S.D. MAYANSKAYA¹, A.A. GILMANOV², A.A. KODIROV², A.YU. TEREGULOV², M.M. MANGUSHEVA¹, E.I. MUKHITOVA³

 ¹Kazan State Medical University, Kazan

²Republican Clinical Hospital, Kazan

³City Clinical Hospital No. 7, Kazan

 Contact details:

Mayanskaya S.D. — MD, Professor of the Department of Hospital Surgery

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-905-316-99-66, e-mail: Smayanskaya@mail.ru

 The article presents two clinical cases with a severe, malignant course of coronary heart disease (CHD). In the first case, a patient had a chronic multivessel lesion of the coronary arteries and constant recurrence of occlusive stenosis both in the area of implanted stents and coronary artery bypass grafts. In the second case, three recurrences of atherothrombosis were observed within 1 month resulting in the development of repeated myocardial infarctions of the same localization. At the same time, both patients took all the necessary basic therapy, dual antiplatelet therapy and high doses of statins. Given this circumstance and the low level of platelet disaggregation, the patients underwent genotyping of thrombophilia factors. Mutations of the SERPINE1 (PAI-1) gene were identified, which controls the plasminogen activator inhibitor, as well as pathological genotypes of the platelet glycoprotein receptor ITGB3(PlA1/PlA2). In addition, the homozygous allele of another platelet glycoprotein ITGA2(Phe224Phe) was found in the 1^st patient, and the fibrinogen beta chain FGB-455 was found in the 2^nd patient. The article discusses the features of these pathological genotypes and their role in the progression of coronary artery disease.

Key words: coronary arteries, acute myocardial infarction, stent restenoses, pathological genotypes SERPINE1, ITGB3, ITGA2, FGB, thrombophilia.

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