cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2022-37-2-28-34cardiotomsk-1416Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESМногососудистое поражение коронарного русла у больных со стабильной ишемической болезнью сердца: актуальное состояние проблемы и пробелы в доказательностиMultivessel coronary bed lesion in patients with stable coronary artery disease: Current state of the problem and gap in evidencehttps://orcid.org/0000-0003-2327-826XОбединскийА. А.ObedinskiyA. A.

Обединский Антон Андреевич, канд. мед. наук, врач-кардиолог, младший научный сотрудник, научно-исследовательский отдел эндоваскулярной хирургии

630055, Российская Федерация, Новосибирск, ул. Речкуновская, 15

Anton A. Obedinskiy, Cand. Sci (Med.), Cardiologist, Junior Research Scientist, Research Department of Endovascular Surgery

15, Rechkunovskaya str., Novosibirsk, 630055, Russian Federation

vrach-555@yandex.ruhttps://orcid.org/0000-0001-8279-8738ОбединскаяН. Р.ObedinskayaN. R.

Обединская Наталья Ростиславовна, врач-рентгенолог, младший научный сотрудник

630090, Российская Федерация, Новосибирск, ул. Институтская, 3а

Natalya R. Obedinskaya, Radiologist, Junior Research Scientist

3а, Institutskaya str., Novosibirsk, 630090, Russian Federation

genzel1985@mail.ruhttps://orcid.org/0000-0001-5643-9109НикитинН. А.NikitinN. A.

Никитин Никита Александрович, руководитель клиники лучевой диагностики, врач-рентгенолог

630099, Российская Федерация, Новосибирск, ул. Коммунистическая, 17

Nikita A. Nikitin, Radiologist, Head of the Clinic for Radiation Diagnostics

17, Kommunisticheskaya str., Novosibirsk, 630099, Russian Federation

n.nikitin91@gmail.comhttps://orcid.org/0000-0002-9940-3541СиротаД. А.SirotaD. A.

Сирота Дмитрий Андреевич, канд. мед. наук, заведующий научно-исследовательским отделом хирургии аорты, коронарных и периферических артерий, врач сердечно-сосудистый хирург

630055, Российская Федерация, Новосибирск, ул. Речкуновская, 15

Dmitriy A. Sirota, Cand. Sci. (Med.), Head of the Research Department of Aortic, Coronary and Peripheral Artery Surgery, Cardiovascular Surgeon

15, Rechkunovskaya str., Novosibirsk, 630055, Russian Federation

d_sirota@meshalkin.ruhttps://orcid.org/0000-0001-5214-8996КрестьяниновО. В.KrestyaninovO. V.

Крестьянинов Олег Викторович, д-р мед. наук, заведующий научно-исследовательским отделом эндоваскулярной хирургии, врач по рентгенэндоваскулярным диагностике и лечению

630055, Российская Федерация, Новосибирск, ул. Речкуновская, 15

Oleg V. Krestyaninov, Dr. Sci. (Med.), Head of the Research Department of Endovascular Surgery, Doctor of Endovascular Diagnostics and Treatment

15, Rechkunovskaya str., Novosibirsk, 630055, Russian Federation

o_krestyaninov@meshalkin.ruНациональный медицинский исследовательский центр имени академика Е.Н. Мешалкина Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Center named after Academician E.N. MeshalkinRussian FederationМеждународный томографический центр Сибирского отделения Российской академии наукРоссияInternational Tomography Center of the Siberian Branch of Russian Academy of SciencesRussian FederationАО Медицинский центр «АВИЦЕННА»РоссияJSC Medical Center “AVICENNA”Russian Federation2022130720223722834Copyright © Обединский А.А., Обединская Н.Р., Никитин Н.А., Сирота Д.А., Крестьянинов О.В., 20222022Обединский А.А., Обединская Н.Р., Никитин Н.А., Сирота Д.А., Крестьянинов О.В.Obedinskiy A.A., Obedinskaya N.R., Nikitin N.A., Sirota D.A., Krestyaninov O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1416

Мировые статистические данные утверждают, что хирургическая реваскуляризация миокарда при многососудистом поражении коронарного русла предпринимается в 40–60% случаев. Однако определение степени поражения коронарных артерий (КА) зачастую проводится путем сопоставления клиники и данных селективной коронарографии (СКГ) без учета оценки функциональной значимости стеноза. До настоящего времени четко не определены алгоритмы ведения пациентов с многососудистым поражением КА и стабильной ишемической болезнью сердца (ИБС): не ясны объем, срок реваскуляризации и критерии полного отказа от оперативного лечения. Множество факторов влияют на кровоснабжение миокарда при многососудистом поражении: тип кровотока, наличие рубца и коллатералей, диаметр пораженной артерии, наличие микроваскулярной дисфункции, все это требует разумного и осмысленного подхода для определения оптимальной тактики. В настоящей обзорной работе авторы определили вектор для дискуссии и представили свое оригинальное мнение о целесообразности/необоснованности подходов к реваскуляризации у больных с многососудистым поражением КА на основе опубликованных клинических исследований (КИ) и современных рекомендаций. Разобраны уже имеющиеся данные, обозначены недостающие сведения, предложены перспективы возможных новых КИ в данном научном направлении.

World statistics data suggest that the surgical revascularization of the myocardium in multivessel coronary artery disease is performed in 40 to 60% of cases. However, severity of coronary artery disease is often evaluated through the analysis of clinical presentation and selective coronary angiography (ICA) data without an assessment of the functional significance of stenosis. A precise algorithm for the treatment of patients with multivessel coronary artery disease and stable coronary artery disease is still unavailable, i.e. extent of revascularization, its time, and criteria for complete withholding of surgical treatment remain unclear. Many factors affect myocardial blood supply in multivessel disease including the type of blood supply to the heart, presence of scar and collaterals, diameter of the affected artery, and presence of microvascular dysfunction. All these factors require rational and intelligent approach to establishing the optimal tactics. In this review, the authors identified discussion vector and presented their original opinion on the advisability/unreasonableness of approaches to revascularization in patients with multivessel coronary disease based on published clinical trials and current recommendations. In addition, we analyzed the existing data, identified the missing information, and proposed the prospects for possible new clinical studies in this scientific field.

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The authors declare that there are no conflicts of interest present.