Clinical Consequences Dependence of Acute Coronary Syndrome Invasive Treatment on the Characteristics of Segmental Injury of Coronary Arteries

Abstract

Cardiovascular diseases are the main cause of mortality and disability factors. Prediction of the possible consequences of treatment, based on data on the features of anatomical localization of lesions, will obviously be able to improve the quality of treatment and reduce the level of disability. Optimization of interventional treatment methods depending on the coronary vasculature anatomical features, the development of collateral blood flow is aimed at the implementation of a personalized approach to the medical care.The aim of the work was to optimize interventional treatment of patients with acute coronary syndrome by studying the features of segmental formation of coronary arteries. The study analyzed the data of 121 patients with acute coronary syndrome who underwent coronary angiography with radial access and stenting of the infarct-related artery. Determination of coronary artery segments was performed according to the numbering method proposed by the American Heart Association. The severity of coronary artery disease was determined according to the Gensini scale. 88.43% of the patients included in the study had multivessel coronary disease. A relation was established between the lesion of segment 10 (r=0.312, p<0.001), segment 11 (r=0.211, p=0.015) and segment 14 (r=0.228, p=0.008) with the occurrence of MI recurrences. In case of diagonal artery lesions (D2), recurrences of MI occurred in 40.0% of patients, in the circumflex artery: 14 segment – 25.0%, and 11segment – 14.29%. In the remaining cases, the proportion of MI recurrences was significantly lower (from 2.67 to 8.86%). Analysis of the segmental localization of the infarct-related area of the coronary artery shows that there are certain "typical" areas of lesions in right and left coronary arteries - the middle section of the right coronary artery and the proximal section of the anterior interventricular branch of the left coronary artery. We also consider the obtained data to be important for predicting the risk of myocardial infarction recurrence, which turned out to be greater with occlusion of the 10th, 11th, and 14th segments of the coronary artery. In patients over 63 years of age, attention should be paid to the fourth segment of the right coronary artery, since occlusion of this section occurs more often in this age group. Atherosclerotic injury to the proximal part of the right coronary artery usually is not accompanied by prodromal syndrome of myocardial infarction in the form of unstable angina pectoris.The number of implanted stents did not reliably affect mortality and long-term survival. Correlations of lesions of certain segments of coronary vessels with previous manifestations of unstable angina pectoris and recurrent course, age and gender differences, presence of comorbidity, especially with arterial hypertension and diabetes have been established. Structural and functional changes in the myocardium were found to be the most severe in pathology of the left main stem. The relation between the lesion of the left main stem and the deterioration in the left ventricle ejection fraction (r=-0.244, p=0.005), the development of the left ventricle aneurysm (r=0.211, p=0.015) was established in 16.67% (in other segments - from 0 to 5.55%), rhythm disorders such as atrial fibrillation (r=0.304, p<0.001) in 25.00% (in other segments – from 2.17 to 9.52%), were more often accompanied by acute heart failure (Killip3-4) in 17.67% (in other segments - from 0 to 7.50%).