Authors
Bocharov A.V.1, Popov L.V.2
1 Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma
2 Clinic of Thoracic and Cardiovascular Surgery St. George’s of National Medical and Surgical Center. N.I. Pirogov, Moscow
Abstract
Objective — to evaluate the efficacy and safety of staged treatment of patients with acute myocardial infarction with ST-segment elevation and multivessel lesion — percutaneous coronary intervention of a clinically-dependent artery with the use of 3rd generation sirolimus drug-elongated stents and further coronary artery bypasssurgery.
Materials and methods: analysis of the results of 2 years of follow-up after revascularization, results of efficacy and safety of a phased approach in patients with acute coronary syndrome with ST segment elevation and multivessel coronary bed disease — stenting of an infarct-dependent artery using 3rd generation stents with a drug coating sirolimus and appropriate incomplete myocardial revascularization by the method of coronary artery bypass surgery no later than 90 days after performing percutaneous coronary intervention ments, — the criterion “non-inferiority” compared withliterature data revascularization method of stenting.
Results: The results of the application of a staged approach to coronary artery revascularization in patients with acute coronary syndrome with ST segment elevation and multivessel coronary lesion are equivalent to the results of treatment of patients with coronary artery disease and multivascular percutaneous coronary intervention.
Keywords: acute coronary syndrome, coronary heart disease, coronary artery bypass grafting, drug-eluting stent.
References
1. Barbarash, L.S. Organizaciya i taktika provedeniya chreskozhnogo koronarnogo vmeshatel’stva pri infarkte miokarda s podemom segmenta ST / L.S. Barbarash, V.I. Ganyukov. – Kemerovo, 2012. – 230 p.
2. ZHbanov, I.V. Rezul’taty revaskulyarizacii miokarda u pacientov s ostrym koronarnym sindromom / ZHurnal kardiologiya i serdechno-sosudistaya hirurgiya. – 2009. – № 3. – Р. 14.
3. Pokazaniya k revaskulyarizacii miokarda (Rossijskij soglasitel’nyj dokument) / L.A. Bokeriyaidr. – NCSSKH im. A.N. Bakuleva RAMN, 2011. – 162 p.
4. Boersma, E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients / E. Boersma // European Heart Journal. – 2006. – Vol. 27 – P. 779–788.
5. Danchin, T. Comparison of Trombolysis Followed by Broad Use of Percutaneous Coronary Intervention With Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Acute Myocardial Infarction Data From the French Registry on Acute ST-Elevation Myocardial Infarction (FAST-MI) / T. Danchin, P. Coste, P. Steg // Circulation. – 2008. – Vol. 118. – P. 268–276.
6. Food and Drug Administration (FDA) (2016) Non-Inferioty Clinical Trials to Establish Effectiveness. GuidanceforIndustry.
7. Hoffman, S.N. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one – to eight – year outcomes. / Hoffman S.N., TenBrook J.A., Wolf M.P., Wong J.B., Pauker S.G., Salem D.N. // Journal of the American College of Cardiology. – 2003. – Vol. 41. – P. 1293–1304.
8. Nallamothu, B.K. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? / B.K. Nallamothu, E.R. Bates // American Journal of Cardiology. – 2003. – Vol. 92. – P. 824–826.
9. Tunes da Silva G. Methods for equivalence and noninferiority testing. / Tunes da Silva G., Logan B.R., Klein J.P. // Biol.BloodMarrowTransplant. – 2009. – Vol. 15. – P. 120–127.
