cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2025-40-3-188-193cardiotomsk-2833Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCLINICAL CASESОдномоментное стентирование ствола левой коронарной артерии и резекция мочевого пузыряпо поводу рака у больного с острым коронарным синдромом без подъема сегмента ST очень высокого риска (клинический случай)Simultaneous stenting of the trunk of the left coronary artery and resection of the bladder for cancer in a patient with very high risk non-ST elevation acute coronary syndrome (clinical case)https://orcid.org/0000-0001-8328-4050СукмановаИ. А.SukmanovaI. A.

Сукманова Ирина Александровна - д-р мед. наук, профессор кафедры кардиологии и сердечно-сосудистой хирургии с курсом ДПО, АГМУ Минздрава России; заведующий кардиологическим отделением для больных с острым коронарным синдромом, АККД.

656038, Барнаул, ул. Ленина, 3; 656055, Барнаул, ул. Малахова, 46

Irina A. Sukmanova - Dr. Sci. (Med.), Professor, Department of Cardiology and Cardiovascular Surgery with the FVE Course, Altai State Medical University; Head of the Cardiology Department for Patients with Acute Coronary Syndrome, Altai Regional Cardiology Dispensary.

40, Lenin str., Barnaul, 656038; 46, Malakhova str., Barnaul, 656055

vdovinai@yandex.ruhttps://orcid.org/0000-0002-3903-0552ПономаренкоИ. В.PonomarenkoI. V.

Пономаренко Ирина Владимировна - канд. мед. наук, ассистент кафедры кардиологии и сердечно-сосудистой хирургии с курсом ДПО, Алтайский государственный медицинский университет Министерства здравоохранения Российской Федерации; врач-кардиолог, кардиологическое отделение для больных с острым коронарным синдромом, Алтайский краевой кардиологический диспансер.

656038, Барнаул, ул. Ленина, 3; 656055, Барнаул, ул. Малахова, 46

Irina V. Ponomarenko - Cand. Sci. (Med.), Assistant, Department of Cardiology and Cardiovascular Surgery with the FVE Course, Altai State Medical University; Cardiologist, Cardiology Department for Patients with Acute Coronary Syndrome, Altai Regional Cardiological Dispensary.

40, Lenin str., Barnaul, 656038; 46, Malakhova str., Barnaul, 656055

ponomarenko.iv89@mail.ruhttps://orcid.org/0000-0002-1001-8779ГордееваД. С.GordeevaD. S.

Гордеева Дарья Сергеевна - врач-ординатор второго года обучения, кафедра кардиологии и сердечно-сосудистой хирургии с курсом ДПО, Алтайский государственный медицинский университет Министерства здравоохранения Российской Федерации.

656038, Барнаул, ул. Ленина, 3

Daria S. Gordeeva - second-year Medical Resident, Department of Cardiology and Cardiovascular Surgery with a FVE Course, Altai State Medical University.

40, Lenin str., Barnaul, 656038

dinamypohtacom@yandex.ruАлтайский государственный медицинский университет Министерства здравоохранения Российской Федерации (АГМУ Минздрава России); Алтайский краевой кардиологический диспансерРоссияAltai State Medical University of the Ministry of Health of the Russian Federation; Altai Regional Cardiological DispensaryRussian FederationАлтайский государственный медицинский университет Министерства здравоохранения Российской Федерации (АГМУ Минздрава России)РоссияAltai State Medical University of the Ministry of Health of the Russian FederationRussian Federation202505102025403188193Copyright © Сукманова И.А., Пономаренко И.В., Гордеева Д.С., 20252025Сукманова И.А., Пономаренко И.В., Гордеева Д.С.Sukmanova I.A., Ponomarenko I.V., Gordeeva D.S.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/2833

Пациенты с новообразованиями имеют более высокий риск развития сердечно-сосудистых заболеваний (ССЗ). У 90% пациентов острая коронарная катастрофа возникает при прогрессировании рака. Сложность ведения таких больных связана с повышенным риском кровотечений, тромботических осложнений и необходимостью хирургического лечения рака в ближайшее время. В данном сообщении анализируется случай одномоментного стентирования ствола левой коронарной артерии (ЛКА) и резекции мочевого пузыря по поводу распадающейся аденокарциномы у пациента с острым коронарным синдромом без подъема сегмента ST (ОКСбпST) высокого риска. Основным принципом ведения таких пациентов на сегодняшний день остается совместная работа мультидисциплинарной команды и индивидуальный подход.

