scholarly journals EVALUATION OF STRENGTH CHARACTERISTICS OF CORONARY STENTS IN THE CREATED MODEL OF “MYOCARDIAL BRIDGE”

2018 ◽  
Vol 8 (1) ◽  
pp. 64-68
Author(s):  
V. V. Plechev ◽  
T. Sh. Sagatdinov ◽  
R. Yu. Rizberg ◽  
I. V. Buzaev ◽  
I. E. Nikolaeva ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Structure Design ◽  
Coronary Stents ◽  
Strength Characteristics ◽  
Myocardial Bridge ◽  
Strength Limit ◽  
Coronary Artery Stenting ◽  
Bridge Type ◽  
Usb Camera

Introduction. Presently there is no unified tactics to treat patients with aberrantly localized coronary arteries of “muscular bridge” type. There are controversial data regarding the benefit of coronary artery stenting due to often stent breakage or perforation of tunneled vessel. There are no major randomized studies regarding this issue. In this regard the goal of this research was to assess strength characteristics of stents in the model of muscular growth that we restored.Materials and methods. The originally developed model enabled to determine the strength limit of coronary stents under conditions that are maximum close to the physiological ones. The stents were placed into a polytetrafluoroethylene tube, the bridge-imitating oscillation frequency was configured to 250 beats per minute. The results of the experiment were recorded on USB-camera each 30 minutes in order to register mechanical defects of the stent.Results and discussion. The stent consisting of cells that are joined with V-shaped connections, showed first signs of strut deformity on the 10th day. Complete breakage happened on the 17th day after implantation. After 2 months observation the stent preserved mechanical firmness without V-shaped connections.Conclusion. Thus, it is not quite correct to support the hypothesis on infeasibility of stent implantation into the coronary artery with a muscular bridge. Taking into consideration the findings it is possible to suppose that the structure, design, form and content of stents predetermine the possibility to implant it into coronary artery with muscular bridge, but require individual approach to every particular patient. 

scholarly journals The usage of personalized scheme of fentanyl administration during coronary artery stenting

2020 ◽  
pp. 11-19
Author(s):  
D.О. Dziuba ◽  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Comparison Group ◽  
Study Groups ◽  
Stress Markers ◽  
Coronary Artery Stenting ◽  
Group 2 ◽  
Personalized Approach ◽  
Fentanyl Administration ◽  
Group 1

The aim – to develop a personalized scheme of fentanyl administrationfor coronary artery stenting. Materials and methods. Ninety patients with ischemic heart disease who underwent planned stenting of the coronary arteries were studied. The patients who underwent surgery were evenly divided into three study groups, depending on mode of the intraoperative analgesic sedation and the approaches to anesthesia. The first comparison group consisted of patients who received slow intravenous administration of diazepam and fentanyl solutions. The second comparison group consisted of patients with balanced administration of fentanyl and propofol solutions to provide analgesic sedation at the level of conscious anesthesia. The study group consisted of patients with a personalized approach to the administration of opiates, namely, we used the original fentanyl test described in the article. Analgesic sedation at the level of conscious anesthesia (ІІІ by Ramsey) was maintained by propofol infusion. Results. The usage of a personalized scheme of fentanyl administration for stenting of the coronary arteries, compared to the standard sedation using combination of diazepam and fentanyl, was accompanied by better indicators of intraoperative blood saturation with oxygen and carbon dioxide (respectively (103.67 ± 22.05) and (39.64 ± 6.85) mm Hg in group 1, (105.70 ± 31.64) and (37.68 ± 7.11) in group 2 and (109.42 ± 34.36) and (36.25 ± 6.52) mm Hg in patients of the 3rd group), lower blood pressure after surgery ((127.85 ± 9.87)/(79.64 ± 8.62) mm Hg in patients of group 1, (129.48 ± 8.73)/(81.05 ± 7.92) mm Hg in group 2 and (131.15 ± 10.64)/(82.68 ± 9.72) mm Hg in group 3), lower level of stress markers (blood cortisol during surgery in patients of the 1st group (8.83 ± 4.58) mmol/L, in patients of the 2nd group – (7.73 ± 2.79) mmol/L, in patients of the 3rd group – (7.55 ± 4.35) mmol/L), as well as lower frequency of detecting episodes of perioperative pain of various origins. Conclusions. A method of personalized anesthesia was elaborated, based on individual scheme of fentanyl administration («fentanyl test») during coronary artery stenting. Its usage is safe (due to the optimal parameters of gas exchange and hemodynamics and fewer side effects, such as nausea and residual sedation) and effective (due to the lower level of stress markers and less frequent complaints of pain of various origins) than when the routine technique was used. Key words: analgesic sedation, individual sensitivity, fentanyl, diazepam, propofol.

