Preview

The Clinician

Advanced search

INDICATIONS FOR MYOCARDIAL REVASCULARIZATION – ARE THEY USING EQUALLY FOR CHOOSING OF INVASIVE STRATEGY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE?

https://doi.org/10.17650/1818-8338-2017-11-3-4-23-33

Abstract

The purpose was to reveal the value of separate indications for myocardial revascularization as well as their combinations for choosing invasive or conservative strategy of treatment in patients with stable coronary artery disease (CAD) during 2012–2015 years.

Materials and methods. The retrospective data of 1196 patients (mean age: 52.5 ± 8.4 years; 77,0 % men) were analyzed, from the register of patients with stable CAD (2012–2015 years), who had separate indications for myocardial revascularization and their combination. Patients were divided into 2 groups: with an invasive (n = 481 patients without considering the revascularization method) and conservative (n = 715 patients) treatment strategy. Indications for revascularization are taken from the recommendations of the European Society of Cardiology 2014.

Results. The most common indication for myocardial revascularization was the presence of any coronary stenosis in combination with the limiting angina in the context of optimal medication (88.1 % in the invasive treatment group, 94.3 % in the conservative therapy group, p < 0.001). In half of the patients in both groups this indication was found in isolation, in the rest – in combination with other indications for surgical treatment. Among the combinations of indications, significant differences between the groups showed the following. Stenosis of the LM >50 % + proximal stenosis LAD >50 %+ limiting angina pectoris occurred in 1.5 % of the patients in the invasive treatment group versus 3.8 % with the conservative strategy (p = 0.020). Proximal stenosis LAD >50 % was more common among operated patients (10.6 % vs 4.6 % in the conservative treatment group, p <0.001). Two- and three-vessel lesions + ejection fraction LV <40 % + limiting angina pectoris also occurred more frequently in the invasive treatment group (2.5 % vs 0.6 % in the conservative strategy group, p = 0.006).The remaining indications for myocardial revascularization and their combination were equally common in both groups.

Conclusion. The presence of isolated proximal LAD stenosis or multivessel lesion with reduced left ventricular function accompanied with limiting angina was associated with the choice of invasive strategy in patients with stable CAD (data for 2012–2015 years). The lesion LM combined with proximal stenosis LAD and limiting angina pectoris and requiring coronary artery bypass grafting was associated with the choice of a conservative strategy. Almost half of the patients (48.6 %) had revascularization to improve the quality of life.

About the Authors

A. S. Korotin
Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Ministry of Health of Russia
Russian Federation

112 Bolshaya Kazachya St., Saratov 410012



A. R. Kiselev
Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Ministry of Health of Russia
Russian Federation

112 Bolshaya Kazachya St., Saratov 410012



Yu. V. Popova
Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Ministry of Health of Russia
Russian Federation

112 Bolshaya Kazachya St., Saratov 410012



O. M. Posnenkova
Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Ministry of Health of Russia
Russian Federation

112 Bolshaya Kazachya St., Saratov 410012



V. I. Gridnev
Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Ministry of Health of Russia
Russian Federation

112 Bolshaya Kazachya St., Saratov 410012



References

1. Montalescot G., Sechtem U., Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949–3003. DOI: 10.1093/eurheartj/eht296.

2. De Bruyne B., Pijls N.H., Kalesan B. et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012; 367(11):991–1001. DOI: 10.1056/NEJMoa1205361.

3. Boden W.E., O’Rourke R.A., Teo K.K. et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356(15):503–16. DOI: 10.1056/NEJMoa070829.

4. Pursnani S., Korley F., Gopaul R. et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circ Cardiovasc Interv 2012;5(4):476–90. DOI: 10.1161/CIRCINTERVENTIONS.112.970954.

5. What is the ISCHEMIA Study? URL access mode: https://www.ischemiatrial.org/ (дата обращения 17.04.2017).

6. Yusuf S., Zucker D., Peduzzi P. et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994;344(8922):563–70. DOI: 10.1016/S0140-6736(94)91963-1.

7. Deb S., Wijeysundera H.C., Ko D.T. et al. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. JAMA 2013;310(19):2086–95. DOI: 10.1001/jama.2013.281718.

8. Windecker S., Kolh P., Alfonso F. et al. 2014 ESC/EACT Guidelines on myocardial revascularization. The Task Force on Myocardial Revascalarization of the European Society of Cardiology (ESC) and the European Association for CardioThoracic Surgery (EACT). European Heart Journal 2014;35(37):2541–619. DOI: 10.1093/eurheartj/ehu278.

9. Korotin A.S., Popo- va Yu.V., Genkal E.N. et al. Evaluation of myocardial revascularization in stable coronary heart disease patients and factors associated with invasive strategy choice. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention 2017;16(4):18–24. (In Russ.). DOI: 10.15829/1728-8800-2017-4-18-24.

10. Oshchepkova E.V., Dovgalevsky P.Ya., Gridnev V.I. et al. Key data elements and definitions of the Russian registry of patients with arterial hypertension, coronary artery disease and chronic heart failure. Cardio-IT 2014;1:0202. (In Russ.).

11. Campeau L. Grading of angina pectoris. Circulation 1976;54(3):522 –3. PMID: 947585.

12. Park S.J., Park D.W. Percutaneous coronary intervention with stent implantation versus coronary artery bypass surgery for treatment of left main coronary artery disease. Circ Cardiovasc Intervent 2009;2(1):59–68. DOI: 10.1161/CIRCINTERVENTIONS.108.831701.

13. Kuznetsov V.A., Bessonov I.S., Zyryanov I.P. et al. Clinical and functional characteristics and treatment of patients with lesion of the left coronary artery trunk in real clinical practice. Kardiologiya = Cardiology 2014;54(1):55–60. (In Russ). DOI: 10.18565/cardio.2014.1.55-60.

14. Litvinenko R.I., Sveklina T.S., Kulikov A.N. et al. Significance of clinical symptoms in the diagnosis of coronary heart disease, taking into account the characteristics of the lesion of the coronary bed. Vestnik Rossijskoj Voenno-medicinskoj akademii = Bulletin of the Russian Military Medical Academy 2015;4(52);43–6. (In Russ.).


Review

For citations:


Korotin A.S., Kiselev A.R., Popova Yu.V., Posnenkova O.M., Gridnev V.I. INDICATIONS FOR MYOCARDIAL REVASCULARIZATION – ARE THEY USING EQUALLY FOR CHOOSING OF INVASIVE STRATEGY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE? The Clinician. 2017;11(3-4):23-33. (In Russ.) https://doi.org/10.17650/1818-8338-2017-11-3-4-23-33

Views: 1809


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1818-8338 (Print)
ISSN 2412-8775 (Online)