The aim – to study and analyze the clinical and functional characteristics and parameters of lipid metabolism in patients after acute myocardial infarction (MI), depending on the progression of atherosclerosis according to the data of repeated coronary angiography (CAG) during a three-year follow-up.Materials and methods. The study prospectively included 91 patients with primary Q-MI, 47 of whom underwent a full cardiac rehabilitation (CR) program with physical training (FT), 44 patients – had only complexes of physical exercises and distance walking in accordance with the terms of MI. For three years, CAG was performed in 38 patients, in 18 (group 1) of whom the progression of the atherosclerotic process was established, in 20 (group 2) progression was not visualized in CAG. 53 patients (group 3) had a stable satisfactory condition and refused to repeat CAG. Treatment was performed in accordance with modern guidelines with urgent stenting of the infarct-dependent coronary artery. All patients underwent dosed testing on a bicycle ergometer, echocardiography and an evaluation of lipid metabolism indicators. Control examinations were carried out at discharge on the 10-15th day of myocardial infarction and in dynamics after 1 and 3 years.Results and discussion. Undesirable cardiovascular events (recurrent MI, coronary artery bypass grafting, restenosis, and hemodynamic significant stenoses) occurred only in the 1st group: 7 events – during the first year, also 7 – during the second year, and the last 14 – during the third year. In the second group, in the first week of myocardial infarction stent thrombosis occurred in 2 patients, coronary bypass grafting was performed according to the data of urgent coronary angiography also in 2 patients. During the 3-years follow up in the group with the progression of atherosclerosis the number of patients with diabetes mellitus tripled, and there was also a tendency to an increase in body mass index. According to the results of the exercise test on a bicycle ergometer and echocardiography, significant differences in the groups were not established, however, a positive trend in the dynamics of observation was noted in patients of the 2nd group without progression of atherosclerosis. Low-density lipoprotein cholesterol values ​​were obtained on the 5–7th day of myocardial infarction at the background of high-intensity statin therapy and were considered as basic. Further results showed the best performance in the first 6–12 months after myocardial infarction with better adherence to medical recommendations in the period as close as possible to acute MI. In the group of patients with progression of atherosclerosis, the maximum decrease in the level of low-density lipoprotein cholesterol (up to 2.10 (1.79–2.38) mmol/L) was observed after 6 months, followed by an increase in 1 and 3 years to a level exceeding the baseline. Variations in this indicator in patients without progression were 1.85–2.02–1.83 mmol/L, which was close to the recommended target values ​​(up to 2019).Conclusions. In the group with the progression of the atherosclerotic process, the number of patients with diabetes mellitus increased over 3 years and a tendency towards an increase in body mass index was observed. Most of the patients returned to smoking by the end of the first year after myocardial infarction, but then 3 years later, some of the patients in group 2 stopped smoking again, which may indicate the effectiveness of training and the psychological component of cardiac rehabilitation in the group without progression of the atherosclerotic process. The results of echocardio­­graphy and the level of exercise tolerance at the time of examination did not differ in patients with and without progression of the atherosclerotic process. Maintaining the target levels of LDL cholesterol is possible only under the condition of long-term high-intensity statin therapy under the supervision of a physician, adherence to the comprehensive recommendations of stage III CR at each contact with the patient.

The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.

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The aim – to study clinical and functional characteristics of patients with ST-segment elevation myocardial infarction (STEMI), the terms of urgent percutaneous coronary intervention (PCI), the coronary artery lesions, gender and age, the parameters of intracardiac hemodynamics depending on the time to PCI; to assess the end-points at 1 year follow-up.Material and methods. Between Feb till May 2015 we conducted a single-center prospective study and enrolled 108 patients with STEMI that underwent PCI (coronary angiography with stenting). We analyzed the terms of PCI after acute coronary syndrome symptoms onset, demographic, anamnestic, clinical, echocardiographic, angiographic data, as well as characteristics of interventions. We studied end-points, such as death, recurrent non-fatal MI, unstable angina, at 12 months follow-up after STEMI. Data on clinical outcomes were available in 100 of 108 patients (92.6 %).Results. According to the study results, half of STEMI patients underwent PCI within 3.5 hours; only 20.4 % patients – within the optimal time window (up to 2 hours); 60 % of patients – from 2 to 6 hours. Only 47 % of patients underwent complete revascularization. However, stenotic lesions ≥ 70 % were identified in 40 % of patients. Severe coronary lesions, suitable for CABG, were detected in 14 % of cases. Large LV aneurysm with intramural thrombus formation was diagnosed in 4 % of patients. Females, compared to males, were older, with the more prevalent concomitant hypertension and diabetes mellitus. Only 33 % of patients were judged as low-risk patients, according to the PAMI-II criteria. At 1 year follow-up, 3 % patients died from recurrent MI. These patients had single- or two-vessel disease, with stenting of the culprit artery. Among patients suitable for CABG, surgical revascularization was performed only in 1/3 cases.Conclusions. The registry data allow to assess the profile of STEMI patients undergoing PCI, as well as short-term (at discharge) and long-term (at 1 year follow-up) outcomes.

In the treatment of patients with myocardial infarction, a special place belongs to cardiac rehabilitation (CR), which today is positioned as a multifaceted multidisciplinary science, combined with preventive cardiology. CR includes physical training, psychological rehabilitation, sessions with a social worker (motivation to return to work); consultations and training programs which embrace discussion of issues of secondary prevention, including modification of risk factors, stimulating adherence to physical activity and drug treatment. Its purpose is to maximize the recovery of the physical, psycho-emotional and social condition of patients with their return to work, to preserve the quality of life and provide long-term detention of the progression of atherosclerosis. The review presents the main historical aspects of the development of CR, provides statistical indicators of inclusion in the program of CR after a cardiac event – myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting, presents indications and contraindications for CR. The data are presented of registries and clinical examinations on the effectiveness of CR with physical training for reducing the rates of overall mortality, cardiovascular mortality, hospitalizations, improvement of quality of life, impact on lipid metabolism and processes of myocardial remodeling. Issues related to the time of the beginning of CR with exercise training after index event, duration and intensity of aerobic exercise, assignment of dynamic and static exercises were discussed. One of the main problems in assessing the effectiveness of CR is the existence of many programs in different countries and even in different centers, which limits the possibility of correct comparison of research results. We provide the results of our own study (n=91) in which 47 patients underwent training on a cycle ergometer 11–45 days after the infarction. No differences were found in load tolerance, depending on the start of training. The efficiency of CR with its physical component has been proved regarding the threshold power level and the hemodynamic value of the work performed. The results are presented of cycling ergometry after training in dynamics during 1 year of observation after myocardial infarction depending on the time of coronary circulation recovery in the infarct-determining coronary artery, the number of affected coronary arteries and the completeness of revascularization. Based on the data of leading associations of rehabilitation and preventive cardiology in Europe and America, the main perspective directions for further development of CR are outlined.