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Современные эндоваскулярные технологии и отдаленный прогноз у больных с ишемической болезнью сердца с поражением ствола левой коронарной артерии
Власов В.Ю., Руденко Б.А., Шаноян А.С. и др. Современные эндоваскулярные технологии и отдаленный прогноз у больных с ишемической болезнью сердца с поражением ствола левой коронаной артерии. Consilium Medicum. 2016; 18 (5): 93–97. DOI: 10.26442/2075-1753_2016.5.93-97
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Vlasov V.Yu., Rudenko B.A., Shanoyan A.S. et al. Modern endovascular technologies and long-term prognosis in patients with left main coronary artery disease. Consilium Medicum. 2016; 18 (5): 93–97. DOI: 10.26442/2075-1753_2016.5.93-97
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Аннотация
Операция коронарного шунтирования (КШ) является «золотым стандартом» реваскуляризации миокарда при поражениях ствола левой коронарной артерии (ЛКА) и имеет наивысший уровень доказательности в европейских и американских рекомендациях. Однако развитие эндоваскулярных методов лечения, и в первую очередь снижение внутристентового рестеноза, способствует рассмотрению ангиопластики со стентированием ствола ЛКА как альтернативы КШ. В статье приводится сравнительный мировой анализ результатов чрескожного коронарного вмешательства и аортокоронарного шунтирования у данной категории пациентов, а также анализируется эффективность эндоваскулярного метода лечения при наличии таких влияющих на прогноз факторов, как: локализация поражения, сахарный диабет, тип антипролиферативного покрытия стента.
Ключевые слова: поражение ствола левой коронарной артерии, чрескожные коронарные вмешательства, операция коронарного шунтирования, ангиопластика со стентированием, эндоваскулярные методы лечения.
Ключевые слова: поражение ствола левой коронарной артерии, чрескожные коронарные вмешательства, операция коронарного шунтирования, ангиопластика со стентированием, эндоваскулярные методы лечения.
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Coronary artery bypass grafting (CABG) is known as the gold standard treatment of unprotected left main coronary artery (LMCA) disease and has the highest level of evidence in European and American recommendations. However development of endovascular methods of treatment, and first of all decrease of in-stent-restenosis allow us to consider angioplasty and stenting of LMCA as an alternative method to CABG. The comparative world analysis of results of percutaneous coronary interventions and CABG is provided in article. It tells also how efficiency of percutaneous coronary interventions depends on such factors as: lesion localization, diabetes, type of drug-eluting stent.
Key words: left main coronary artery disease, percutaneous coronary interventions, coronary artery bypass grafting, angioplasty and stenting, endovascular methods of treatment.
Key words: left main coronary artery disease, percutaneous coronary interventions, coronary artery bypass grafting, angioplasty and stenting, endovascular methods of treatment.
Полный текст
Список литературы
1. Mehta J, Hamby RG, Hoffman G. Medical-surgical aspects of left main coronary disease. J Thorac Cardiovasc Surg. 1976; 71 (1): 137–41.
2. Proudfit WL, Bruschke AVG, Stones FM. Natural history of obstructive coronary artery disease: ten-year study of 601 nonsurgical cases. Prag Cardiovasc Dis 1978; 21: 53–78.
3. Taylor H, Deumite N, Chaitman B et al. Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation 1989; 79: 1171–9.
4. Cohen MV, Gorlin R. Main left coronary artery disease. Clinical experience from 1964–1974. Circulation 1975; 52: 275–85.
5. Saint-Pierre A, Amiel M, Jamet C et al. Significance of atheromatous stenoses of common trunk of the left coronary artery. Arch Mal Coeur Vaiss 1974; 67 (11): 1305–15.
6. Hill R, Bagust A, Bakhai A, Dickson R et al. Coronary artery stents: a rapid systematic review and economic evaluation. Health Technol Assess 2004; 8: 1–242.
7. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) / S.C.Smith et al. J Am Coll Cardiol 2006; 47 (1): 1–121.
