Aim. To find out the relationship of the severity of patients condition, with acute myocardial infarction without ST segment elevation (NSTEMI), upon admission to the hospital on the basis of the Global Registry of Acute Coronary Events (GRACE) scale with the time interval between the onset of the disease and up to hospitalization (painhospitalization), and to clarify the effect of the GRACE score on the time interval to endovascular procedures (EVP) doorballoon, in real clinical practice. Material and methods. The study included 421 NSTEMI patients. Patients were admitted between 2000 and 2017. All patients underwent coronary angiography followed by EVP. Depending on the clinical condition, at admitted to the hospital, patients were divided into risk groups on the GRACE scale. According to the indicators painhospitalization and doorballoon 3 time intervals were allocated: 6 hours, 624 and 24 hours. Results. At admission, 73.9% (311) patients had an average and high risk on the GRACE scale. Patients with high risk were significantly more often (49.6%) hospitalized during the first 6 hours after onset of the disease than later (p0.05). 2/3 of all patients and 3/4 of patients with high risk had the time interval of painhospitalization up to 24 hours. 51.8% patients in the total group and 65.8% among high-risk patients had a doorballoon interval up to 6 hours. During first 24 hours after hospitalization EVP was successfully completed on 90.7% of patients. One patient had a fatal outcome. At discharge none of the patients were observed the symptoms of angina pectoris and congestive heart failure. Conclusion. In the all group, according to the allocated time intervals painhospitalization, patients were distributed practically equally. The severity of the condition of the studied patients is indicated by the fact that almost 3/4 of them had a high and average risk on the GRACE scale. It is encouraging that in the first 6 hours from the onset of the disease, high-risk patients were significantly more often hospitalized. Almost 2/3 of high-risk patients and more than half of all patients had a doorballoon indicator-up to 6 hours. It is important that in the first 24 hours, successful EVP was performed in 90.7% of patients. Thus, our results (low mortality, absence of angina and heart failure after EVP) indicate the correct management and treatment of NSTEMI patients, which is close to the latest world recommendations, comes from real life circumstances and can be recommended for real clinical practice.

Aim      To study the effect of residual coronary injury after a percutaneous coronary intervention (PCI), as evaluated with the SYNTAX scale (residual SYNTAX score, RSS), on the mid-term prognosis for patients with non-ST elevation acute myocardial infarction (NSTEMI) and also to determine threshold RSS values for patients at high and low risk of adverse cardiac events.Material and methods  A single-center, retrospective study was performed. From 421 patients with NSTEMI after PCI with stenting, 169 patients were selected who originally had multivessel coronary disease and who had undergone a repeated inpatient examination, including mid-term (11.7±3.0 mos.) coronary angiography. The endpoints were recurrent clinical manifestations of angina, repeat revascularization (RR), unstable angina (UA), recurrent acute myocardial infarction (AMI), cardiac death, and also a composite endpoint (major adverse cardiac events, MACE) that included UA, recurrent AMI, and cardiac death. After revealing a significant direct correlation between RSS and the probability of recurrent AMI, UA, MACE, or RR (p <0.05) using the ROC analysis, we have established threshold RSS values that divided patients into groups with high and low risk of the cardiac events listed above.Results For a significantly high risk of recurrent AMI (area under the curve, AUC 0.79±0.05; 95 % confidence interval, CI 0.68–0.89; р=0.048), the threshold RSS score was 8 (sensitivity 100 %, specificity 70.9 %). For UA and MACE, the RSS scores were both 3 (AUC 0.68±0.5; 95 % CI 0.58–0.79; p=0.005 and AUC 0.71±0.05; 95 % CI 0.61–0.8; p=0.001, respectively). The probability of UA during the observation period with RSS >3 was 4.07 times higher and that of MACE was 5.23 times higher than with RSS<3 (95 % CI 1.44–11.49; р=0.01 and 95 % CI 1.88–14.53; р=0.001, respectively).Conclusion      The study demonstrated a significant, direct correlation between the RSS and the risk of adverse cardiac events in patients with NSTEMI during one year of observation. Specific threshold values were obtained, which may help in choosing both the extent of revascularization and the tactics for postoperative management of patients.

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Aim. Secondary atrial septal defect (ASD II) is one of the most common congenital heart defects. While all the issues of endovascular correction of this disease in children and young patients have been practically resolved, many issues still remain debatable regarding the treatment of adult patients. In the proposed work, the author analyzes the main information’s discussed in the literature concerning this issue, such as the expediency and tactics of treatment of adult patients with ASD II, depending on its anatomical forms, the status of intracardiac and pulmonary-arterial hemodynamics, the presence of concomitant diseases. Materials and methods. The article presents a literature review based on the results of searching of publications in Russian and international bibliographic da-tabases (PubMed, eLIBRARY, Medscape, etc.). Results. Analysis of the literature data in most cases indicates the feasibility and high efficiency of endovascular closure of hemodynamically significant ASD II in elderly patients. The analysis of dynamic observations in the long term after endovascular treatment, reveals a decrease in MPAP as well as the size of the right heart. At the same time, compliance with certain rules makes the intervention quite safe, regardless of the age of patients and, to a certain extent, the severity of symptoms. In the literature, it is particularly emphasized that when determining the management tactics of adult patients with ASD II in order to prevent possible complications, should be objectively evaluated and taken into account such factors that determine their initial state as: the presence of high MPAP, volume overload of the right heart, and vice versa, underloading of the left heart, the conditions of the heart valves, the presence of arterial hypertension, existence of heart rhythm disorders, ischemic heart disease and left ventricle dysfunction. Conclusion. Modern medical literature convincingly proves that with the right selection of patients, transcatheter closure is a safe, highly effective method of correction of ASD II, accompanied by real economic effect and it should be considered a standard in the treatment of middle-aged and elderly patients. At the same time, studies on long-term results show that the positive functional effect does not have age restrictions.