Clinical characteristics of patients with coronary artery disease and atherosclerosis of the coronary arteries, depending on the degree of their stenosis

A comparative analysis was conducted on 114 patients with stable ischemic heart disease (SIHD) and stenoses of coronary arteries (CA) in the range of less than 60% of the artery diameter (Group 1, 58 patients) and more than 60% (Group 2, 56 patients). It was shown that the angina syndrome does not always depend on the degree of CA stenosis; however, typical chest pain and a higher functional class (FC) were significantly more frequently observed in patients with hemodynamically significant lesions of the CA (Group 2). These patients were characterized by fasting hyperglycemia against the background of excess body weight, eccentric hypertrophy of the myocardium, a significant decrease in glomerular filtration rate, and signs of myocardial ischemia were diagnosed during stress tests, as well as electrical instability of the heart manifested as ventricular extrasystole and short paroxysms of unstable ventricular tachycardia. In contrast, patients in Group 1 exhibited hypertensive remodeling of the myocardium against a background of diastolic dysfunction, with significantly more frequent one-vessel lesions of the CA and predominantly paroxysms of atrial fibrillation recorded. In the second stage, an analysis was conducted on patients with SIHD and coronary artery stenoses in the range of 60–90% based on instantaneous blood flow reserve (iBFR). Subgroup 1 (28 patients) had an iBFR of less than 0.84; Subgroup 2 (28 patients) had an iBFR of more than 0.94. Patients in Subgroup 1 significantly differed from those in Subgroup 2 in terms of diabetes mellitus development, presence of atherogenic dyslipidemia, and a higher FC of angina. The aforementioned characteristics of Subgroup 1 increase the likelihood of low iBFR values with the same baseline pre-test probability of stenosing atherosclerosis of the CA. According to the results of the third stage, it was noted that after one year, the clinical condition of patients in both the endovascular treatment subgroup (Subgroup 1, 12 patients) and the medication therapy subgroup (Subgroup 2, 12 patients) significantly improved. The angina syndrome was significantly less frequently reported in Subgroup 1, and their FC was notably lower. In Group 1 and Subgroup 2, against the background of using dihydropyridine calcium channel antagonists, a significantly more favorable course of the angina syndrome was observed. According to one-year prospective monitoring, no cardiovascular complications were registered.