[The features of a functional state of the coronary circulation in women-smokers with non st elevation acute coronary syndrome].

INTRODUCTION: Acute coronary syndrome is one of the most adverse prognostic clinical forms of ischemic heart disease. In recent years, attention of researchers and cardiologists practical attract female patients due to a substantial increase in the prevalence including acute coronary syndrome, differences in the causes and features of its course. Women often diagnosed myocardial infarction without ST elevation and nonobstructive coronary heart disease associated with coronary spasm or stratification of coronary artery. The study of the pathophysiological mechanisms of myocardial infarction also showed the existence of certain gender differences. However, the available literature contains little data on the impact of smoking on morphological and functional condition of the coronary arteries in women with severe forms of coronary heart disease.

AIM: to conduct contrastive analysis of coronary circulation state according to data of coronarography (CAG) in women with non ST elevation acute coronary syndrome.

MATERIALS AND METHODS: 61 women aged 35-77 were examined (middle age 57, 9±1,2) who were hospitalized because of non ST elevation acute coronary syndrome. Depending on smoking habit all the patients of general group were divided into two subgroups. First subgroup (n=29, middle age 54,3±1,5) consisted of smoking women who had been smoking for 5 years ≥5 cigarettes a day (an average number of smoked cigarettes per day was 9,8) Second subgroup (n=32, middle age 61,8±1,3) consisted of ill non-smoking women. We studied a type of coronary circulation? its nature, localization and evidence of coronary arteria damage and characteristics of microvascular and collateral blood flow.

RESULTS: smoking women with non ST elevation acute coronary syndrome more often have bigger damages of coronary arteria: hemodynamically relevant and diffusive damages mostly located in proximal medial segments often with connected damage of distal segments especially of the left coronary arteria and its interventricular branch that causes a compensatory hypernormal development collateral blood flow and predominance of right blood supply type. Approximately 59,02% of women have sustainable violation of coronary microcirculation and myocardial perfusion, especially in cases of absence of coronary arteria hemodynamically relevant stenosis; much more often (by half) it is observed in smoking women (75,86%) that can be recognized on a coronarography as rather delayed blood flow and retention of contrast release. One-third of women occurs in the setting of almost unchanged coronary red vessels.

CONCLUSION: durable smoking causes hard vessel damages with the occurrence of hemodynamic stenosis in proximal and medial segments of magistral coronary arteries, which are often connected with their distal (diffusive) changes and more frequent violation in microcirculation system.