The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale. Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated. Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05). Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.

The aim. To investigate the course, quality of life and risk factors depending on gender in patients with stable isch-emic coronary disease, multivascular coronary injury and reduced left ventricular systolic function Materials and methods. In a one-center study of the Ukrainian Children’s Cardiac Center, Clinic for Adults analyzed data from 107 patients with coronary artery disease, multivascular coronary artery injury and reduced left ventricular systolic function (LV EF below 35%), who underwent complete revascularization from January until December 2020. Among those surveyed were 67 (62.6%) men and 40 (37.4%) women aged 54 to 83 years. Myocardial infarction was diagnosed in 95 (88.7%) patients. Hypertension was diagnosed in 50 (74.6%) men and 35 (87.5%) women. Diabetes was registered in 13 (19.4%) men and 14 (35.0%) women. Results and discussion. According to the multivariate analysis, the most significant factors in reaching the endpoint during the annual follow-up after CABG and PCI were: worse left ventricular systolic function; the presence of diabetes mellitus; and lack of postoperative statin therapy. Conclusion. Gender features in long-term results after myocardial revascularization were revealed. Women were more likely to complain of angina in the postoperative period and rather hospitalized than men, but they were less likely to undergo myocardial revascularization. The quality of life after CABG and PCI in female patients was slightly reduced compared to that in men. After the intervention, men were less likely to take statins than women. Regardless of the type of myocardial revascularization in women, LV EF was higher than in men.

The aim. To evaluate clinical and prognostic effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on primary (progression of heart failure, rehospitalization) and secondary endpoints (death from cardiovascular disease and from all causes) in patients with heart failure with reduced ejection fraction (HFrEF) within 8 months after percutaneous coronary intervention (PCI). Materials and methods. In a one-center study on the basis of the Ukrainian Children’s Cardiac Center, Clinic for Adults we analyzed the data for drug and interventional treatment of 166 patients with coronary artery disease and reduced left ventricular ejection fraction (LVEF) (<40%), who underwent PCI in the last 8 months. Among the 166 patients studied, 86 (51.8%) patients received SGLT2 inhibitors as an adjunct to the standard baseline therapy, and 80 (48.2%) patients did not receive SGLT2 inhibitors after PCI. Results and discussion. The primary combined outcome was observed in 10 patients (6.02%) in the group of patients taking SGLT2 inhibitors and 35 patients (21.08%) without addition of SGLT2 inhibitors (hazard ratio 0.72; 95% CI, 0.65-0.85; p <0.001). The incidence of the secondary combined result was lower in the group receiving SGLT2 inhibitors than in the comparison group (risk ratio, 0.85; 95% CI, 0.75-0.95; p <0.001). Conclusions. The use of SGLT2 inhibitors in addition to the standard therapу provided a 72% reduction in the relative risk, estimated by the incidence of primary combined endpoint in particular, hospitalization due to the heart failure decompensation by 34% in the same group, and the secondary endpoint by 50%. The advantage of SGLT2 inhibitors over the standard therapy in the effect on the primary endpoint did not depend on the complete or incomplete myocardial revascularization by PCI in patients over an 8-month follow-up period. SGLT2 inhibitors use in patients after PCI with reduced left ventricular systolic function over the 8-month follow-up period led to regression of angina according to the KCCQ-TSS questionnaire, decreased functional class according to the New York classification, and increased LVEF.

The article presents a clinical case of treatment of a patient with acute massive pulmonary embolism. A 70-year-old patient was urgently admitted to the intensive care unit with complaints of sudden onset of chest pain for the first time, severe shortness of breath and two episodes of syncope in the last 4 hours. When the patient was admitted to the hospital, the heart rate was 131 beats / min, blood pressure was 80/50 mm Hg, SpO2 was 88 %, and PO2 was 76 mm Hg. Echocardiographically revealed dilated right atrium and right ventricle, hyperechogenic «floating» formation of the right atrium; moderate tricuspid regurgitation and pronounced pulmonary hypertension with systolic pressure in the pulmonary artery ~ 63 mm Hg were observed, and preserved systolic function of the left ventricle; inferior vena cava 20 mm, on the udder did not fall. It was urgently decided to carry out thrombolytic therapy to the patient in connection with unstable hemodynamics. The patient was started administration of alteplase according to the accelerated scheme: 10 mg of tissue plasminogen activator as an intravenous bolus for 1 minute of administration, then – intravenous infusion of alteplase 90  mg for the next 2 hours until the maximum total dose of 100 mg. Three hours after thrombolytic therapy – hemodynamic parameters of the patient had a positive dynamics: blood pressure – 125/80 mm Hg, pulse – 76/min, SaO2 – 98 %, PO2 – 90 mm Hg. On transthoracic echocardiography – no thrombus in the right atrium and right ventricle, as well as a small tricuspid regurgitation, with slight pulmonary hypertension (PsystRV – 36 mm Hg). This clinical case demonstrates thrombolysis with alteplase – «rescue therapy» and a fairly effective treatment option for patients with unstable hemodynamics, acute massive pulmonary embolism, complicated by thrombosis of the right atrium and/or right ventricle and existing hypertensive.

The aim – to analyze of the complex treatment of a patient with coronary artery disease and subclavian-vertebral robbery syndrome, diagnostic methods of examination, observation and treatment.Materials and methods. The patient with coronary artery disease and occlusion of the left subclavian artery. Physical assessment methods were used? Such as: examination of the patient, anamnesis; laboratory and instrumental investigations – general blood analysis, biochemical blood analysis, electrocardiogram, echocardiography, coronary angiography of the carotid and subclavian arteries.Results and discussion. This complex interventional method of treating the patient had rather good angiographic result. The implantation of the stent system into the area of ​​critical lesion of the main left coronary artery and stent system in the occlusion of the left subclavian artery led to avoid the open surgical operation in the patient and to reduce the period of rehabilitation with a low postoperative risk.Conclusion. According to the international experience, in cases of planned phased treatment of coronary and peripheral arteries that require surgical intervention, it is better to give preference to the endovascular technique in patients with hemodynamically significant lesions. Percutaneous transluminal angioplasty and stenting should be the first therapeutic method for eliminating the problem of symptomatic lesions of the coronary and peripheral arteries.