scholarly journals Hair pin bends of epicardial coronary arteries - a unique feature in multiple myocardial bridges

2019 ◽  
Vol 10 (3) ◽  
pp. 2250-2254
Author(s):  
Mohandas G.V ◽  
Sitansu k.Panda
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Unique Feature ◽  
Ischemic Heart ◽  
Myocardial Bridging ◽  
Myocardial Bridge ◽  
Anatomical Variant ◽  
Myocardial Bridges ◽  
Artery Disease

Myocardial bridge(MB) is an anatomical variant. Sometimes MB can cause compression over the coronary arteries and causes ischemic heart diseases.MB associated with bends of coronary arteries double the risk of coronary artery disease. So the present study aimed to find out the incidence of bends of the coronary artery along with the myocardial bridging. 100 heart specimens were obtained from routine dissection conducted for undergradu­ate students in the department of Anatomy IMS & SUM Hospital Bhubaneswar. After the simple dissecting procedure, epicardial coronary arteries, their branches and myocardial bridges and hairpin bends of coronary arteries were observed. Myocardial bridges present 41 (41%) over Left anterior descending artery(LAD) only.Among 41 hearts single myocardial bridge present in 37((90.25%)  hearts, double myocardial bridge were present in 3((7.31%)  hearts and triple myocardial bridges present in only one heart(2.44%). Hairpin bends of the coronary artery were present in double and triple myocardial bridged hearts only. No hairpin bends of the coronary artery was observed in the single myocardial bridge. Hair pin bends of the coronary arteries are the unique features of the myocardial bridges in multiple myocardial bridges, i.e. double and triple myocardial bridges. However, hairpin bends of coronary arteries were absent in single myocardial bridged hearts.

scholarly journals Anesthesiologic management of elective endovascular stenting of coronary artery

2021 ◽  
Vol 20 (5) ◽  
pp. 4-10
Author(s):  
A. V. Tsarkov ◽  
A. L. Levit
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Anesthetic Management ◽  
Endovascular Stenting ◽  
Endovascular Interventions ◽  
Anginal Pain ◽  
Coronary Artery Stenting ◽  
Comparison Groups ◽  
Invasive Method ◽  
Sedation Group

Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO2).Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

scholarly journals Does Myocardial Bridge Appear More Frequently and Diffusely on Radial Access Coronary Angiography?

2021 ◽  
Author(s):  
oktay senoz ◽  
zeynep yapan emren
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Clinical Laboratory ◽  
Conventional Coronary Angiography ◽  
Myocardial Bridge ◽  
Radial Access ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Abstract Background: Although the incidence of myocardial bridge (MB) has been defined in different conventional coronary angiography (CCA) studies,the frequency of MB in radial access coronary angiography (RACA) is unknown.The aim of this study was to determine the incidence of MB in patients undergoing RACA.Method: A total of 2600 consecutive patients who underwent RACA were retrospectively investigated to detect the presence of MB.The clinical,laboratory, and angiographic features of the patients with MB were analyzed. Results: MB was detected at an incidence of 10.2%, in 255/2600 patients who underwent RACA.The most involved coronary artery was the left anterior descending artery (LAD) (86.9%) and the mid segment (84.9%) was the most affected section.Co-involvement of multiple coronary arteries by MB was 7.8%. Coronary artery disease (CAD) was determined in 102 (36.2%) of the coronary arteries with MB, 82.4% which were proximal to the MB.Conclusion: These data demonstrated that the incidence of MB able to be detected on RACA was much higher than reported in previous CCA studies.

scholarly journals Myocardial bridging in the course of coronary arteries and its clinical significance

2020 ◽  
Vol 11 (6) ◽  
pp. 58-62
Author(s):  
Gunjan Rai ◽  
Soumya Khanna ◽  
Royana Singh
Keyword(s):  
Coronary Artery ◽  
Sudden Death ◽  
Coronary Arteries ◽  
Arterial Disease ◽  
Myocardial Bridging ◽  
Myocardial Bridge ◽  
Diagonal Branch ◽  
Myocardial Bridges ◽  
Coronary Arterial Disease ◽  
Congenital Coronary Artery Anomalies