8. Савченко А.П., Черкавская О.В., Руденко Б.А., Болотов П.А. Интервенционная кардиология. М.: ГЭОТАР-Медиа, 2010; с. 253–66. / Savchenko A.P., Cherkavskaia O.V., Rudenko B.A., Bolotov P.A. Interventsionnaia kardiologiia. M.: GEOTAR-Media, 2010; s. 253–66. [in Russian]
9. O’Keefe JH Jr, Hartzler GO, Rutherford BD et al. Left nain coronary angioplasty: early and late results of 127 acute and elective procedures. Am J Cardiol 1989; 64: 144–7.
10. Sabik JF, Blackstone EH, Firstenberg M, Lytle BW. A benchmark for evaluation innovative treatment of left main coronary disease. Circulation 2007; 116 (Suppl.): 232–9.
11. Tan WA, Tamai H, Park SJ et al. Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. Circulation 2001; 104 (14): 1609–14.
12. Boccalatte M, Sousa P, Ali H et al. Unprotected left main coronary stenting: Long- and medium-term outcomes. Am J Cardiol 2001; 88 (Suppl. 1): 4–6.
13. Kosuga K, Tamai H, Ueda K et al. Initial and long-term results of angioplasty in unprotected left main coronary artery. Am J Cardiol 1999; 83 (1): 32–7.
14. Kim YH, Park DW, Lee SW et al. Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents. Circulation 2009; 120: 400–7.
15. Palmerini T, Marzocchi A, Tamburino C et al. Two-year clinical outcome with drug-eluting stents versus bare-metal stents in a real-world registry of unprotected left main coronary artery stenosis from the Italian Society of Invasive Cardiology. Am J Cardiol 2008; 102: 1463–8.
16. Park SL, Kim YH. Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: Comparison with bare metal stent implantation. J Am Coll Cardiol 2005; 45: 351–6.
17. Morice MC, Serruys PW, Kappetein AP et al. Outcomes in patients with de novo left main disease treated with either percuyaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2010: 121 (24): 2645–53.
18. Morice MC, Serruys PW, Kappetein AP et al. Five-Year Outcomes in Patients with Left Main Desease Treated with Either Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in the SYNTAX trial. Circulation 2014; 129: 2388–94.
19. Windecker S, Kolh Ph, Alfonso F et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. Published August 29, 2014.
20. Park DW, Kim YH, Yun SC et al. Long-term outcomes after stenting vs. coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardial 2010; 56 (17): 1366–75.
21. Ahn JM, Roh JH, Kim YH et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease: Five-year outcomes of the PRECOMBAT study. J Am Coll Cardiol 2015; DOI:10.1016/j.jacc.2015.03.033
22. Chen SL et al. Distal left main coronary bifurcation lesion predict worse outcome in patients undergoing percutaneous implantation of drug-eluting stents: results from the Drug-Eluting Stent for the Treatment of Left Main Disease (DISTAL) study. Cardiology 2009; 113 (4): 264–73.
23. Niemela M, Kervinen K, Erglis A et al. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Stude III. Circulation 2011; 123 (1): 79–86.
24. Farkouh ME, Domanski M, Sleeper LA et al. Strategies for multivessel revascularization in patients with diabetes. N Engl JMed 2012; 367: 2375–84.
25. Акчурин Р.С., Власова Э.Е., Мершин К.В. Сахарный диабет и хирургическое лечение ишемической болезни сердца. Вестн. РАМН. 2012; 1: 14–9. / Akchurin R.S., Vlasova E.E., Mershin K.V. Sakharnyi diabet i khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa. Vestn. RAMN. 2012; 1: 14–9. [in Russian]
26. Raber L, Juni P, Nuesch E et al. Long-term comparison of everolimus-eluting and sirolimus-eluting stents for coronary revascularization. J Am Coll Cardiol 2011; 57: 2143–51.
