ABSTRACT
Study aim was assessment of efficacy of early invasive tactics of treatment of patients with various forms of unstable angina at the background of preexisting ischemic heart disease. We compared noninvasive and invasive estimation of risk in 354 patients admitted to the N.V.Sklifosofsky Institute of Urgent Aid in 2002 to 2008. Percutaneous coronary interventions on infarct related artery (IRA) during 1 procedure were carried out in 144 patients (41%), indications to coronary artery (CA) bypass surgery were found in 167 patients (47%), 43 patients (12%) were treated conservatively. Coronary angiography performed in the first 48 hours gives an opportunity to determine indications to myocardial revascularization, to avoid discrepancy between choice of treatment tactics and noninvasive assessment of risk. The latter can be used with the aim of optimization of timing of early invasive strategy. In high risk it is expedient to employ it immediately, in medium - without delay allowed in recommended time intervals. Rentgenoendovascular restoration of IRA conducted during one procedure is an optimal type of myocardial revascularization in many patients including those with multiple CA involvement. Method of choice in patients with stenoses of left CA trunk or its equivalents is surgical revascularization of the myocardium. Detection of indications for myocardial revascularization in patients with unstable angina including those at medium and low risk confirms necessity of application of early invasive strategy as conventional strategy ensuring timeliness of pathogenetic treatment. Absence of indications to myocardial revascularization in a limited group of patients gives an opportunity to clarify diagnosis, prescribe drug therapy and prevent unjustified hospitalizations.
Subject(s)
Angina, Unstable , Angioplasty, Balloon, Coronary , Coronary Angiography/methods , Coronary Artery Bypass , Myocardial Ischemia/complications , Thrombolytic Therapy , Angina, Unstable/diagnosis , Angina, Unstable/etiology , Angina, Unstable/mortality , Angina, Unstable/physiopathology , Angioplasty, Balloon, Coronary/methods , Angioplasty, Balloon, Coronary/statistics & numerical data , Coronary Artery Bypass/methods , Coronary Artery Bypass/statistics & numerical data , Early Medical Intervention/methods , Electrocardiography/methods , Female , Humans , Male , Middle Aged , Risk Assessment , Risk Factors , Stents , Survival Analysis , Thrombolytic Therapy/methods , Thrombolytic Therapy/statistics & numerical data , Treatment OutcomeABSTRACT
The purpose of the study was to evaluate different methods of myocardial revascularization. Three hundred and twenty-two patients with non-stable stenocardia were divided into two groups: group one consisted of 226 patients with mono-, bi-, or tri-vascular lesion of the coronary arteries (CA), who underwent percutaneous coronary intervention (PCCI) on the symptom-related CA (128 patients) or coronary bypass surgery (CBS) without cardiopulmonary bypass (59 patients); group two consisted of 96 patients with tri-vascular lesion of CA only, who underwent CBS with cardiopulmonary bypass (CPB) (32 patients) or without CPB (52 patients). The rest patients in both groups received drug therapy. The data from the research show that PCCI on the symptom-related CA is the method of choice in most patients, including those with tri-vascular lesion. In cases with extensive isolated stenosis of anterior descendent coronary artery and chronic occlusions preference may be given to CBS without CPB. CBS with CPB is the method of choice in patients with left CA trunk stenosis and left ventricular dysfunction. In this group of patients, CBS without CPB does not lead to complete myocardial revascularization and thus does not make surgery successful.
