The dissertation contains a new solution to the current problem of cardiology in
the field of knowledge 22 "Health care" (specialty 222 "Medicine") - improving the
results of interventional treatment in patients with stable coronary heart disease by
improving the tactics of endovascular revascularization interventions based on the
assessment of the fractional reserve of blood flow.
To achieve the aims and objectives, an open prospective non-comparative singlecenter study was conducted, in which we analyzed the data obtained during clinical and
instrumental examination of 123 patients with stable coronary artery disease and
intermediate (50-90%) stenotic lesions of the coronary arteries (according to CVG),
examined at the State Institution "Heart Institute of the Ministry of Health of Ukraine"
from June to December 2019. Among them, there were 74 (60.2%) patients who
underwent functional assessment of coronary artery lesions by FFR during CVG.
The study did not include patients with acute coronary syndrome; recent (within
the last month) acute myocardial infarction (MI); acute heart failure (HF); severe
comorbidities (in particular, malignancies with a life expectancy of less than 1 year);
heart valve disease requiring surgical correction; history of cardiac surgery; significant
lesions of the left coronary artery (LCA) trunk; non-obstructive coronary artery disease
(stenosis <50%); coronary artery stenosis >90%; multivessel lesions that indicated
coronary artery bypass grafting; and lack of informed consent to participate in the study.
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Among the enrolled patients were 90 (73.2%) men and 33 (26.8%) women aged
39 to 82 years, with a mean age (mean standard deviation) of (62 9) years. Body
mass index (BMI) was (hereinafter referred to as median (Me), interquartile range
[IQR]) 29.1 (26.5-31.8) kg/m2. Overweight (OB) (BMI 25-29.9 kg/m2) was present in
55 (44.7%) cases. Obesity (BMI ≥30 kg/m2) was recorded in 49 (39.8%) patients.
Arterial hypertension (AH) (hypertensive disease) was diagnosed in 117 (95.1%)
people, stable angina pectoris in 99 (80.5%) patients, including 70 (70.7%) and 29
(29.3%) patients with functional classes (FC) II and III (according to the classification
of CCS (Canadian Cardiovascular Society) [1]), respectively. 56 (45.5%) had data on a
previous MI, in particular, a repeat MI in 4 (3.3%) cases. PCV was previously performed
in 49 (39.8%) patients.
The stages of HF were determined according to the ABCD classification []. HF
stage B was diagnosed in 39 (31.7%) patients, and stage C was noted in 84 (68.3%)
people.
A history of stroke or transient ischemic attack (TIA) was recorded in 20 (16.3%)
patients. Atrial fibrillation (AF) was registered in 23 (18.7%) patients (paroxysmal form
– 7, persistent – 8, and permanent – 8), atrial flutter – in 5 (4.1%) persons.
30 (24.4%) patients had type 2 diabetes mellitus (DM). Peripheral artery disease
(PAD) was diagnosed in 16 (13.0%) people (carotid artery disease – 14 cases, subclavian
artery – 1, lower limb arteries – 3, renal arteries – 1). 2 (1.6%) patients were diagnosed
with chronic obstructive pulmonary disease (COPD) or bronchial asthma, respectively.
According to KDIGO criteria [12], 18 (14.6%) people had signs of chronic kidney
disease (CKD).
Background pharmacotherapy included the following drugs: angiotensinconverting enzyme (ACEI) inhibitors – in 66 (53.7%) patients; angiotensin II receptor
blockers (ARBs) – 33 (26.8%); sacubitril/valsartan – 6 (4.9%); mineralocorticoid
receptor antagonists – 26 (21.1%); β-blockers – 90 (73.2%); calcium channel blockers –
32 (26.0%); nitrates – in 5 (4.1%) patients; thiazide/thiazide-like diuretics – 26 (21.1%);
loop diuretics – 19 (15.4%); (in total, diuretics were prescribed to 33.3% of patients
[n=41]); amiodarone – 7 (5.7%); sotalol – 2 (1.6%); digoxin – 2 (1.6%); statins – 123
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(100%); acetylsalicylic acid – 103 (83.7%); clopidogrel – 89 (72.4%); ticagrelor - 6 (4.9
%) (in general, antiplatelet therapy was prescribed to 116 (94.3 %) patients, in particular,
double therapy - in 82 (66.7 %) cases). Oral anticoagulants were prescribed to 24
(19.5%) patients, oral antihyperglycemic drugs to 15 (12.2%), insulin to 3 (2.4%).
Laboratory studies were carried out according to standard methods. The mean
levels of fasting blood glucose, creatinine and serum total cholesterol (Cholesterol) were
5.8 (5.3-6.7) mmol/L, 89 (78-97) μmol/L and 4.4 (3.5-5 .5) mmol/l, respectively. The
calculated glomerular filtration rate (GFR) (according to the CKD-EPI formula (2021)
[13]) was 79.5 (70.8-92.2) ml/min/1.73 m2. In 9 (7.3%) patients, a decrease in GFR <60
ml/min/1.73 m2 was found.