27. Mehilli J, Richardt G, Valgimigli M et al. Zotarolimus- versus everolimus-eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol 2013; Epud ahead of print.
28. Daemen J, Wenaweser P, Tsuchida K et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007; 369 (9562): 667–8.
29. Chieffo A, Park SJ, Meliga E et al. Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry. Eur Heart J 2008; 29: 2108–15.
30. Samin K Sharma, Usman Baber. The shifting pendulum for DAPT after PCI. Balancing long-term risks for bleeding and thrombosis. J Am Coll Cardiol 2015; 66 (9): 1046–9.
2. Proudfit WL, Bruschke AVG, Stones FM. Natural history of obstructive coronary artery disease: ten-year study of 601 nonsurgical cases. Prag Cardiovasc Dis 1978; 21: 53–78.
3. Taylor H, Deumite N, Chaitman B et al. Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation 1989; 79: 1171–9.
4. Cohen MV, Gorlin R. Main left coronary artery disease. Clinical experience from 1964–1974. Circulation 1975; 52: 275–85.
5. Saint-Pierre A, Amiel M, Jamet C et al. Significance of atheromatous stenoses of common trunk of the left coronary artery. Arch Mal Coeur Vaiss 1974; 67 (11): 1305–15.
6. Hill R, Bagust A, Bakhai A, Dickson R et al. Coronary artery stents: a rapid systematic review and economic evaluation. Health Technol Assess 2004; 8: 1–242.
7. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) / S.C.Smith et al. J Am Coll Cardiol 2006; 47 (1): 1–121.
8. Савченко А.П., Черкавская О.В., Руденко Б.А., Болотов П.А. Интервенционная кардиология. М.: ГЭОТАР-Медиа, 2010; с. 253–66. / Savchenko A.P., Cherkavskaia O.V., Rudenko B.A., Bolotov P.A. Interventsionnaia kardiologiia. M.: GEOTAR-Media, 2010; s. 253–66. [in Russian]
9. O’Keefe JH Jr, Hartzler GO, Rutherford BD et al. Left nain coronary angioplasty: early and late results of 127 acute and elective procedures. Am J Cardiol 1989; 64: 144–7.
10. Sabik JF, Blackstone EH, Firstenberg M, Lytle BW. A benchmark for evaluation innovative treatment of left main coronary disease. Circulation 2007; 116 (Suppl.): 232–9.
11. Tan WA, Tamai H, Park SJ et al. Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. Circulation 2001; 104 (14): 1609–14.
12. Boccalatte M, Sousa P, Ali H et al. Unprotected left main coronary stenting: Long- and medium-term outcomes. Am J Cardiol 2001; 88 (Suppl. 1): 4–6.
13. Kosuga K, Tamai H, Ueda K et al. Initial and long-term results of angioplasty in unprotected left main coronary artery. Am J Cardiol 1999; 83 (1): 32–7.
14. Kim YH, Park DW, Lee SW et al. Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents. Circulation 2009; 120: 400–7.
15. Palmerini T, Marzocchi A, Tamburino C et al. Two-year clinical outcome with drug-eluting stents versus bare-metal stents in a real-world registry of unprotected left main coronary artery stenosis from the Italian Society of Invasive Cardiology. Am J Cardiol 2008; 102: 1463–8.
16. Park SL, Kim YH. Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: Comparison with bare metal stent implantation. J Am Coll Cardiol 2005; 45: 351–6.
17. Morice MC, Serruys PW, Kappetein AP et al. Outcomes in patients with de novo left main disease treated with either percuyaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2010: 121 (24): 2645–53.
18. Morice MC, Serruys PW, Kappetein AP et al. Five-Year Outcomes in Patients with Left Main Desease Treated with Either Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in the SYNTAX trial. Circulation 2014; 129: 2388–94.
19. Windecker S, Kolh Ph, Alfonso F et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. Published August 29, 2014.
20. Park DW, Kim YH, Yun SC et al. Long-term outcomes after stenting vs. coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardial 2010; 56 (17): 1366–75.
