THE EFFECT OF THE SINUS NODE IF-CHANNEL INHIBITOR ON THE CLINICAL COURSE OF STABLE CORONARY ARTERY DIS-EASE AND NEUROHUMORAL REGULATION OF BLOOD VESSELS IN PATIENTS AFTER INTRA-VENOUS CORONARY ANGIOGRAPHY

Cardiovascular diseases cause 4.3 million deaths in Europe every year, which accounts for 48% of all deaths. Coronary artery disease (CAD) accounts for approximately one-half of deaths attributable to cardio-vascular diseases. Endothelial dysfunction (ED), oxidative stress, dyslipidemia, and systemic immune-inflammation activation are currently known to play an important role in the pathogenesis of CAD. The inflammatory processes play a significant role in both the formation of atherosclerotic plaque and the injury to unstable atheroma followed by thrombotic occlusion and the development of cardiovascular complications. The aim of the research was to study the effect of ivabradine on the clinical course of the disease, endothelial function and indicators of the body's immune-inflammatory response in patients with stable CAD after myocardial revascularization within 12 months of treatment. The study recruited 120 patients with chronic CAD, heart failure (HF) with preserved left ventricular (LV) ejection fraction (EF), who underwent coronary artery (CA) stenting. All the patients were randomized according to the number of the affected CA and the method of treatment. The addition of ivabradine to therapeutic complex for patients with stable CAD after CA stenting was found to significantly reduce and maintain target heart rate (HR) for long periods of time thereby improving QoL and exercise tolerance (ET), preventing complications, helping patients in returning to work. The lowest angina attack frequency after PCI was achieved in patients receiving ivabradine. Our study confirmed reaching target HR after intervention irrespective of the number of the affected CA in ivabradine group of patients as evidenced by the results of the ASSOCIATE and BEAUTIFUL trials which showed that ivabradine is indicated for treatment of stable angina and insufficiently controlled HR (>70 bpm). Ivabradine improves the clinical picture and neurohumoral status in patients who underwent intravascular coronary angioplasty irrespective of the number of the CA affected; it contributes to positive dynamic changes in endothelin-1 (ET-1), indicators of immune-inflammatory activity and systemic inflammatory response over a certain period in patients with stable CAD after combined cardiosurgical and therapeutic treatment. The reduction in ET-1 level up to the 6th month of treatment was observed in both groups; however, the percent value was greater in patients of the main group (р<0.05). On the 12th month of treatment, ET-1 level continued to reduce significantly in patients of the main group and almost corresponded to that in healthy individuals. In contrast, in patients of the control group, the level of ET-1 continued to reduce moderately and almost did not differ from the first 6-month treatment indicator (р>0.05). The indicators of the immune-inflammatory response and systemic inflammation, namely tumor necrosis factor (TNF-α) and C-reactive protein (CRP), significantly reduced on the 6th and 12th months of treatment in patients, who received ivabradine. In patients, who underwent background therapy, a significant reduction in these indicators was observed till the 6th month of treatment only (р<0.05). The comparison of the immune-inflammatory response indicators on the 6th month of treatment among patients of both groups revealed the reduction in TNF-α and CRP with a greater percent value in patients of the main group.