Andrejs Ērglis

Analysis of Polymorphisms at the Adiponectin Gene Locus in Association with Type 2 Diabetes, Body Mass Index and Cardiovascular Traits in Latvian Population

Analysis of Polymorphisms at the Adiponectin Gene Locus in Association with Type 2 Diabetes, Body Mass Index and Cardiovascular Traits in Latvian Population Despite the number of recently conducted studies seeking to determine the association between genetic variants of adiponectin gene and susceptibility to type 2 diabetes (T2D) and increased body mass index (BMI), the results obtained are often inconsistent. To determine the impact of common polymorphisms in promoter and coding regions of adiponectin gene on these conditions in Latvian population, we selected ten SNPs (rs2241767, rs1501299, rs3777261, rs16861210, rs2241766, rs822396, rs182052, rs17300539, rs16861194, rs266729) based on haploblock structure and previously reported association studies. The selected SNPs were screened in a study group of 835 participants from the Genome Data Base of Latvian Population and mainly consisted of patients with T2D and coronary heart disease. None of the individual polymorphisms were significantly associated with T2D status or BMI when analysed using logistic or linear regression and adjusted for gender, age and other significant covariates. Frequency of rs2241766 T allele homozygotes however was significantly increased in T2D patients compared to controls (uncorrected P = 0.007). When analysed with other traits, the rs182052 G allele was found to be less frequent in patients suffering from myocardial infarction (P = 0.02; OR = 0.76, CI95% [0.61-0.92]) compared to others. Haplotype analysis revealed significant association of one haplotype with atrial fibrillation (uncorrected P = 0.01). In summary, we conclude that SNPs in adiponectin gene are unlikely to represent the risk for T2D, but may be involved in pathogenesis of CHD in the Latvian population. Adiponektīna Gēna Lokusa Asociācijas Analīze Saistībā Ar Otrā Tipa Diabētu, Ķermeņa Masas Indeksu Un Kardiovaskulārām Pazīmēm Latvijas Populācijā Neraugoties uz daudzajiem adiponektīna gēna variantu asociācijas pētījumiem saistībā ar otrā tipa diabētu (T2D) un paaugstinātu ķermeņa masas indeksu (ĶMI), līdz šim iegūtie rezultāti bieži ir pretrunīgi. Lai noskaidrotu adiponektīna gēna promotera un kodējošā rajona bieži sastopamo polimorfismu ietekmi uz šīm pazīmēm Latvijas populācijā, balstoties uz haplobloku struktūru un iepriekš zināmiem asociācijas pētījumiem, tika izvēlēti desmit SNP (rs2241767, rs1501299, rs3777261, rs16861210, rs2241766, rs822396, rs182052, rs17300539, rs16861194, rs266729). Izvēlētie SNP tika genotipēti pētījuma grupā, kas sastāvēja no 835 Valsts iedzīvotāju genoma datu bāzes gēnu donoriem. Šajā grupā bija pārsvarā no T2D un koronārās sirds slimības (KSS) pacienti. Neviens no individuāliem polimorfismiem nebija būtiski asociēts ar T2D vai ĶMI, lietojot daudzfaktoru logistiskās vai lineārās regresijas analīzes un korigējot rezultātus pēc dzimuma, vecuma un citiem būtiskiem līdzfaktoriem. Tomēr tika atrasts, ka rs2241766 T alēles homozigotu frekvence T2D pacientu vidū bija būtiski lielāka nekā kontroles grupā (nekorigēta P = 0.007). Analizējot saistībā ar citām pazīmēm, rs182052 G alēle tika biežāk atrasta pacientiem ar miokarda infarktu (P = 0.02; OR = 0.76; CI95%[0.61-0.92]), salīdzinot ar pārējo pētījuma grupu. Haplotipu analīze atklāja viena haplotipa būtisku asociāciju ar mirdzaritmiju (nekorigēta P = 0.01). Kopumā var secināt, ka adiponektīna gēna polimorfismi nav uzskatāmi par būtiskiem T2D riska faktoriem, bet varētu būt iesaistīti koronārās sirds slimības patogenēzē Latvijas populācijā.