Background: Sudden death in young adults in absence of any risk factor related to coronary arterial disease has been reported. It could be because of some unrecognized congenital coronary artery anomalies like myocardial bridging. The clinician should keep myocardial bridging as a differential diagnosis in cases of sudden death in young individuals having no risk factors of coronary artery diseases. Aims and Objective: The present study was conducted to know the prevalence of myocardial bridge and percentage of distribution of myocardial bridges in the course of different coronary arteries of cadaveric hearts. Material and Methods: The study was conducted in the department of Anatomy, IMS, BHU Varanasi. Total numbers of 49 formalin preserved hearts were taken for the study. The hearts were meticulously dissected to see the distribution and location of myocardial bridge. Coronary arteries with myocardial bridge were photographed and data was statistically analyzed.Out of 49 hearts, 26(53.06%) showed myocardial bridging. Total numbers of bridges were found to be 34 in number. Among the 26 myocardial bridged hearts 8 hearts (30.76%) showed double myocardial bridges and 18 hearts (69.23%) showed single myocardial bridges. In hearts with double myocardial bridging, 5 of them showed myocardial bridging in the territory of both anterior interventricular artery (AIVA) and posterior interventricular artery (PIVA) and 3 showed bridging in the territory of anterior interventricular artery and its diagonal branch. Among the18 single myocardial bridging 16 were in the course of anterior interventricular artery and two showed myocardial bridging in one of the diagonal branch of AIVA. There were 24 myocardial bridges in the course of AIVA, 16 as a part of single myocardial bridged hearts and 8 as a part of double myocardial bridged heart with the percentage of distribution were 2 (8.33%)in the proximal 1/3rd,18(75%)were in middle 1/3rd and 4(16.66%) were in distal 1/3rd. Conclusion: Due to the presence of high percentage of reported myocardial bridges in cadaveric hearts, the clinicians should always screen the young individuals and athletes having myocardial ischemia for the myocardial bridges along with other etiological factors.

INDEPENDENT PREDICTORS AND PROGNOSIS OF LONG-TERM MYOCARDIAL INFARCTION IN PATIENTS WITH UNSTABLE ANGINA AFTER CORONARY ARTERY STENTING

2021 ◽  
Vol 5 (1) ◽  
pp. 1109-1120
Author(s):  
A. Miadzvedzeva ◽  
◽  
L. Gelis ◽  
O. Polonetsky ◽  
I. Russkikh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Coronary Arteries ◽  
C Reactive Protein ◽  
Endogenous Thrombin Potential ◽  
Reactive Protein ◽  
Coronary Artery Stenting

Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7±1.6 years. Results. Repeated UA developed in 91 (55.2%) pts during a 7-year follow-up period, myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent predictors of MI risk included: baseline D-dimer level ≥796 ng/ml AUC 0.766 (RR 5.272; 95% CI 2,125-13,082), endogenous thrombin potential ≥2294.5 nM*min AUC 0.912 (RR 4,769; 95% CI 2,457-10,546), N-terminal fragment of brain natriuretic peptide (NTproBNP) ≥816 pg/ml AUC 0.794 (RR 1,935; 95% CI 1,218-3.075), homocysteine level ≥16 µmol/l AUC 0.707 (RR 1.971; 95% CI 1.140-3.406), highly sensitive C-reactive protein ≥6.4 g/l AUC 0.790 (RR 1.333; 95% CI 1.081-1.644), number of affected arteries≥ 3 AUC 0.714 (RR 2.129; 95% CI 1.237-2.664). The developed model for predicting myocardial infarction included the initial level of endogenous thrombin potential≥2294.5 nM * min, D-dimers ≥796 ng / ml, and the number of affected coronary arteries≥ 3. For the developed model, the AUC was 0.964, which corresponds to the excellent quality of the model. Conclusion. The prognosis of myocardial infarction in patients with unstable angina and stenting of the coronary arteries receiving the standard antiplatelet therapy involves laboratory criteria that reflect the activation of the hemostatic system and the residual thrombogenic risk.

scholarly journals Multislice computed tomography in the evaluation of coronary atherosclerosis dynamics: data three-year observation in patients with myocardial infarction-segment elevation ST and stenting of coronary arteries

2021 ◽  
Vol 27 (6) ◽  
pp. 19-30
Author(s):  
L. M. Babii ◽  
V. O. Shumakov ◽  
O. P. Pogurelska ◽  
A. Yu. Rybak ◽  
I. E. Malynovska ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Multislice Computed Tomography ◽  
Atherosclerotic Lesions ◽  
Msct Coronary Angiography ◽  
Coronary Artery Stenting ◽  
Progression Of Atherosclerosis

