Despite the technological developments in the healthcare industry, cardiovascular disease mortality occupies a leading place among the structure of general mortality of the population. The use of modern treatment methods, especially, percutaneous coronary intervention, provides timely assistance to patients with acute coronary syndrome and helps to reduce mortality frequency. Currently, clear algorithms for the management of patients with ST-segment elevation myocardial infarction have been developed. However, despite it, there are paradigms in the management of patients with non-ST-segment elevation myocardial infarction (NSTEMI). This is primarily due to the fact that the vast majority of patients with NSTEMI are elderly and senile persons. This review article presented the main factors that adversely affect short- and long-term prognosis and results of clinical studies dedicated to the study of this problem.

Spontaneous coronary artery dissection (SCAD) is one of the rarest causes of acute coronary syndrome. SCAD is most common in women <60 years of age (≥90% of cases) compared with men (10-12%). The rapid development of technologies used in interventional cardiology has made it possible to improve diagnostics and understand the pathogenesis. The management strategy in patients with SCAD is debatable and differs significantly from approaches to coronary atherosclerosis treatment. The review presents the results of recent studies. The angiographic classification of SCAD, the diagnostic algorithm and the choice of optimal treatment depending on clinical manifestations are also described.

Background. Transcatheter aortic valve replacement is a safe and effective procedure in patients with severe aortic stenosis who are at high surgical risk. One of the most commonly diagnosed complications after transcatheter aortic valve replacement is postoperative complete heart block, requiring in most cases the permanent pacemaker implantation.Aim. The study aims to identify independent prognostic factors of permanent pacemaker implantation after transcatheter aortic valve replacement.Methods. This retrospective study included 336 patients who underwent transcatheter self-expanding aortic valve replacement between 2015 and 2021. 28 patients (8.3%) after procedure required the permanent pacemaker implantation. Patients with a previously implanted permanent pacemaker, surgical aortic valve replacement, transcatheter aortic valve replacement in history and patients after conversion of endovascular intervention to surgical replacement were excluded from the study.Results. The mean age of patients was 75.4 ± 7.4 years. Diabetes mellitus (50.0 versus 28.6%, p = 0.03), baseline right bundle-branch block (32.1 versus 3.9%, p < 0.05), and smaller length of the interventricular membranous septum (5.5 ± 2.2 and 6.9 ± 1.8 mm, p < 0.05) were more common in the permanent pacemaker implantation patient group. The groups were comparable in terms of other clinical, demographic and instrumental characteristics. There were no statistically significant differences between the groups in major procedural complications. Independent prognostic factors of permanent pacemaker implantation were baseline complete right bundle-branch block (OR 21.01, 95% CI 5.86–75.42, p < 0,001), mean transcatheter aortic valve implantation depth below the aortic annulus (OR 1.42, 95% CI 1.16–1.74, p = 0.001) and the length of the interventricular membranous septum (OR 0.7, 95% CI 0.50–0.95, p = 0.02).Conclusion. The frequency permanent pacemaker implantation after transcatheter aortic valve replacement procedure depends on some initial clinical factors, procedural aspects, and postoperative conduction disorders. In this registry, independent prognostic factors of a permanent pacemaker implantation were the baseline complete right bundle-branch block, mean transcatheter aortic valve implantationdepth and the length of the interventricular membranous septum. Received 19 March 2022. Revised 18 April 2022. Accepted 19 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. ZaynobidinovData collection and analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianStatistical analysis: A.A. Baranov, A.G. Badoian, D.A. KhelimskiiDrafting the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. ZaynobidinovCritical revision of the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. ZaynobidinovFinal approval of the version to be published: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. Zaynobidinov