Left main coronary artery stenosis: cardiologist view

Барбараш, О. Л.; Поликутина, О. М.; Тавлуева, Е. В.; Барбараш, Н. А.

doi:10.15275/kreatkard.2015.02.01

Cited by 5 publications

(5 citation statements)

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“…Особого внимания требует ротационная атерэктомия в области сильно кальцинированного "незащищенного" ОС ЛКА, поскольку данный сосуд обеспечивает кровоснабжение 75% массы миокарда ЛЖ при "правом" или "сбалансированном" типе кровоснабжения и 100% -в случае "левого" типа кровоснабжения [15]. Данное вмешательство до каза но эффективно [16], однако в случае осложнения в ви де замедления кровотока может приводить к гемодинамическому коллапсу.…”

Section: Discussionunclassified

Endovascular rotational atherectomy for multivessel coronary calcification involving the main trunk of left coronary artery and the left anterior descending artery

Shukurov,

Myasnikov,

Kulikova

et al. 2024

Cardiovasc Ther Prev

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The revascularization strategy for severe calcification is one of the most pressing problems of modern percutaneous coronary interventions, since it is observed more and more often and significantly complicates traditional endovascular treatment. Currently, the method of choice for severe coronary calcification is rotational atherectomy, which allows modification of atheromatous mass with an increase in the vessel lumen to allow satisfactory balloon angioplasty and stenting. This article presents a case of a patient at very high cardiovascular risk with a burdened coronary history and severe clinical symptoms of exertional angina while receiving the optimal multiagent therapy. The examination revealed a multivessel coronary calcification, but the patient was denied coronary artery bypass grafting due to high perioperative risks. SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery score) score I – 25,5 points, SYNTAX score II — 40,4% and 70,1% for percutaneous coronary intervention and coronary bypass surgery, respectively, European System for Cardiac Operative Risk Evaluation (EuroSCORE II) — 4,95%. Attempts at traditional percutaneous intervention were unsuccessful and the patient underwent endovascular rotational atherectomy followed by stenting of affected coronary segments, against the background of which there was an improvement in exercise tolerance with a decrease in angina class.

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Section: Discussionunclassified

Endovascular rotational atherectomy for multivessel coronary calcification involving the main trunk of left coronary artery and the left anterior descending artery

Shukurov,

Myasnikov,

Kulikova

et al. 2024

Cardiovasc Ther Prev

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“…В настоящей работе включение ТПКР в структуру модели (7) приводило к увеличению ее прогностической способности (AUC -0,843). Ранее было показано, что при сочетании ТПКР и поражения ствола ЛКА, которое имело место у 52% пациентов с острым коронарным синдромом, частота развития фатальных осложнений резко возрастала [15]. В нашей работе атеросклеротическое ремоделирование ствола ЛКА увеличивало риск ГЛ в 3,2 раза, а включение данного предиктора в модель (5) лишь незначительно увеличивало ее прогностический потенциал по сравнению с базовой моделью (4) (AUC 0,837 vs 0,836).…”

Section: Discussionunclassified

Parameters of complete blood count and coronary lesions in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

Geltser,

Shahgeldyan,

Domzhalov

et al. 2023

Russ J Cardiol

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Aim. To evaluate the predictive potential of complete blood count (CBC) and coronary involvement parameters for predicting inhospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).Material and methods. This single-center cohort retrospective study was conducted using data from 4677 electronic medical records of patients with STEMI (3203 men and 1474 women). Two groups of people were identified: group 1 — 318 (6,8%) patients who died in hospital; group 2 — 4359 (93,2%) patients with a favorable outcome. The degree of influence of predictors on the end point was determined by the Shapley method.Results. The best quality metrics had a model with structure included, in addition to 7 CBC factors, indicators of three-vessel coronary involvement, left coronary artery remodeling and coronary perfusion after PCI with the TIMI score <2 (AUC — 0,845, sensitivity — 0,78, specificity — 0,786) . The greatest contribution to the implementation of the end point was associated with the level of hemoglobin, white blood cells, immune-inflammatory index and neutrophils >75,4%. Coronary artery parameters had a less noticeable effect on inhospital mortality, and the minimal effect was plateletcrit >0,22%, lymphocytes <13,3% and erythrocyte sedimentation rate.Conclusion. This multivariate logistic regression model based on a combination of CBC indicators and indicators characterizing the coronary system has high predictive accuracy, which determines the prospects for its further use as one of the available risk assessment tools in clinical practice.

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“…Широко известно, что у пациентов с коронарным атеросклерозом доминантность кровоснабжения сердца имеет большое значение для клинического течения ишемической болезни сердца (ИБС) и размера зоны инфаркта миокарда [21]. Согласно полученным нами данным, обладатели правого типа кровоснабжения сердца имеют преимущество перед лицами с другими типами организации коронарного кровотока при развитии ТЭЛА, повышая их шансы на выживание.…”

Section: Discussionunclassified

The Importance of the Type of Heart Circulation for the Prognosis of Pulmonary Embolism

et al. 2019

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Aim. To study the distribution of the type of heart circulation (left- dominant, right- dominant, and mixed (balanced) in patients with pulmonary thromboembolism of fatal and non-fatal outcome. Materials and methods. More than 36,000 case histories, protocols and findings of post-mortem examinations of patients hospitalized in 2003–2012 were subjected to analysis. (ten year period). Statistical processing of the actual material was carried out using the SAS 9 and SPSS 21 software packages. The critical level of significance p for all used procedures of statistical analysis was assumed to be 0.05. Results of the study. The study included 893 cases of pulmonary embolism registered in the data of the case histories and materials of the pathoanatomical studies. Data on the type of heart circulation and a detailed description of the coronary artery atherosclerosis were present in 264 cases: in 171 patients with pulmonary embolism and fatal outcome, and in 93 patients with pulmonary embolism and non-fatal outcome. A clear predominance was found in the group with pulmonary embolism and non-fatal outcome of patients with the right type of heart circulation – 78.5% versus 7% in the group of people who died with pulmonary embolism (p<0.0001). Accordingly, persons with “non-right type of heart circulation” (left and balanced) predominantly prevailed among patients with pulmonary embolism and fatal outcome. At the same time, the dead with the right type of heart circulation in all cases had a stenosis of the right coronary artery (RCA) more than 60%. RCA dominance in the heart circulation with absence its significant stenosis creates more favorable hemodynamic conditions for survival in patients with pulmonary embolism. Owners of other types of organization of coronary blood flow (“non-right type of heart circulation”) have a worse prognosis both in the absence of coronary atherosclerosis and, moreover, in its presence, especially in the case of significant atherosclerotic lesion of the RCA pool. At the same time, in patients with the right type of heart circulation and hemodynamically significant atherosclerosis RCA in conditions of pulmonary embolism the prognosis is also unfavorable. In view of the above, in patients with coronary atherosclerosis, timely restoration of blood flow in RCA (coronary artery stenting) is great importance in relation to the prognosis associated not only with coronary heart disease, but also with PE.

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Left main coronary artery stenosis: cardiologist view

Cited by 5 publications

References 0 publications

Endovascular rotational atherectomy for multivessel coronary calcification involving the main trunk of left coronary artery and the left anterior descending artery

Endovascular rotational atherectomy for multivessel coronary calcification involving the main trunk of left coronary artery and the left anterior descending artery

Parameters of complete blood count and coronary lesions in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

The Importance of the Type of Heart Circulation for the Prognosis of Pulmonary Embolism

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