THE RESULTS OF MYOCARDIAL REVASCULARIZATION IN NON-ST-ELEVATION ACUTE CORONARY SYNDROME PATIENTS AND MULTIVESSEL DISEASE

Aim. To evaluate in-hospital and long-term outcomes of treatment in non-ST-elevation acute coronary syndrome (NSTEACS) according to the revascularization strategy.

Material and methods. In the study under the framework of singlecenter registry, in 2012-2015, 400 patients included, with NSTEACS and multivessel disease (MD). According to the revascularization strategy, all patients were selected to three groups: staged percutaneous intervention (PCI) — PCI-PCI, for 265 (66,5%) patients, bypass grafting (CBG) — 84 (20,2%), and PCI at first step and then CBG (PCI-CBG) in 34 (8,75%). Remaining patients were treated conservatively — 17 (4,5%). Endpoints were such adverse cardiovascular events as death, myocardial infarction, stroke or transient ischemia, repeated revascularization.

Results. The highest GRACE values up to 138,1±25,7 were in PCI-PCI group (p=0,00001), but the most severe coronary lesion by SYNTAX 28,7±10 was in CBG group (p=0,00001). The highest surgical risk by EuroScore II was in CBG group — 4,32±2 (p=0,003). The group PCI-PCI showed the highest mortality, reached 7,5% by 12 months (5,3% inhospital and 2,2% further), and long-term mortality in PCI-CBG and CBG groups was 2,9% and 2,4%, respectively (p>0,05) (all fatal cases in these groups were in-hospital). The leading by MI prevalence in 12 months was PCI-PCI group (6,8%), and in PCI-CBG and CBG groups all MI cases were 5,9% and 1,2% in-hospital, respectively (p>0,05). Minimal levels of repeated revascularization had the groups PCI-CBG and CBG — 5,88% and 0%, resp., and in PCI-PCI group this level reached 9,81%.

Conclusion. The most complete myocardial revascularization in NSTEACS patients can be achieved with such strategies as PCI-CBG and CBG, regardless the highest grade of coronary lesion. Revascularization strategy as the staged PCI, is applicable with in the highest GRACE patients and requiring revascularization as soon as possible. The development needed, of algorithms of optimal strategy of revascularization in NSTEACS, with MD, based upon objective criteria, and meaning the higher rate of CBG approach fulfilling the most complete revascularization.

1. Goodacre S, Calvert N. Cost effectiveness of diagnostic strategies for patients with acute, undifferentiated chest pain. Emerg Med J 2003; 20:429-33.

2. Corcoran D, Grant P, Berry C. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment. Int J Cardiol Heart Vasc2015; Sep 1;8:131-7.

3. Abdullaev FZ, Mamedov VSh, Bagirov IM, et al. Features of ischemic heart disease and myocardial revascularization in patients younger than 40 years. Cardiology and cardiovascular surgery 2015;2:21-6. Russian (Абдуллаев Ф.З. Мамедов В.Ш., Багиров И.М. и др. Специфика ишемической болезни сердца и реваскуляризации миокарда у пациентов до 40 лет. Кардиология и сердечно-сосудистая хирургия 2015;2:21-6).

4. Nicholl J, Mason S. Return of the “corridors of shame”. BMJ 2013; 347:f4343.

5. Thygesen K, Alpert JS, Jaffe AS, et al. “Third Universal Definition of Myocardial Infarction” translation of ESC Guidelines 2013. Eur Heart J 2012;33:2551-67. doi:10.1093/eurheartj/ehs184

6. Gnavi R, Rusciani R. Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Difference sorinequities? Int J Cardiol 2014 Oct 20;176(3):724-30. doi: 10.1016

7. Kang JS, Goodman SG, Yan RT, et al. Management and outcomes of non-ST elevation acute coronary syndromes in relation to previous use of antianginal therapies (from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE]). Am J Cardiol 2013; Jul 1;112(1):51-6.

8. Blachutzik F, Achenbach S, Troebs M, et al. Angiographic Findings and Revascularization Success in Patients With Acute Myocardial Infarction and Previous Coronary Bypass Grafting. Am J Cardiol 2016 Aug 15; 118(4):473-6. doi: 10.1016

9. Khoso AA, Kazmi KA, Tahir S, et al. Mode of Coronary Revascularization and Short term Clinical Outcomes in Patients with Chronic Kidney Disease. Pak J Med Sci. 2014 Nov-Dec; 30(6):1180-5. doi: 10.12669

10. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2015. doi:10.1093/eurheartj/ehv320.

11. Asrar UI, Haq M, Rudd N, Sibiakto I, et al. Predictors and outcomes of early coronary angiography in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction. Open Heart 2014 Jun 13;1(1):e000059. doi: 10.1136

12. Fukui T, Tabata M. Early and long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention in patients with left main disease: singlecenter results of multidisciplinary decision making. Gen Thorac Cardiovasc Surg. 2014; May; 62(5):301-7.

13. Barbarash LS, Ganyukov VI, Popov VA, et al. Hospital treatment of acute coronary syndrome without ST-segment elevation in multivessel coronary artery disease, depending on the method and revascularization strategy. Heart Gazette 2013; Tom VIII(XX): 17-22. Russian (Барбараш Л.С., Ганюков В.И., Попов В.А., и др. Госпитальные результаты лечения острого коронарного синдрома без подъема сегмента ST при многососудистом поражение коронарных артерий в зависимости от метода и стратегии реваскуляризации. Кардиологический вестник. 2013; ТомVIII(XX): 17-22).

14. Parikh SV, de Lemos JA, Jessen ME, et al. Timing of in-hospital coronary artery bypass graft surgery for non-ST-segment elevation myocardial infarction patients results from the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines). JACC Cardiovasc Interv 2010; 3(4):419-27.

15. Vora AN, Rao SV. Bleeding Complications After PCI and the Role of Transradial Access. Curr Treat Options Cardiovasc Med. 2014 May; 16(5):305. doi: 10.1007