21. Ahn JM, Roh JH, Kim YH et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease: Five-year outcomes of the PRECOMBAT study. J Am Coll Cardiol 2015; DOI:10.1016/j.jacc.2015.03.033
22. Chen SL et al. Distal left main coronary bifurcation lesion predict worse outcome in patients undergoing percutaneous implantation of drug-eluting stents: results from the Drug-Eluting Stent for the Treatment of Left Main Disease (DISTAL) study. Cardiology 2009; 113 (4): 264–73.
23. Niemela M, Kervinen K, Erglis A et al. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Stude III. Circulation 2011; 123 (1): 79–86.
24. Farkouh ME, Domanski M, Sleeper LA et al. Strategies for multivessel revascularization in patients with diabetes. N Engl JMed 2012; 367: 2375–84.
25. Акчурин Р.С., Власова Э.Е., Мершин К.В. Сахарный диабет и хирургическое лечение ишемической болезни сердца. Вестн. РАМН. 2012; 1: 14–9. / Akchurin R.S., Vlasova E.E., Mershin K.V. Sakharnyi diabet i khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa. Vestn. RAMN. 2012; 1: 14–9. [in Russian]
26. Raber L, Juni P, Nuesch E et al. Long-term comparison of everolimus-eluting and sirolimus-eluting stents for coronary revascularization. J Am Coll Cardiol 2011; 57: 2143–51.
27. Mehilli J, Richardt G, Valgimigli M et al. Zotarolimus- versus everolimus-eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol 2013; Epud ahead of print.
28. Daemen J, Wenaweser P, Tsuchida K et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007; 369 (9562): 667–8.
29. Chieffo A, Park SJ, Meliga E et al. Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry. Eur Heart J 2008; 29: 2108–15.
30. Samin K Sharma, Usman Baber. The shifting pendulum for DAPT after PCI. Balancing long-term risks for bleeding and thrombosis. J Am Coll Cardiol 2015; 66 (9): 1046–9.
________________________________________________
1. Mehta J, Hamby RG, Hoffman G. Medical-surgical aspects of left main coronary disease. J Thorac Cardiovasc Surg. 1976; 71 (1): 137–41.
2. Proudfit WL, Bruschke AVG, Stones FM. Natural history of obstructive coronary artery disease: ten-year study of 601 nonsurgical cases. Prag Cardiovasc Dis 1978; 21: 53–78.
3. Taylor H, Deumite N, Chaitman B et al. Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation 1989; 79: 1171–9.
4. Cohen MV, Gorlin R. Main left coronary artery disease. Clinical experience from 1964–1974. Circulation 1975; 52: 275–85.
5. Saint-Pierre A, Amiel M, Jamet C et al. Significance of atheromatous stenoses of common trunk of the left coronary artery. Arch Mal Coeur Vaiss 1974; 67 (11): 1305–15.
6. Hill R, Bagust A, Bakhai A, Dickson R et al. Coronary artery stents: a rapid systematic review and economic evaluation. Health Technol Assess 2004; 8: 1–242.
7. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) / S.C.Smith et al. J Am Coll Cardiol 2006; 47 (1): 1–121.
8. Savchenko A.P., Cherkavskaia O.V., Rudenko B.A., Bolotov P.A. Interventsionnaia kardiologiia. M.: GEOTAR-Media, 2010; s. 253–66. [in Russian]
9. O’Keefe JH Jr, Hartzler GO, Rutherford BD et al. Left nain coronary angioplasty: early and late results of 127 acute and elective procedures. Am J Cardiol 1989; 64: 144–7.
10. Sabik JF, Blackstone EH, Firstenberg M, Lytle BW. A benchmark for evaluation innovative treatment of left main coronary disease. Circulation 2007; 116 (Suppl.): 232–9.
11. Tan WA, Tamai H, Park SJ et al. Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients. Circulation 2001; 104 (14): 1609–14.
