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

https://doi.org/10.15829/1728-8800-2017-2-52-58

Abstract

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.

About the Authors

R. S. Tarasov
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


Yu. N. Neverova
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


V. I. Ganyukov
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


S. V. Ivanov
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


O. A. Nagirnyak
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


L. S. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Kemerovo


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Review

For citations:


Tarasov R.S., Neverova Yu.N., Ganyukov V.I., Ivanov S.V., Nagirnyak O.A., Barbarash O.L., Barbarash L.S. THE RESULTS OF MYOCARDIAL REVASCULARIZATION IN NON-ST-ELEVATION ACUTE CORONARY SYNDROME PATIENTS AND MULTIVESSEL DISEASE. Cardiovascular Therapy and Prevention. 2017;16(2):52-58. (In Russ.) https://doi.org/10.15829/1728-8800-2017-2-52-58

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ISSN 1728-8800 (Print)
ISSN 2619-0125 (Online)