surgical revascularization, as well as the search for pharmacological substances capable of stimulating the process of angiogenesis during these surgeries to improve short and long-term outcomes. The article presents a review of experimental and clinical studies on the effect of coronary artery bypass surgery on angiogenesis and highlights the place of pyrimidine derivatives in therapeutic angiogenesis in coronary artery disease.

INTRODUCTION: Despite the increased volume of rendered high-tech assistance and objective improvement of the condition of the majority of operated patients, the parameters of physical activity and working capacity in this category of patients remain low. AIM: To study the effect of 5-oxymethyluracil with angiogenic properties on the quality of life of patients in the early and long-term period after coronary artery bypass grafting (CABG). MATERIALS AND METHODS: The randomized prospective study included two groups of patients: the main group (n = 87) which in the perioperative period of CABG (5 days before and 14 days after surgery), in addition to standard therapy, received the drug 5-oxymethyluracil), and the control group (n = 81) which received standard therapy. The groups were comparable in gender, age, basic clinical and functional characteristics and peculiarities of surgical intervention. The quality of life of patients was determined by the Seattle Angina Questionnaire (SAQ) before CABG surgery (upon admission to the vascular surgery department) and after surgery (after 2 months and 1618 years). There were no statistically significant differences in the preoperative parameters of quality of life in the control and main groups. RESULTS: In the long-term period of surgical revascularization of the myocardium (1618 years after the operation) the severity of angina according to SAQ was: in the control group 33.30 (20.00-60.00), in the main group 60.00 (33.30-70.00; р = 0.0407). Other scales of SAQ, including physical activity, stability of anginal course, satisfaction with treatment and perception of the disease, did not demonstrate any differences between the studied groups in 2 months or 1618 years after CABG. CONCLUSION: Perioperative use of 5-oxymethyluracil influenced the improvement of only one parameter of quality of life according to the SAQ questionnaire the severity of angina, with statistically significant differences between the groups in the long-term period of CABG (1618 years after surgery). According to SAQ questionnaire, there was no effect on the remaining parameters of the quality of life with the underlying perioperative use of the studied drug in all follow-up periods.

Significance. Reserving resources of the health care system to combat the spread of the new coronavirus infection makes it relevant to identify unused reserves for reducing mortality from diseases of the circulatory system through a more efficient use of the resources available to the regions to control cardiovascular diseases, as well as using resources of the neighboring regions through effective schemes of interregional routing of patients. Purpose. To assess performance and predictive accuracy of the developed information system "Cardionet" in ambulance service and, using this system, to analyze the existing routing schemes for patients with acute coronary syndrome (ACS) in the Kursk region to select the optimal routing schemes in terms of the time spent on transporting patients with ACS to cardiovascular centers, including cases of interregional cooperation. Material and methods. Performance and predictive accuracy of the "Cardionet" information system were analyzed on the basis of the ambulance service of the Kursk region. The digital twin of the Kursk region was used to study the time indicators of transportation of patients with acute coronary syndrome by ambulance teams to medical organizations on the basis of the current procedure versus routing with automatically determined optimal route, including during interregional cooperation with cardiovascular centers of the neighboring regions. Results. The difference between the estimated and actual time of transportation when using the “Cardionet” information system equaled to 1.17 ± 5.52 minutes on average (p=0.1534), which is statistically insignificant and indicates a high predictive accuracy of the software product for calculating the patient transportation time. Due to introduction of the interregional cooperation, the regional average transportation time for patients with acute coronary syndrome with ST segment elevation was reduced by 10.43 ± 5.39 minutes, with the estimated decrease in mortality from myocardial infarction equaling to 2.62%. In four districts of the region, the time saved ranged from 41.5 ± 19.99 to 95.4 ± 21.52 minutes, and the predicted decrease in mortality from myocardial infarction - from 10.43% to 23.91%. In six out of 28 districts of the Kursk region, the routing of patients with acute coronary syndrome without ST-segment elevation is suboptimal in terms of the transportation time. Improvement of the routing schemes using the “Cardionet” information system will save 11.63 ± 4.37 to 40.05 ± 13.65 minutes on average. Conclusion. The use of the “Cardionet” information system for routing patients with acute coronary syndrome helps to decrease time required for patient transportation to medical organizations, which is a significant reserve for reducing mortality from diseases of the circulatory system.