Insufficient control of heart rate in stable coronary artery disease patients in Latvia

BACKGROUND AND OBJECTIVE Heart rate (HR) ≥70 beats per minute (bpm) increases cardiovascular risk in coronary artery disease (CAD) patients. The objective of the analysis is to characterize HR as well as other clinical parameters in outpatients with stable CAD in Latvia. MATERIALS AND METHODS CLARIFY is an ongoing international registry of outpatients with established CAD. Latvian data regarding 120 patients enrolled in CLARIFY and collected at baseline visit during 2009-2010 were analyzed. RESULTS The mean HR was 67.7±9.5 and 66.9±10.7bpm when measured by pulse palpation and electrocardiography, respectively. HR ≤60bpm and ≥70bpm was observed in 25% and 35.8% of patients, respectively. When analyzing patients with angina symptoms, 22.8% had HR ≤60bpm while HR ≥70bpm was observed in 33.3% of the cases. HR ≥70bpm was observed in 36.2% of patients with symptoms of chronic heart failure. Beta-blockers were used in 81.7% of the patients. Metoprolol (long acting succinate), bisoprolol, nebivolol and carvedilol in average daily doses 63.8, 5.3, 4.5, and 10.4mg/d were used in 47, 37, 11 and 3 cases, respectively. Among patients with HR ≥70bpm 79.1% were using beta-blockers. Medications did not differ significantly between the three groups according to HR level (≤60, 61-69 and ≥70bpm). CONCLUSIONS Despite the wide use of beta-blockers, HR is insufficiently controlled in the analyzed sample of stable CAD patients in Latvia. Target HR ≤60bpm is achieved only in 25% of the patients while more than one third have increased HR ≥70bpm.

Heart rate and other risk factors in outpatients with stable coronary artery disease in Latvia

Heart rate and other risk factors in outpatients with stable coronary artery disease in Latvia The aim of the study was to characterise coronary artery disease (CAD) outpatients in Latvia by risk factors (RF) including heart rate (HR), physical examination data, clinical data and treatment. Twelve practitioners had each examined and questioned 6 to 12 patients with established CAD (n = 120). The most frequent cardiovascular (CV) RF and co-morbidity were dyslipidemia (94.2%) and hypertension (78.3%), respectively. Prevalence of increased resting HR (≥70 bpm) was 35.9% and 33.6%, when measured by pulse palpation and electrocardiography, respectively. Regarding other RFs, prevalence of treated but insufficiently controlled blood pressure 140/90 mmHg, total cholesterol 1 > 5 mmol/l and triglycerides > 1.7 mmol/l was 25.8%, 30.1% and 33.3%, respectively. Aspirin, statins and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers were used in 96.7%, 94.2% and 85.0% of cases, respectively. Beta blockers were used in 81.7% of cases. Average daily doses of most frequently used β blockers (metoprolol and bisoprolol) were 32% and 53% from target doses, respectively. In three cases β blockers were combined with ivabradin. Our results suggest that practitioners follow guidelines and consider CV prevention by treating CAD patients. Our data identified, however, unused potential for better control of increased HR by higher doses and combinations of HR-reducing agents. Sirdsdarbības frekvence un citi riska faktori ambulatori ārstētiem pacientiem ar stabilu koronāro sirds slimību Latvijā Novērojuma mērķis bija raksturot ambulatori ārstētus pacientus ar stabilu koronāro sirds slimību (KSS) Latvijā - riska faktoru (RF), tajā skaitā palielinātas sirdsdarbības frekvences (SF) sastopamību, fizikālās un klīniskās izmeklēšanas rezultātus un ārstēšanu. Vienas vizītes ietvaros tika apsekoti un iztaujāti 120 ambulatori ārstēti pacienti ar stabilu KSS. Divpadsmit praktizējoši ārsti katrs ievāca datus par 6-12 pacientiem un aizpildīja gadījuma ziņojuma veidlapas. Biežāk sastopamais kardiovaskulārais (KV) RF bija dislipidēmija (94,2%), biežākā blakus saslimšana — arteriālā hipertensija (78,3%). Palielināta SF (≥70 x/min) bija 35,9% gadījumu, nosakot ar pulsa palpāciju un 33,6%, nosakot ar elektrokardiogrāfijas metodi. Citu ārstētu, bet nekontrolētu RF sastopamība bija sekojoša: arteriālais asinsspiediens 140/90 mm Hg bija 25,8% pacientu, kopējais holesterīns 5 mmol/l - 30,1%, triglicerīdi 1,7 mmol/l - 33,3% pacientu. Aspirīnu saņēma 96,7% pacientu, statīnus - 94,2%, bet angiotenzīnu konvertējošā enzīma inhibitorus vai angiotenzīna receptoru blokatorus - 85,0% pacientu. Beta blokatori tika lietoti 81,7% gadījumu. Biežāk lietoto beta blokatoru metoprolola un bisoprolola vidējās devas bija attiecīgi 32% un 53% no mērķa devām. Trijos gadījumos beta blokatori tika kombinēti ar ivabradīnu. Novērojuma rezultāti ļauj secināt: praktizējošie ārsti, ārstējot KSS pacientus, seko vadlīnijām un cenšas uzlabot pacientu prognozi. Tomēr ir vēl papildus iespējas labāk kontrolēt palielinātu SF, lietojot lielākas SF samazinošo līdzekļu devas un tos kombinējot.

