Progression markers of coronary calcification

Aim To evaluate the relationship between clinical parameters, biomarkers of bone turnover and the progression of coronary artery calcification (CAC) in patients with stable coronary heart disease (CHD) based on long-term (5 years) follow-up. Material and methods The single-center, prospective, non-randomized observational study included 111 men with CHD, admitted for CABG. All patients in the preoperative period underwent the following procedures: color duplex scanning (CDS) of the brachiocephalic arteries (BCA), multi-slice computed tomography (MSCT) coronary angiography to assess the degree of CAC using the Agatson score (calculation of the coronary artery calcium score – CACS), estimation of femoral neck bone mineral density with the T-score calculation and clinical assessment of biomarkers of bone metabolism (calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone). The vital status of patients was ascertained after 3–5 years of follow-up after CABG, CDS of the BCA and MSCT-coronary angiography were repeated. To identify the most significant clinical and anamnestic risk factors and form a model of predictors of CAC progression, patients were divided into two groups depending on the high increase in CACS (an increase in the score of more than 100 Agatston units (AU). Results 16 (14.4%) out of 111 patients failed to establish contact for the next stage of the study. In 4 (3.6%) cases death was registered (3 – fatal myocardial infarction, 1 – fatal stroke). The CAC progression was assessed in 91 patients (81.9%). Patients who showed signs of CAC progression comprised a group of 60 (65.9%) patients; without CAC progression – 31 (34.1%) patients. The “end points” in the groups were comparable and were detected in 18 cases (19.7%): recurrent angina in 16 patients (p=0.368), non-fatal myocardial infarction in 1 (p=0.162) and 1 emergency stenting (p=0,162) of the coronary artery that was not subjected to CABG. The risk model for CAC progression included an initial decrease in femoral neck bone mineral density and nonadherence to statins for 5 years after CABG (p=0.001). Conclusion 65.9% of men with stable CHD showed the signs of CAC progression for 5 years after CABG, according to MSCT. The main predictors of CAC were: low cathepsin K levels and low bone mineral density in the preoperative period, low OPG 5 years post-CABG. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”; 6, Sosnovy Blvd, Kemerovo, 650002, Russia

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

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.

Assessment of efficiency and safety of application of the reproduced drug of Mertenil® according to MSCT-coronary angiography

In article possibility of an assessment of efficiency of therapy by the reproduced drug Mertenil of production of JSC Gideon Richter (Hungary) appointed for the purpose of primary prevention of the cardiovascular diseases. Increase of level of lipoproteid of the low density is one of the most powerful risk factors of death. Today therapy of a statin is carried out both for secondary and for primary prevention of cardiovascular diseases. For an assessment of dynamics of atherosclerotic processat patients with the diagnosis: CHD hypercholesterolemia without visual verification of defeat of the proximal coronary course possibility of use of a multispiral computer tomography of coronary arteries with calculation of a coronary calcic index is considered.