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.

scholarly journals Myocardial bridge and coronary artery fistulas in a patient with angina

2019 ◽  
Vol 10 (2) ◽  
pp. 137-141
Author(s):  
Aleksandra A. Kholkina ◽  
Yuriy R. Kovalev ◽  
Vladimir A. Isakov ◽  
Natal’ya O. Gonchar
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Angina Pectoris ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Myocardial Bridge

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

scholarly journals Is myocardial bridge more frequently detected on radial access coronary angiography?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oktay Şenöz ◽  
Zeynep Yapan Emren
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Conventional Coronary Angiography ◽  
Myocardial Bridge ◽  
Femoral Access ◽  
Radial Access ◽  
The Difference ◽  
Artery Disease

Abstract Background Although the incidence of myocardial bridge (MB) has been defined in different femoral access conventional coronary angiography (FACCA) studies, the frequency of MB on radial access coronary angiography (RACA) is unknown. The aim of this study was to determine the difference in the incidence of MB between patients undergoing RACA and FACCA. Method A total of 2500 consecutive patients who underwent RACA and a total of 1455 consecutive patients who underwent FACCA were retrospectively investigated to detect the presence of MB. The incidences of the groups were calculated separately and compared. The clinical and angiographic features of the patients with MB were analyzed. Results MB was detected at an incidence of 10.2%, in 255/2500 patients who underwent RACA, and 1.8% in 27/1455 patients who underwent FACCA (p < 0.001). In both RACA and FACCA patients, the most involved coronary artery was the left anterior descending artery (LAD) (86.9% and 93.1%) and the mid-segment (84.9% and 88.9%) was the most affected section. Co-involvement of multiple coronary arteries by MB was 7.8% in patients who underwent RACA and 7.4% in patients who underwent FACCA. Coronary artery disease (CAD) was determined in 111 (35.7%) of the coronary arteries with MB, of which 81.9% were proximal to the MB. No significant CAD was detected in any of the vessels of 69.8% (178/255) of the patients who underwent RACA for different clinical indications. Conclusion These data demonstrated that the incidence of myocardial bridge able to be detected on RACA was much higher than FACCA.

scholarly journals Cytokine status in middle-aged men with acute coronary syndrome after coronary artery stenting

2021 ◽  
Vol 12 (2) ◽  
pp. 5-12
Author(s):  
Vadim A. Gostimskiy ◽  
Vladimir S. Vasilenko ◽  
Elena A. Kurnikova ◽  
Sergey V. Shenderov ◽  
Ol’ga P. Gurina
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Reference Values ◽  
Proinflammatory Cytokines ◽  
Coronary Syndrome ◽  
Coronary Artery Stenting ◽  
Anti Inflammatory ◽  
Artery Disease

Background. Inflammatory cytokines and growth factors are involved in various mechanisms of coronary artery disease. Clinical studies have shown the correlation between the increase in the level of proinflammatory cytokines and the severity of coronary artery disease, while the data on the role of proinflammatory interleukin IL-8 and anti-inflammatory interleukin IL-4 are contradictory. The aim of the study is to assess the levels of proinflammatory cytokines (IL-8, TNF-) and anti-inflammatory interleukin (IL-4) in patients with various forms of coronary artery disease who underwent coronary artery stenting. Materials and methods. By the method of enzyme-linked immunosorbent assay, the levels of cytokines were determined in 30 patients with acute coronary syndrome who underwent primary stenting of the coronary arteries and in 24 patients with chronic coronary syndrome who had previously had myocardial infarction with stenting of an infarction-associated artery, who were admitted to the clinic for staged stenting of the coronary arteries. Results. In patients with chronic coronary syndrome the levels of IL-4 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-4 there was an increase 3,70 0,24 and 240,85 49,25 pg/ml, р 0,001. In patients with chronic coronary syndrome the levels of IL-8 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-8 there was an increase 7,34 1,29 and 110,33 27,67 pg/ml, р 0,001. Conclusion. Most likely the increase in the level of IL-4 has a compensatory character and, along with a slight increase in TNF-, can be considered as a positive factor stabilizing the course of the disease. There may be some relationship between of the increase in the level of interleukins in patients with acute coronary syndrome on the degree of stenosis of the coronary arteries (9095%) and impaired myocardial contractility was established.

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