Transcatheter Vs. Surgical Closure of Atrial Septal Defects in Adults

Abstract Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002–2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņš Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p < 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

Abstract Coronary artery chronic total occlusions (CTO) are common — approximately one-third of patients with significant coronary artery disease on angiography have at least 1 CTO. Invasive treatment of these lesions still remain a major challenge for interventional cardiology due to their complexity. Historically, success rates have improved to about 60–70% by using only the traditional antegrade approach. The results have dramatically improved during the last decade after more widespread application of new retrograde techniques. The aim of our study was to review and analyse single hospital experience in CTO invasive treatment and to evaluate the long-term results. A total of 519 patients undergoing percutaneous coronary interventions (PCI) for CTO at a single tertiary PCI centre (Rīga East University Hospital), were included in the study. The median age was 64 years (38–88), and 80% were male. The retrograde approach (RA) was used for 167 (32.2%) of the CTO PCI patients. The overall patient success rate was 81.3% and it increased from 73.9% in 2007 to 95.2% in 2015 (p < 0.001). Mean patient observation time was five years. Overall survival was found significantly better in patients group after successful CTO PCI procedures (Long-rank test, p = 0.013).

Evaluation Of Massive Parallel Sequencing As A Diagnostic Tool For Familial Hypercholesterolemia

Abstract Familial hypercholesterolemia (FH) is one of the most common single gene disorders, which is mostly inherited as an autosomal dominant trait. The physical signs of FH are elevated low density lipoprotein cholesterol (LDL-C), elevated total cholesterol (TC) levels and tendon xantomas. Identification and early treatment of affected individuals is desirable and in lack of physical symptoms DNA-based diagnosis provides confirmation of diagnosis and enables early patient management. The majority of FH cases are caused by mutations in four genes (APOB, LADLR, PCSK9, and LDLRAP1). There are commercial kits available for testing of the 20 most common FH causing mutations, but the spectrum of disease-causing mutations is quite diverse in various populations and these tests cover only a minority of disease-causing genetic variants. There is therefore a need to determine the full spectrum of mutations in LDLR, APOB, PCSK9, and LDLRAP1 genes in each population. Here we report mutations found in 16 patients with suspected FH in a sample from the Genome Database of the Latvian population enrolled at the Latvian Centre of Cardiology. We used the next generation sequencing approach to determine the full spectrum of mutations in coding regions of LDLR, APOB, PCSK9, and LDLRAP1. In total we found 22 missense mutations, from which only rs5742904 (Arg3527Gln) in APOB gene had been previously described as a FH-causing mutation confirming FH in one patient. Possible FH-causing mutations however, were identified in the majority of patients. The conclusion is that the most commonly employed commercial mutation panel is not sufficient for diagnosis of FH patients and NGS can help to identify FH-causing mutations in the Latvian population.

