MAJOR RISK FACTORS OF HIGH-GRADE VENTRICULAR ARRHYTHMIAS IN THE COURSE OF PLANNED TRANSLUMINAL BALLOON ANGIOPASTY WITH STENTING OF CORONARY ARTERIES IN PATIENTS WITH CHRONIC CORONARY ARTERY DISEASE

To study ventricular arrhythmias (VA) registered before and after the planned procedure of transluminal balloon coronary angioplasty (PTCA) with stenting of coronary arteries and to reveal risk factors of high-grade VA., 106 patients aged 58.2±8.9 years (37 80 years, 76 men and 30 women) with chronic coronary artery disease (CAD) were examined. The study subjects’ assessment included questioning, physical examination, 12 lead ECG at rest, echocardiography, and 72 hour Holter monitoring. Surgical revascularization of myocardium was performed in all study subjects: in 83% of cases, PTCA with stenting of coronary arteries was carried out; in 10.4% of cases, direct stenting of coronary arteries; and 6.6% of cases, PTCA without stenting. VA one day prior to PCI. (Day 1 of Holter monitoring) were revealed in 88.7% of patients. On the second day of Holter monitoring (PTCA., strict bed rest), the incidence of high-grade VA increased statistically significantly from 35.8% to 51.9% (p=0.0054), prevalence of Grade 4B ventricular premature beats (VPB), from 11.3% to 21.7% (p=0.037). On Day 3 of Holter monitoring, the incidence of VA decreased statistically significantly as compared with Day 2 from 91.5% to 83% (p=0.008). The incidence of high-grade VA on Day 3 decreased statistically significantly as compared with Day 2, as well, from 51.9% to 40.6% (p=0.0376) that is slightly higher than the baseline level (before revascularization), 40.6% and 35.8%, p>0.05, respectively. For prediction of high-grade VA incidence on Day 2 of Holter monitoring, a logistic regression model was created. In the patients with a history of thrombolysis, the likelihood of high-grade VA during PCI and on the first day after the procedure is 14.9 times higher. In patients with altered RCA (according to the coronary angiography data), the likelihood of high-grade VA is 8.04 times higher than in patients with alterations of other coronary arteries. In the patients with a history of myocardial infarction, the risk of high-grade VA during and on the first day after PCI is 3.1 times higher and 1.2 times higher if the LDLP (low density lipoproteins) >3 mmol/l. The LDLP level exceeding 3 mmol/l, history of myocardial infarction, history of thrombolysis, and the alteration of RCA (according to the coronary angiography data) explain development of high-grade VA in 51.2% of patients. Thus, the patients with chronic CAD with an aggregate of the following factors: history of thrombolysis, alteration of RCA according to the coronary angiography data, history of myocardial infarction, serum LDLP >3 mmol/l have a high risk of clinically significant VA during the planned PCI and on the first day after it.

chronic coronary artery disease, coronary arteries, transluminal balloon coronary angioplasty, stenting, ventricular arrhythmias, Holter monitoring

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