Abstract Introduction Elective percutaneous coronary intervention (PCI) is accompanied by intraoperative ischemic myocardial injury (IIMI) up to 30% of the cases despite successfully performed procedure. Pharmacological preconditioning can prevent IIMI; Nicorandil is considered promising for this purpose. Purpose To study the possibility of pharmacological preconditioning by oral Nicorandil to ptevent ischaemic myocardial injury and 4a type myocardial infarction (MI) in patients with a stable form of coronary artery disease (CAD) before PCI. Material and methods 182 patients with CAD and indications for PCI were randomized into two groups: Nicorandil treatment group (additionally to β-blockers and a calcium channel blockers, n=90) and the control group (β-blockers and a calcium channel blockers, n=92). Nicorandil per os was prescribed 2 days before the PCI (30 mg/day); on the day of PCI – 2 hours before intervention (20 mg), 6–12 hours after PCI – 10 mg. The analysis of hs-Troponin I (hs-Tr) and creatine phosphokinase-MB (CK-MB)was carried out before PCI and 24, 72 hours after the procedure. The diagnosis of MI 4a type was established according to fourth universal definition. Double antiplatelet therapy was prescribed to all patients. Results Clinical profile (age, BMI, BP, creatinin clearance, LDL-cholesterol, glucose) of the patient groups were comparable by the basic parameters. The rate of hs-Tr after 24 hours has approached the 99th percentile from the upper limit of normal in 146 patients (80%). The increment of mean level of hs-Tr 24 hours after PCI has not distinguish statistically between the Nicorandil and the control group (364 vs 725 pg/ml, p=0,1). Mean of CK-MB increment in the control group has approached 2,5 ng/ml vs 0,5 ng/ml in the Nicorandil group (p=0.06). Among women (n=61), the increment of hs-Tr in 24 hours after PCI was statistically significantly lower (287 vs 1135 pg/ml, p=0,04) in the Nicorandil group compared to the control group. MI 4a type was detected in 12% of patients in the control group, and it decreased to 3% of patients in the Nicorandil group (p=0,05), it was observed in 21% in women in the control group and in 3% in the Nicorandil group. Conclusion Nicorandil treatment using before PCI decreases the risk of MI 4a in patients with a stable CAD due to the realization of pharmacological preconditioning. Funding Acknowledgement Type of funding source: None

Objective: Inflammation is one the major factors of atherosclerosis.The purpose of this study was to assess cutaneous microcirculatory parameters in patients with coronary artery disease (CAD) compared to healthy controls and to determine possible association between cutaneous microcirculatory function and IL-6 as inflammation marker.Materials and methods: This study enrolled 26 patients with established CAD (55.8±5.3 years; 24 males) and 21 healthy subjects (49.1±5.6 years; 15 males).Patients with hypertension and diabetes were excluded.Microcirculation was assessed using laser Doppler flowmetry (LDF) at rest and with the vasoconstrictor (respiratory, cold and venous occlusion) and vasodilator (heating and arterial occlusion) tests on the forearm.Basal skin perfusion and the maximum relative increase/decrease in skin blood flow to each stimulus were determined.IL-6 was measured using ELISA in CAD patients.Results: No significant differences were observed between two groups in basal skin perfusion.However, patients with CAD showed significantly increased vasoconstrictor response in cold test (p<0.05)with no difference in respiratory and venous occlusion test.Additionally, vasodilator response to local heating and arterial occlusion was significantly reduced in patients with CAD compared with healthy subjects (both p<0.05).There was no correlation between IL-6 and microcirculatory parameters in CAD patients. Conclusion:The results of cold test in patients with CAD are suggestive of enhanced constrictor response to sympathetic (noradrenergic) stimulation.Decreased vasodilator reserve in heating test indirectly indicates vasomotor dysfunction of microvascular endothelium in patients with CAD.Decreased response to arterial occlusion test in patients with CAD suggests impaired microvessel sensitivity to products of ischemic metabolism and possible regulatory effect of prostanoid metabolites.Lack of association between IL-6 and microcirculatory parameters suggests that these microcirculatory disturbances in CAD patients are independent of inflammation.

Efremova, Y.; Soboleva, G.; Andreeva, E.; Radukhina, N.; Tararak, E.; Karpov, Y. Author Information

Ojective: To estimate structural changes and endothelial function of arteries in pts with Coronary Artery Disease (CAD), Essential Hypertension (EH) and their conjunction. Material and Methods: The study involved 3 groups of pts (n = 120): 1st gr - 34 pts with CAD (angina pectoris, coronary artery stenoses more than 70%, ischaemia by ECG stress-test; mean age 57 yrs, 76% males, 54%smokers); 2nd gr - 46 pts with CAD + EH (mean age 62 yrs; 85% males,15% smokers); 3rd gr - 40 pts with EH I-III grade (mean age 56 yrs, 30% males, 30% smokers). Carotid artery intima-media thickness (IMT), distensibility coefficient (DC), stiffness parameter ¦β and carotid elasticity by carotid artery compliance (CAC) measurements were performed on high-resolution ultrasound images. Arterial stiffness as brachial-ankle pulse wave velocity (PWV ab), augmentation index (AI), atherosclerosis index ABI were assessed (Vasera VS-1000, Japan). Endothelium-dependent, flow-mediated vasodilatation (FMD) of the brachial artery (Celermajer, 1992) was estimated by high-resolution ultrasonography (12 MHz,Vivid 7, GE).Flow-mediated changes in upper limb PWV were measured during reactive hyperemia by oscillometry device (Vasera VS-1000, Japan) using the approach similar to described earlier by K. Naka et al. (2006). Results: Are presented in Tab.N1(mediana,25 and 75 procentili). Increase the sex/age adjusted IMT was detected in 57% CAD + EH pts, as well as the most decreased values of DC and most increased of stiffness parameter β. Increase the sex/age adjusted PWV was detected in 49% EH pts and 43% CAD + EH pts. Conclusion: Conjunction of CAD and EH accelerates the vascular wall remodeling, lower extremities atherosclerosis and increase of arterial stiffness. In pts with CAD the greatest endothelial vasomotor dysfunction was revealed.