Control of Resting Heart Rate and Other Risk Factors Over a Three-year Period in Outpatients with Stable Coronary Artery Disease in Latvia

Abstract The aim of the study was to evaluate control of heart rate (HR) and other risk factors (RF) over athree-year period in coronary artery disease (CAD) outpatients in Latvia. Patients (n = 120) were examined and questioned at baseline time and annually (four times in total). Increased resting HR (≥70 bpm) when measured by palpation was present in 35.8% of cases at baseline time, 35.6%, 29.8% and 35.1% of cases at Y1, Y2 and Y3, respectively; when measured by electrocardiography: in 33.6% (baseline), 36.8% (Y1), 26.7% (Y2), 33.7% (Y3) of cases. The proportion of patients with increased HR did not significantly change in Y1–Y3 vs baseline. Systolic blood pressure was lower in Y1 and Y3 vs baseline (P = 0.005 and P = 0.003, respectively). The proportion of patients with increased blood pressure (≥140/90 mmHg) was lower in Y1, Y2 and Y3 than at baseline (P = 0.018, P = 0.030 and P = 0.017, respectively). The proportion of patients with a decreased level of high density lipoprotein cholesterol (<1.2 mmol/l for women and <1.0 mmol/l fom men) was lower in Y1–Y3 compared to baseline (P < 0.001). A substantial (about one-third) and stable proportion of patients with increased HR≥70 bpm over the three-year period in the examined sample of treated CAD patients indicates that there is a need for better control of this RF.

Healthy Alternatives of the Mediterranean Diet in Latvia

Abstract The milestone of illness prophylaxis is a healthy lifestyle, which is composed of regular physical activity and a healthy diet. Following the Mediterranean diet for two years has been shown to have significant decrease in cardiovascular death by 9%, cancer by 6%, Parkinsons and Alzheimers by 13%. This diet helps to control the perfect weight, improves lipid profile and diminishes the risk of diabetes. The Mediterranean diet consists of extra virgin olive oil, vegetables and fruit, wholegrain products, legumes, nuts and seeds, dairy products (with no other sources of fat other than milk fat), fish (at least twice a week), poultry, veal, pork in limited amount, and eggs - 0-4 per week. It is possible to adapt this kind of alimentation in the Nordic countries, but it is important to find products grown there with similar nutritional characteristics. Nowadays, fresh fruits and vegetables can be bought all year round, but it is essential to use seasonal products. In Latvia, at this point, attention should be brought to more efficient storage and conservation. We have a vast variety of legumes and cereals. The selection of dairy products should be bigger and of higher quality, because you rarely see local cheeses made in an artisanal manner at the marketplaces. There is good availability of saltwater fish in the cities, but in the countryside the only fish one can buy is salted and smoked, having exaggeratedly high amounts of salt. Consumption of meat and its products should be lowered to a maximum of three times per week. A special attention should be brought to game (such as deer), because it contains low levels of cholesterol and higher amounts of unsaturated fatty acids due to the alimentation of wild herbs. Unfortunately, there is a lack of good quality oil in Latvia, because no other product can be compared to the nutritious components of extra virgin olive oil and its effects on cardiovascular health. Consumption of high amounts of olive oil decreases the incidence of stroke by 41%. Education should be conducted widely to promote tradition and gastronomic heritage as a cultural aspect. Healthy lifestyle has to be visible to everyone at any time as a constant reminder of its importance. Abstrakts Slimîbu profilakses pamatâ ir veselîgs dzîvesveids, ko veido regulâra fiziskâ aktivitâte un veselîga diçta. Ïoti svarîgi ir balansçt uzòemto kaloriju daudzumu ar adekvâtâm fiziskâm aktivitâtçm. Pçdçjo gadu laikâ tieði Vidusjûras diçta tiek uzskatîta par visveselîgâko dzîvesveidu sirds un asinsvadu slimîbu profilaksç. Sekojot Vidusjûras diçtai divu gadu garumâ, ir novçrota mirstîbas mazinâðanâs no kardiovaskulârajâm saslimðanâm par 9%, no vçþa par 6%, no Parkinsona un Alcheimera slimîbâm - par 13%. Pozitîvie rezultâti ir skaidrojami ar to, ka veselîga diçta palîdz kontrolçt svaru un uzlabot lipîdu profilu. Samazinâs arî risks saslimt ar cukura diabçtu, jo uzlabojas glikozes vielmaiòa. Ievçrojami samazinâs iekaisuma un audzçja maríieri. Vidusjûras diçtu definç produktu grupas: auksti spiesta olîveïïa - svarîgs mononepiesâtinâto taukskâbju avots; daudz augïu un dârzeòu; pilngraudu produkti, pâkðaugi, rieksti un sçklas; pazeminâta tauku satura piena produkti (bez pievienotiem augu taukiem); zivis (vismaz divas reizes nedçïâ); putnu gaïa, liellopa gaïa un cûkgaïa nelielos daudzumos; olas - 0-4 nedçïâ. Ðâda veida uzturu ir iespçjams pielâgot arî ziemeïvalstîs, atrodot produktus ar lîdzîgu uzturvçrtîbu. Ïoti svarîgi ir pievçrst uzmanîbu svaigo produktu sezonalitâtei. Tâ kâ Latvijâ ir ïoti îss veìetatîvais periods, nepiecieðams ir uzlabot konservçðanas un uzglabâðanas metodes ziemas mçneðiem. Ziemeïos ir pieejama liela graudaugu un pâkðaugu izvçle. Jâpievçrð lielâka uzmanîba piena produktu kvalitâtei un jâveicina zemnieku raþoto produktu patçriòð, kâ arî jâsamazina rûpnieciski raþotu produktu patçriòð. Gaïas produktu îpatsvars diçtâ bûtu jâsamazina lîdz trîs reizçm nedçïâ, dodot priekðroku meþa dzîvnieku gaïai, kas ir bagâta ar nepiesâtinâtâm taukskâbçm un dzelzi, bet tajâ ir zemâks piesâtinâto tauku saturs. Latvijâ diemþçl netiek raþotas augstas kvalitâtes augu eïïas. Auksti spiestas olîveïïas (extra virgin) uzturvielas ir grûti salîdzinâmas un aizvietojamas ar citâm, tâs ievçrojami spçj uzlabot kardiovaskulâro veselîbu. Augsts ðîs olîveïïas patçriòð spçj samazinât insulta risku lîdz pat 41%.

