Aim. To study the results of primary percutaneous coronary intervention in ST elevation myocardial infarction patients (STE MI) in multivessel disease (MD) according to the multifocal disease (MFA) (peripheral lesion ≥30%).

Material and methods. Current study concerns on the evaluation of hemodynamically significant and nonsignificant lesion influence on the prevalence of cardiovascular adverse events in 227 patients during 12 months after primary percutaneous intervention (PCI). The first group consisted of STEMI patients, MD of coronary vessels and MFA, underwent primary PCI (n=63) (STEMI+MFA), second group consisted of patients without MFA (n=164) (STEMI).

Results. In STEMI+MFA patients comparing to those without MFA (peripheral arteries lesions more than 30%) there were worse in-hospital and long term outcomes of primary PCI by the prevalence of combined endpoint (death, MI, culprit lesion intervention): 17,4% vs. 6,7% and 30,2% vs. 13,4%, resp. (p <0,05).

Conclusion. The prognostic significance of MFA (peripheral arteries lesions more than 30%) after primary PCI in the cohort of patients with STEMI and MD remains underexplored. Current study has shown that presence MFA after primary PCI is a negative prognostic factor in patients with STEMI and MD.

OPCAB (Off-pump coronary artery bypass) remains nowadays an alternative method to traditional on-pump technique of the myocardial revascularization especially in high-risk and elderly patients. A successful adoption of this technique depends on a surgeon’s experience, a cooperative team and standardization of all steps in anesthesiological and surgical procedures in perioperative period. This article describes the perioperative policy adopted in our institution and our view on the role and place of OPCAB in the treatment of patients with coronary heart disease.

Aim. To develop the method and media for cognitive impairment correction in patients with arterial hypertension, combined with diabetes mellitus 2nd type.

Material and methods. Totally 120 included with essential arterial hypertension (EAH), associated with diabetes 2nd type, with insufficient blood pressure (BP) level control. Patients with AH had 2nd grade of BP increase with mild of moderate compensated DM 2nd type with the level of glycosylated hemoglobin about 6,25%. The patients had quite high number of concomitant diseases and risk factors. All patients received basic antihypertensive therapy (beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin receptor inhibitors). Also the patients took the drugs for concomitant pathology (hypolipidemic drugs, nitrates, glucose lowering drugs). The necessary criteria for inclusion was informed consent. At outpatient stage of the study, first visit and in a year the complex of events was done: anamnesis and complaints clarification; palpation and auscultation of the heart and major vessels; BP measurement on upper extremities by Korotkov; ECG registration, Echocardiography. The biochemical sampling of fasting plasma was done: the level of glucose was measured, of glycosylated hemoglobin, lipid profile (cholesterol, triglycerides, LDL, HDL), clotting parameters (INR, APTT, fibrinogen), electrolytes (K, Mg). Also the patients completed medical questionnaires of a specific purpose. The score of psychic status was used: MINI-MENTAL STATE EXAMINATION (MMSE) M.F. FOLSTEIN, S.E. FOLSTEIN, P.R. HUGH, 1975. And if there were prominent cognitive disorders Kudesan® was prescribed — mitochondrial coenzyme Q10 — at the dosage of 60 mg per day during the next 2 months. Dosage of the drug used according to medical instructions.

Results. The data witnesses that clinical effect was achieved in patients with Kudesan®: the significant improvement of cognitive functions in patients by MMSE score. The effectiveness of Q10 compound was measured by the clinical properties matching after the treatment. Before the treatment the clinical data compared were identical with the absence of statistical significance among them (p>0,01).

Conclusion. The positive influence of complex therapy is shown on the cognitive functions in patients with AH at the background of diabetes 2 type. The study showed that the inclusion of Q10 compound into the standard treatment of arterial hypertension with diabetes 2nd type is associated with positive clinical effect, especially in relevant cognitive function improvement, significant decrease of systolic and diastolic BP, relevant decrease of blood pressure variability, significant of glucose and glycosylated hemoglobin level decrease, significant Mg level increase.

Prognosis and prevention of cardiac complications of non-cardiac surgery is an important clinical task. Currently quite a lot is known on various scales of myocardial infarction risk prognosis and the death in perioperational period, as on drug treatment and prevention. The issue whether to perform coronary arteriography and preventive coronary revascularization before noncardiac surgical interventions in patients with high cardiological risk score remains controversial. Current review concerns on the perspectives of perioperational myocardial infarction pathogenesis and also analyses in details the results of current retro- and prospective studies of efficacy and safety of various types of preventive coronary revascularization with the aim to reduce the prevalence of extracardiac surgery.

Lercanidipine is a dihydropyridine calcium antagonist of the 3rd generation, with high level of vasoselectivity, long lasting effect and good antihypertensive effectiveness. The review shows the main specifics of pharmacokinetics and mechanism of action of the drug. It is known that lercanidipine supports renoprotection, left ventricle hypertrophy reduction, improvement of elastic properties of the vessels and central blood pressure decrease. Sympathetic activation in lercanidipine is almost absent, that makes up its good tolerability and improves patients’ compliance.

The article takes into consideration practical issues of novel oral anticoagulants (factor Xa inhibitors) usage with the aim of prevention of thromboembolic complications in nonvalvular atrial fibrillation.

A clinical case presented the patient with this pathology under high risk of thromboembolic complications with several years follow-up.