Patients with neoplasms have a higher risk of developing cardiovascular diseases. In 90% of patients, acute coronary catastrophe occurs with the progression of cancer. The complexity of managing such patients is associated with an increased risk of bleeding, thrombotic complications and the need for surgical treatment of cancer in the near future. We analyze a case of simultaneous stenting of the trunk of the left coronary artery and resection of the bladder for decaying adenocarcinoma in a patient with acute coronary syndrome without high-risk ST segment elevation. The main principle of managing such patients today remains the joint work of a multidisciplinary team and an individual approach.

острый коронарный синдромствол левой коронарной артериионкологические заболеваниямультидисциплинарная командаacute coronary syndrometrunk of the left coronary arteryoncological diseasesmultidisciplinary teamникто из авторов не имеет финансовой заинтересованности в представленных материалах или методахno author has a financial or property interest in any material or method mentionedReferencesШаленкова М.А., Иванов А.В., Климкин П.Ф. Острый коронарный синдром у пациентов с онкологическим заболеванием: особенности течения и возможности прогнозирования госпитального и отдаленного (6 месяцев) периодов с использованием биомаркеров GDF-15, NT-proBNP, hs-CRP. Кардиология. 2021;61(10):4–13.Shalenkova M.A., Ivanov A.V., Klimkin P.F. Acute coronary syndrome in patients with cancer: features of the course and the possibility of predicting hospital and long-term (6 months) periods using GDF-15, NT-proBNP, hs-CRP biomarkers. Kardiologiia. 2021;61(10):4–13. (In Russ.)]. https://doi.org/10.18087/cardio.2021.10.n1765.Lyon A.R., López-Fernández T., Couch L.S., Asteggiano R., Aznar M.S., Bergler-Kleinet J. et al. ESC Scientific Document Group, 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). Eur. Heart J. 2022;43(41):4229–4361. https://doi.org/10.1093/eurheartj/ehac244.Lyon A.R., López-Fernández T., Couch L.S., Asteggiano R., Aznar M.S., Bergler-Kleinet J. et al. ESC Scientific Document Group, 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). Eur. Heart J. 2022;43(41):4229–4361. https://doi.org/10.1093/eurheartj/ehac244.Jain V., Rifai M.A., Brinzevich D., Taj M., Saleh M., Krittanawong C. et al. Association of premature atherosclerotic cardiovascular disease with higher risk of cancer: a behavioral risk factor surveillance system study. Eur. J. Prev. Cardiol. 2021;29(3):493–501. https://doi.org/10.1093/eurjpc/zwab084.Jain V., Rifai M.A., Brinzevich D., Taj M., Saleh M., Krittanawong C. et al. Association of premature atherosclerotic cardiovascular disease with higher risk of cancer: a behavioral risk factor surveillance system study. Eur. J. Prev. Cardiol. 2021;29(3):493–501. https://doi.org/10.1093/eurjpc/zwab084.Lau E.S., Paniagua S.M., Liu E. Jovani M., Li S.X., Takvorian K. et al. Cardiovascular risk factors are associated with future cancer. JACC Cardio Oncol. 2021;3(1):48–58. https://doi.org/10.1016/j.jaccao.2020.12.003.Lau E.S., Paniagua S.M., Liu E. Jovani M., Li S.X., Takvorian K. et al. Cardiovascular risk factors are associated with future cancer. JACC Cardio Oncol. 2021;3(1):48–58. https://doi.org/10.1016/j.jaccao.2020.12.003.Sturgeon K.M., Deng L., Bluethmann S.M., Zhou S., Trifiletti D.M., Jiang C. et al. A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur. Heart J. 2019;40(48):3889– 3897. https://doi.org/10.1093/eurheartj/ehz766.Sturgeon K.M., Deng L., Bluethmann S.M., Zhou S., Trifiletti D.M., Jiang C. et al. A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur. Heart J. 2019;40(48):3889– 3897. https://doi.org/10.1093/eurheartj/ehz766.Willems R., Winckers K., Biesmans C., de Vos-Geelen J., Ten Cate H. Evolving data on cardiovascular complications in cancer. Thromb. Res. 2022;213(1):87–94. https://doi.org/10.1016/j.thromres.2022.01.003.Willems R., Winckers K., Biesmans C., de Vos-Geelen J., Ten Cate H. Evolving data on cardiovascular complications in cancer. Thromb. Res. 2022;213(1):87–94. https://doi.org/10.1016/j.thromres.2022.01.003.