Relation of the Leu40Arg variant of glycoprotein IIIA to personal and family history of myocardial infarction

Relation of the Leu40Arg variant of glycoprotein IIIA to personal and family history of myocardial infarction GPIIb/IIIa fibrinogen receptor is a key element of the thrombotic pathway. In this study, we investigated the possible relation of PlA1/A2 polymorphism (1565T>C; Leu33Pro) and a rare 1586T>G (Leu40Arg) variation of GPIIIa gene to personal and family history of myocardial infarction (MI) among 601 patients with angiographically confirmed coronary heart disease. Four hundred and fifteen patients had MI and 94 of individuals reported family history of premature MI. The Arg40 (1586G) variant (n = 4) was present exclusively in MI-patients and significantly correlated with a family history of premature MI (P = 0.013), whereas the Pro33 (1565C; PlA2) allele (n = 204) was similarly prevalent among different groups of patients. These data indicate the importance of the Arg40 variant but do not support a significant role of Pro33 allele in susceptibility to MI. Glikoproteīna iiia leu40arg varianta saistība ar miokarda infarkta personīgo un gimenes vēsturi GPIIb/IIIa fibrinogēna receptors ir centrāls trombogenēzes elements. Balstoties uz 601 pacientu ar angiogrāfiski apstiprinātu koronāro sirds slimību, pētījumā analizēta GPIIIa gēna PlA1/A2 polimorfisma (1565T>C; Leu33Pro) un retas 1586T>G (Leu40Arg) variācijas asociācija ar miokarda infarktu (MI) un priekšlaicīga MI gimenes anamnēzi. 415 no pacientiem bija raksturīgs miokarda infarkts un 94 — MI gimenes vēsture. Arg40 (1586G) variants (n = 4) tika konstatēts vienīgi MI pacientos un būtiski korelēja ar pāragra MI gimenes anamnēzi (P = 0.013). Pro33 (1565C) alēle (n = 204), savukārt, dažādās pacientu grupās bija izplatīta līdzīgi. Šie rezultāti liecina par Arg40 varianta nozīmi, bet neapstiprina Pro33 alēles lomu MI predispozīcijā.