12. Boccalatte M, Sousa P, Ali H et al. Unprotected left main coronary stenting: Long- and medium-term outcomes. Am J Cardiol 2001; 88 (Suppl. 1): 4–6.
13. Kosuga K, Tamai H, Ueda K et al. Initial and long-term results of angioplasty in unprotected left main coronary artery. Am J Cardiol 1999; 83 (1): 32–7.
14. Kim YH, Park DW, Lee SW et al. Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents. Circulation 2009; 120: 400–7.
15. Palmerini T, Marzocchi A, Tamburino C et al. Two-year clinical outcome with drug-eluting stents versus bare-metal stents in a real-world registry of unprotected left main coronary artery stenosis from the Italian Society of Invasive Cardiology. Am J Cardiol 2008; 102: 1463–8.
16. Park SL, Kim YH. Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: Comparison with bare metal stent implantation. J Am Coll Cardiol 2005; 45: 351–6.
17. Morice MC, Serruys PW, Kappetein AP et al. Outcomes in patients with de novo left main disease treated with either percuyaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2010: 121 (24): 2645–53.
18. Morice MC, Serruys PW, Kappetein AP et al. Five-Year Outcomes in Patients with Left Main Desease Treated with Either Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in the SYNTAX trial. Circulation 2014; 129: 2388–94.
19. Windecker S, Kolh Ph, Alfonso F et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. Published August 29, 2014.
20. Park DW, Kim YH, Yun SC et al. Long-term outcomes after stenting vs. coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardial 2010; 56 (17): 1366–75.
21. Ahn JM, Roh JH, Kim YH et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease: Five-year outcomes of the PRECOMBAT study. J Am Coll Cardiol 2015; DOI:10.1016/j.jacc.2015.03.033
22. Chen SL et al. Distal left main coronary bifurcation lesion predict worse outcome in patients undergoing percutaneous implantation of drug-eluting stents: results from the Drug-Eluting Stent for the Treatment of Left Main Disease (DISTAL) study. Cardiology 2009; 113 (4): 264–73.
23. Niemela M, Kervinen K, Erglis A et al. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Stude III. Circulation 2011; 123 (1): 79–86.
24. Farkouh ME, Domanski M, Sleeper LA et al. Strategies for multivessel revascularization in patients with diabetes. N Engl JMed 2012; 367: 2375–84.
25. Akchurin R.S., Vlasova E.E., Mershin K.V. Sakharnyi diabet i khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa. Vestn. RAMN. 2012; 1: 14–9. [in Russian]
26. Raber L, Juni P, Nuesch E et al. Long-term comparison of everolimus-eluting and sirolimus-eluting stents for coronary revascularization. J Am Coll Cardiol 2011; 57: 2143–51.
27. Mehilli J, Richardt G, Valgimigli M et al. Zotarolimus- versus everolimus-eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol 2013; Epud ahead of print.
28. Daemen J, Wenaweser P, Tsuchida K et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007; 369 (9562): 667–8.
29. Chieffo A, Park SJ, Meliga E et al. Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry. Eur Heart J 2008; 29: 2108–15.
30. Samin K Sharma, Usman Baber. The shifting pendulum for DAPT after PCI. Balancing long-term risks for bleeding and thrombosis. J Am Coll Cardiol 2015; 66 (9): 1046–9.
Авторы
В.Ю.Власов*, Б.А.Руденко, А.С.Шаноян, В.П.Мазаев, А.Ш.Ахадова, Ф.Б.Шукуров
ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петро- веригский пер., д. 10, стр. 3
*avrelliy@yandex.ru
ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петро- веригский пер., д. 10, стр. 3
*avrelliy@yandex.ru
________________________________________________
V.Yu.Vlasov*, B.A.Rudenko, A.S.Shanoyan, V.P.Mazaev, A.Sh.Akhadova, F.B.Shukurov
State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3
*avrelliy@yandex.ru
State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3
*avrelliy@yandex.ru
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