Authors
Bocharov A.V.1, Popov L.V.2
1 Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma
2 Pirogov National Medical and Surgical Center, Clinic of Thoracic and Cardiovascular Surgery St. George’s, Moscow
Abstract
Materials and methods: a comparative analysis of the results of surgical and endovascular treatment of patients with coronary heart disease and multivessel lesions of the coronary arteries after successfully performed earlier stenting of the clinical-dependent artery using stents of the 3rd generation with drug coating for acute coronary syndrome (250 patients). All patients at the first stage underwent stenting of the clinically-dependent artery for vital signs due to acute coronary syndrome. The second stage was performed no later than 90 days from the date of stenting of the clinical-dependent artery — complete functional revascularization, which was carried out by methods of coronary artery bypass grafting or stenting. 121 patient complete revascularization of the myocardium was performed by the method of coronary artery bypass grafting. 129 patients, coronary revascularization was conducted using stenting. Long-term results were evaluated for 2 years. End points of observation — cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, re-revascularization and combined macce point.
Results: the analysis of the results revealed a statistically significant difference between the groups in the frequencies of nonfatal myocardial infarction, re-revascularization, return of the angina clinic, as well as the combined macce point, which were higher in the stenting group. The presence of generalized atherosclerosis, hypertension and hyperlipidemia significantly more often lead to re-revascularization in the stenting group. Arterial hypertension and hyperlipidemia in 5.45 and 10 times more often cause the return of angina clinic in the group of patients with endovascular treatment strategy, respectively.
Conclusions: in patients with coronary heart disease and multivascular lesions of the coronary arteries of intermediate severity on the scale of Syntax, who underwent successful stenting of clinical-dependent artery for acute coronary syndrome, the incidence of nonfatal myocardial infarction, re-revascularization, return of angina clinic, as well as the combined macce point is significantly higher in the group of percutaneous coronary interventions.
Generalized atherosclerosis, hypertension and hyperlipidemia significantly more often lead to re-revascularization in the group of percutaneous coronary interventions. Arterial hypertension and hyperlipidemia in 5.45 and 10 times more often cause the return of angina clinic in the group of patients with endovascular treatment strategy, respectively.
Keywords: acute coronary syndrome, coronary heart disease, multivessel coronary artery disease, coronary artery bypass grafting, coronary artery stenting.
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