DOI: 10.25881/BPNMSC.2019.68.74.004

Authors

Bocharov A.V.1, Popov L.V.2

1 Kostroma regional clinical hospital named after Korolev E.I., Kostroma

2 Federal State Public Institution «National Medical and Surgical Center named after N.I. Pirogov» of the Ministry of Healthcare of the Russian Federation

Abstract

Objective: to evaluate the long-term results of endovascular revascularization of the coronary bed with drug-coated stents of the 3rd generation in patients with acute coronary syndrome without ST-segment elevation and multivessel coronary artery lesion in comparison with coronary artery bypass grafting.

Materials and methods: the analysis of the results of 2-year follow-up of stage treatment of patients with acute coronary syndrome without St-segment elevation and multivessel lesion, who underwent stenting of clinical-dependent artery for emergency indications, and then complete functional revascularization of myocardium by stents with drug-coated sirolimus of 3 generation was performed within 90 days. Efficacy and safety assessment was carried out according to the criteria of “non-inferiority” in comparison with the literature data of myocardial revascularization by coronary artery bypass grafting.

Results: endovascular myocardial revascularization in the early periods after stenting of the clinically dependent artery in patients with acute coronary syndrome without ST segment elevation and multivessel lesion has an advantage over aortocoronary bypass surgery at the combined Mace end point, but loses in the frequency of the need for repeated interventions.

Keywords: acute coronary syndrome, percutaneous coronary intervention, 3rd generation drug eluting stent, coronary artery bypass surgery.

References

1. Chasova IE, Oshchepkova EV. Fight with cardiovascular disease: problems and ways to solve them at the present stage. Bulletin Raszdravnadzor. 2015; (5): 7-10. (In Russ).

2. Bokeriya L.A., Alekyan B.G. Rentgenehndovaskulyarnaya diagnostika i lechenie zabolevanij serdca i sosudov v Rossijskoj Federacii – 2015 god. – Moscow: NCSSKH im. N.A. Bakuleva, 2016. (In Russ).

3. Volkov VS. Ehkstrennaya diagnostika i lechenie v neotlozhnoj kardiologii: rukovodstvo dlya vrachej. Moscow: MIA, 2010. S. 163 (In Russ).

4. Braunwald E. Unstable Angina and Non-ST Elevation Myocardial Infarction. Am J Respir Crit Care Med. 2012; 185(9):924-932. DOI: 10.1164/rccm.201109-1745CI.

5. Obshaja vrachebnaja praktika: natsionalnoe rukovodstvo. Ed by I.N. Denisov, O.M. Lesnyak. Moscow: GEОTAR-Media; 2013. 976 p. (In Russ).

6. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction N Engl J Med. 2010; 362 (23): 2155-2165. DOI: 10.1056/NEJMoa0908610.

7. Karpov YuA, Samko AN, Buza VV. Koronarnaya angioplastika i stentirovanie. Moscow: MIA; 2010. S. 10–14 [In Russ).

8. Fukui T, Tabata M, Tobaru T, Asano R, Takanashi S, Sumiyoshi T. Early and long-term outcomes of coronary artery bypass grafting and percutaneous coronary intervention in patients with left main disease: single-center results of multidisciplinary decision making. Gen Thorac Cardiovasc Surg. 2014; 62(5):301 -307. DOI:10.1007/s11748-013-0357-7.

9. Head SJ, Kaul S, Mack MJ et al. The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. Eur Heart J. 2013; 34(32): 2510–2518.

10. Palmerini Т, Genereux Ph, Caixeta A, Cristea E, Lansky A, Mehran R, Dangas G, Lazar D, Sanchez R, Fahy M, Ke Xu, Stone GW. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. J Am Coll Cardiol. 2011; 57(24): 2389–2397.

11. Roffi M, Patrono C, Collet JP et al. 2015 ESC Guidlines for the management of acute coronary syndromes in patients presenting without persistent ST – segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST – Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267-315. DOI: 10.1093/eurheartj/ehv320.

12. Rekomendatsii ESC/EACTS po revaskulyarizatsii miokarda 2014 godа // Rossijskij kardiologicheskij zhurnal. 2015;(2): 5–81 (In Russ).

13. Hoffman SN, TenBrook JA, Wolf MP, Wong JB, Pauker SG, Salem DN. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one – to eight – year outcomes. Journal of the American College of Cardiology. 2003; 41: 1293-1304. DOI: 10.1016/S0735-1097(03)00157-8.

14. Committee for proprietary medicinal products (CPMP) (2004). Points to consider on the choice of non-inferiority margin. [cited 2018 Oct 18].

15. Food and Drug Administration (FDA) (2016) Non-Inferioty Clinical Trials to Establish Effectiveness. Guidance for Industry. [cited 2018 Nov 20].

For citation

Bocharov A.V., Popov L.V. The results of early-stage endovascular myocardial revascularization in patients with acute coronary syndrome without ST-segment elevation. Bulletin of Pirogov National Medical & Surgical Center. 2019;14(2):20-22. (In Russ.) https://doi.org/10.25881/BPNMSC.2019.68.74.004