Клиническая практика (Feb 2020)
Comparison of strategies for myocardial revascularization in patients with coronary heart disease and multivessel coronary artery disease
Abstract
Justification. To this day, the problem of choosing the method of complete revascularization in the category of patients with acute coronary syndrome without the ST segment elevation and multi-vascular lesions of the coronary bed does not lose its relevance. The goal of this study was to compare the results of surgical manipulations in patients who underwent percutaneous coronary intervention using 3rd-generation drug-coated stents and coronary artery bypass grafting, according to the two-year follow-up data. Methods. The results of surgical and endovascular revascularization strategies were compared in 140 patients with ischemic heart disease and multivessel coronary disease after previously successfully performed stenting of a clinically dependent artery using 3rd-generation drug-coated stents for acute coronary syndrome without the ST segment elevation based on the results of a two-year follow-up. Results. There were no statistically significant differences in clinical, demographic and operational characteristics between the groups, except for the number of smoking patients, wich was significantly higher in the PCI group. In the PCI group, there was a statistically significant difference in the frequency of repeated revascularizations and the combined MACCE point. Discussion. The obtained results showed the advantage of CABG in a group of patients with previously successfully performed PCI of the clinically dependent artery for non -STEMI and multi-vascular lesions. Conclusion. In patients with coronary artery disease and multivascular lesions of the coronary bed, who had successfully underwent stenting of the clinical-dependent artery using stents of the 3rd generation with drug coating for acute coronary syndrome without the ST segment elevation, and intermediate severity of lesions on the SYNTAX scale when performing full functional revascularization by coronary artery bypass grafting or stenting, there are no differences in the indicators of cardiovascular mortality, myocardial infarction, acute cerebrovascular disease, frequency of return of the clinic angina pectoris, with the exception of the frequency of repeated revascularization and composite MACCE points, which was statistically significantly higher in the group of stenting.
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