Object of the research: myocardial infarction (MI) against a background of angiographically intact and changed coronary arteries (CA) by the data of selective coronaroventriculography (SCVG). Purpose of the research: to reveal pathogenetic mechanisms, which influence the clinical course and prognosis of MI, on the basis of studying clinical-anamnestic, angiographic and genetic indices. Methods of the research: general clinical, laboratory, biochemical (kinetic, polymerase chain reaction and polymerase chain reaction with subsequent restrictive analysis) studies, instrumental and statistical methods. Theoretical and practical results: a possible development of MI against a background of angiographically intact CA was confirmed. IM-associated variants of the angiographic picture of CA were revealed. Anatomical peculiarities in CA structure (hypoplasia, convolutions and smaller diameters, “muscle bridges”) were the most frequent CA changes in the absence of angiographic signs. Predictors of the unfavourable close (hospital period) and remote (up to two years) prognosis were detected depending upon the angiographic examination data. Additional genetic risk factors of the atherosclerotic lesion of CA were suggested. Novelty: it was found out that the presence and expression degree of the atherosclerotic lesion of CA (angiographically intact, slightly changed, a haemodynamically significant stenosis) produced a marked effect on the character and severity of MI course. Clinical peculiarities of acute MI against a background of angiographically intact CA were revealed: a less prolonged anginal syndrome (up to 35 min), which is not sensitive to taking organic nitrates, or the asthmatic variant of the course accompanied by significant rise of the cardiac fraction of creatinine phosphokinase (MB-CFK). It was found out that the development of severe complications within the acute period of MI (cardiogenic shock, acute left ventricular failure [ALVF], LV aneurysm, life-threatening arrhythmiae) was associated with thehaemodynamically significant CA stenosis, which required invasive correction or aortocoronary shunting (ACS). For the first time, it was established that the patients, who had suffered MI against a background of angiographically intact CA, by SCVG data, in 70 % of cases had anatomical peculiarities in CA structure, of them: hypoplasia – 40 %, convolution and smaller diameters – 20 %, “muscle bridges” – 10 %. It was proved that patients with IM in their anamnesis against a background of slightly changed CA most frequently had some monovascular lesion (76.7 %), electrocardiographic and SCVG data about the localization of MI differing from each other in 26.7 % of cases. It was revealed that A1166C-polymosphism of ATIIR1 gene had an effect on the clinical course of MI, development of possible complications during the acute period of MI. It was found out that MI complications (ALVF, early postinfarction angina, recurrent course of MI) were most frequently observed in carriers of mutant C allele with T+31C-CC genotype (53.5 %). For the first time, the effect of a combination of mutation of two genes (angiotensinogene [ATG] and ATIIR1) for the atherosclerotic process spreading, the clinical course and tendency to frequent cardiovascular events, whose course had a complicated character. A relationship of the combination of ATG mutations Т+31С-СС/ ATIIR1-СС+АС with a high demand for ACS was proved. Predictors of an unfavourable remote, after (1.8±0.4) years, MI prognosis: an acute disturbance of the cerebral circulation up to MI, a long-term anamnesis of the coronary disease, chronic heart insufficiency of IIA grade, a high activity of the total CFK fraction – > (866.3 ± 329.1) U/L, and an increase of MB-CFK up to (204.8 ± 22.1) U/L in primary MI, a polyvascular atherosclerotic and significant (> 50 %) CA lesion accompanied by hypoplasia, clinical manifestations of the systemic atherosclerotic process with the involvement of the coronary, cerebral and peripheral arteries, dyslipidaemia: total cholesterol more than (6.5 ±0.2) mM/l, cholesterol of very low density lipoproteins over (2.1 ± 0.6) mM/l, triglycerides over (4.0 ± 0.5) mM/l, atherogenity coefficient over 4.5 ± 0.1) mM/l, low tolerance to physical loads: the amount of consumed oxygen (O2) – (4.3±1.3) metabolic equivalents, acute coronary syndrome and second MI in dynamics, presence of a combination of ATG mutations Т+31С-СС/ ATIIR1-СС+АС with a high demand for ACS. Degree of introduction: results of the research were introduced into the practical activity of the Rehabilitation Department of Kharkiv City Hospital No. 8, the Cardiology Department of the Ukrainian Railway Central Hospital in Kharkiv City, the Polyclinical Department of the Izium Central Town Hospital of the Kharkiv Region, the Cardiology Department of the Kupiansk Central Town Hospital of the Kharkiv Region, as well as the Cardiology Department of the Krasnograd Central District Hospital of the Kharkiv Region, as it is confirmed by acts on introduction. Sphere of application: medicine, therapy departments.