Long-term Clinical Results for Randomised Comparison of Paclitaxel-eluting versus Bare-metal Stents in Unprotected Left Main Coronary Artery Disease

Long-term Clinical Results for Randomised Comparison of Paclitaxel-eluting versus Bare-metal Stents in Unprotected Left Main Coronary Artery Disease To optimise percutaneous coronary intervention (PCI) strategy for unprotected left main (ULMCA) disease we performed a randomised study: IVUS-guided bare metal stent (BMS) versus paclitaxel-eluting stent (PES) implantation after lesion pre-treatment with cutting balloon (CB) for unprotected LM lesions. The purpose of this randomized study was to evaluate six-month and three-year clinical results. Several recent publications have demonstrated good short- and midterm outcomes in patients with left main artery disease after stent implantation. However, data on long-term comparison of BMS and PES for LM lesions are limited. Patients with left main coronary artery disease enrolled at Latvian Centre of Cardiology were randomly assigned to either BMS (n = 50) or PES implantation (n = 53). All interventions were IVUS-guided and CB pre-treatment before stenting was performed in all patients. All patients were scheduled for six-month and three-year follow-up. The primary endpoint was major adverse cardiac events (MACE) defined as death, Q wave myocardial infarction or target lesion revascularisation (TLR). Baseline clinical and procedural characteristics were comparable in both groups. At six months, the MACE-free survival rate was 70% in BMS and 87% in PES patients (P < 0.05). At three years, MACE occurred in 18 patients (36.0%) in the BMS and seven patients (13.2%) in the PES group (P < 0.05). The current study demonstrates the benefit of IVUS guided paclitaxel-eluting stent implantation after cutting balloon pre-treatment in left main coronary artery disease over bare metal stent implantation at six months and three years. Ar Paklitakselu Pildīta Stenta Vai Parasta Metāla Stenta Implantācija Neprotektētā Kreisās Koronārās Artērijas Kopējā Stumbra Bojājumā: Ilgtermiņa Klīnisko Rezultātu Randomizēts Salīdzinājums Lai optimizētu perkutānās koronārās intervences stratēīju neprotektētiem kreisās koronārās artērijas kopējā stumbra bojājumiem, veicām randomizētu pētījumu: intravaskulārās ultraskaņās (IVUS) kontrolētu parasta metāla stentu (BMS) un ar paklitakselu pildītu stentu (PES) implantācijas salīdzinājumu, pēc aterosklerotiskās plāksnes sagatavošanas ar griezošo balonu. Pētījuma mērķis bija apsekot pacientus pēc sešiem mēnešiem un trim gadiem, vērtējot viņu klīnisko stāvokli. Vairāki nesen publicēti ziņojumi demonstrējuši labus īstermiņa un vidēja termiņa rezultātus pacientiem pēc stentu implantācijas kreisās koronārās artērijas kopējā stumbra bojājumos. Tomēr dati par parasta metāla stentu un ar paklitakselu pildītu stentu ilgtermiņa rezultātiem šai pacientu kohortai ir limitēti. Randomizējām Latvijas Kardiologijas centra pacientus ar kreisās koronārās artērijas kopējā stumbra aterosklerotiskiem bojājumiem BMS (n = 50) vai PES (n = 53) stentu implantācijai. Visas koronārās intervences bija IVUS kontrolētas, visiem pacientiem pirms stenta implantācijas aterosklerotisko plāksni sagatavoja ar griezošo balonu. Visiem pacientiem nozīmēta sešu mēnešu un trīs gadu apsekošana. Primārais beigu punkts bija liels kardiāls nelabvēlīgs notikums, ko definēja kā nāvi, Q miokarda infarktu vai mērķa bojājuma atkārtotu intervenci. Vispārējie pacientu un procedūras parametri bija salīdzināmi abās grupās. Pēc sešiem mēnešiem lielos nelabvēlīgos kardiālos notikumus nebija piedzīvojuši 70% BMS un 87% PES grupas pacienti (P < 0,05). Trīs gados lielos nelabvēlīgos kardiālos notikumus bija piedzīvojuši 18 BMS pacienti (36,0%) un septiņi PES pacienti (13,2%) (P < 0,05). Mūsu pētījuma sešu mēnešu un trīs gadu apsekošanas rezultāti pierādījuši IVUS kontrolētu, ar paklitakselu pildītu stentu implantācijas pārākumu pār parasta metāla stentu implantāciju pacientiem ar kreisās koronārās artērijas kopējā stumbra bojājumiem, pirms stenta implantācijas bojājumu sgatavojot ar griezošo balonu.