No abstract

The aim – to reveal features of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilatation in ST-elevation acute coronary syndrome (STEMI) patients of different age groups. Materials and methods. We analyzed the data of instrumental examination of patients who were admitted to the emergency departments from 2000 to 2015, with STEMI. Patients were distributed into two groups depending on age: 1 group – patients < 45 years, 2 group ≥ 45 years. Coronary angiography (CAG) was performed within the first hours after the admission. Endothelium-dependent, flow-mediated vasodilation (FMD) test and echocardiography were performed within 24 hours of admission and again on the 7th day. Results and discussion. According to сoronary angiography, elder patients were more likely to have infarction-dependent coronary artery disease (33.3 vs. 20.3 %; p=0.037), and multi-vessel coronary artery disease (12.0 vs. 4.8 %; p=0.048). Patients in the 1st group demonstrated a lower frequency of hemodynamically significant lesions of coronary vessels (p<0.001) and less marked disorders of the lipid spectrum. Patients of the group 1 had less thickness of the interventricular septum. 10.7±1.5 mm versus 11.6±1.6 mm, p=0.024). Young patients had initially better diastolic function (Е/А) (1.29±0.40 versus 1.00±0.52, p=0.008). At day 7 in patients of the 1st group there was a more marked increase in the left ventricular ejection fraction and end-diastolic diastolic index of the left ventricle (7.6 versus 3.4 %; p<0.05) than in the patients of the 2nd group. Young patients demonstrated a tendency to increase of end-diastolic index > 10 %, in dynamics, at 39.7 versus 27.8 % elder patients (p=0.053), lower growth of the diameter of the brachial artery (4.7±4.1 vs. 6.7±5.1 %; p<0.05), but more rapid improvement of endothelial function in the dynamics of observation (104 vs. 23 %; p<0.05). Conclusions. The percentage of damage of coronary artery disease in STEMI young patients did not differ from elder patients but insignificant coronary artery stenosis is detected more often (р<0.001) and acute myocardial infarction in the right coronary artery is less common (р<0.037). Young patients with multi-vessel coronary disease have significant violations of the lipid blood spectrum (increased levels of total cholesterol, low density lipoprotein cholesterol). Indicators of intracardiac hemodynamic did not differ between age groups initially, however, the course of acute myocardial infarction in young patient was characterized by the tendency to develop early post-infarction dilatation (p=0.053). According to the FMD test young patients at the onset had a worse indicator of than elder patients (p<0.043), however the diameter of the brachial artery in the dynamics of observation, significantly increased (p<0.05).

CLARIFY (The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is a large multicenter project in the patients with a stable coronary artery disease (CAD). Within 5 years (2009–2014) 32,703 patients with confirmed diagnosis of CAD from 45 countries worldwide took part in the registry. Study results have demonstrated the significant differences between the current international standards of management and real-life clinical practice. Despite the fact that Ukrainian doctors actively used the complete list of the medicinal products recommended in the stable CAD (ASA, statins, BBs, ivabradine, ACE inhibitors), the control of therapy efficacy was very low and not only relative to the symptoms (after 5-year follow-up, angina attacks were persistent in 74 % of patients versus 16.9 % of the European patients). It should be noted that the clinical status of patients enrolled in Ukraine was more severe compared with the general group: 24.1 % of patients with the severe angina (ІІІ FC), in Europe – 2.2 %, in the world population – 1.6 %. Rate of the myocardial revascularization (surgical, endovascular) was very low in Ukraine as for 5-year study – only 5.9 %. As a result, our patients had 2-fold need in the hospitalization, 2-fold rate of fatal MI and acute cerebrovascular accidents (stroke + TIA) and 3-fold rate of the unstable angina. Control of such main risk factors of CAD, as BP levels < 140/90 mm Hg, LDL cholesterol levels < 1.8 mmol/L, HR < 70 beats per minute was insufficient both in the Ukrainian and global populations. During the study both Ukrainian and European patients have not demonstrated the dynamics in life style modification (majority of subjects continued sedentary lifestyle, were overweight, had signs of the abdominal obesity and smoked). Taking into consideration the results of the CLARIFY study, significant optimization of management of patients with stable CAD is still necessary.

The review provides information on neutrophils, which are important effector cells of the innate immune response and form the first line of defence against infection. Issues of maturation and functional activity of cells are highlighted. The stages of the vital activity of neutrophils are shown – migration, chemotaxis, adhesion, oxygen explosion, absorption, degranulation, apoptosis. Special attention is paid to neutrophilic extracellular traps and the importance of myeloperoxidase. Today, these cells are increasingly viewed as a potential biomarker with specific treatments.

The article presents the case of the development of acute thrombosis of two coronary arteries in a 35-year-old patient without atherosclerotic lesion of the heart vessels according to optical coherence tomography. Acute myocardial infarction in a patient developed on the background of previous diffuse myocarditis, foci of which of different time were identified during magnetic resonance imaging. Smoking and chronic intoxication due to contact with paint and varnish materials and regular intake of alcohol were the only risk factors for myocarditis and coronary thrombosis that were able to be detected in this patient.