Лубоятникова Е.С., Дупляков Д.В. Острый коронарный синдром у пациентов со злокачественными новообразованиями. Российский кардиологический журнал. 2017;(3):140–144. https://doi.org/10.15829/1560-4071-2017-3-140-144.Luboyatnikova E.S., Duplyakov D.V. Acute coronary syndrome in malignancy patients. Russian Journal of Cardiology. 2017;(3):140–144. (In Russ.)]. https://doi.org/10.15829/1560-4071-2017-3-140-144.Guo W., Fan X., Lewis B.R., Johnson M.P., Rihal C.S., Lerman A. et al. Cancer patients have a higher risk of thrombotic and ischemic events after percutaneous coronary intervention. JACC Cardiovasc. Interv. 2021;14(10):1094–1105. https://doi.org/10.1016/j.jcin.2021.03.049.Guo W., Fan X., Lewis B.R., Johnson M.P., Rihal C.S., Lerman A. et al. Cancer patients have a higher risk of thrombotic and ischemic events after percutaneous coronary intervention. JACC Cardiovasc. Interv. 2021;14(10):1094–1105. https://doi.org/10.1016/j.jcin.2021.03.049.Valgimigli M., Bueno H., Byrne R.A., Gardner R.S., Baumbach A., Böhm M. et al. ESC Scientific Document Group, ESC Committee for Practice Guidelines (CPG), ESC National Cardiac Societies, 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for CardioThoracic Surgery (EACTS). Eur. Heart J. 2017;39(3):213–260. https://doi.org/10.1093/eurheartj/ehx419.Valgimigli M., Bueno H., Byrne R.A., Gardner R.S., Baumbach A., Böhm M. et al. ESC Scientific Document Group, ESC Committee for Practice Guidelines (CPG), ESC National Cardiac Societies, 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for CardioThoracic Surgery (EACTS). Eur. Heart J. 2017;39(3):213–260. https://doi.org/10.1093/eurheartj/ehx419.Барбараш О.Л., Кашталап В.В. Российские и европейские рекомендации 2020 года по ведению пациентов с острым коронарным синдромом без подъема сегмента ST: упростились ли подходы к антитромботической терапии? Комплексные проблемы сердечно-сосудистых заболеваний. 2021;10(2):92–101.Barbarash O.L., Kashtalap V.V. 2020 Russian and European clinical practice guidelines for the management of NSTEMI patients: have approaches to antithrombotic therapy been simplified? Complex Issues of Cardiovascular Diseases. 2021;10(2):92–101. (In Russ.)]. https://doi.org/10.17802/2306-1278-2021-10-2-92-101.Багрий А.Э., Борота А.В., Хоменко М.В., Цыба И.Н., Ефременко В.А., Щукина Е.В. и др. Вопросы тактики лечения кардиологических больных, подвергающихся некардиологическим хирургическим вмешательствам. Кардиология. 2017;57(6):52–58.Bagrii A.E., Borota A.V., Khomenko M.V., Tsyba I.N., Efremenko V.A., Shchukina E.V. et al. Clinical case of successful nephrectomy and stenting of the coronary arteries in acute period of myocardial infarction in a patient with kidney cancer. Kardiologiia. 2017;57(6):52–58. (In Russ.).Chang M., Lee C.W., Ahn J.M., Cavalcante R., Sotomi Y., Onuma Y. et al. Comparison of outcome of coronary artery bypass grafting versus drugeluting stent implantation for non-ST-elevation acute coronary syndrome. Am. J. Cardiol. 2017;120(3):380–386. https://doi.org/10.1016/j.amjcard.2017.04.038.Chang M., Lee C.W., Ahn J.M., Cavalcante R., Sotomi Y., Onuma Y. et al. Comparison of outcome of coronary artery bypass grafting versus drugeluting stent implantation for non-ST-elevation acute coronary syndrome. Am. J. Cardiol. 2017;120(3):380–386. https://doi.org/10.1016/j.amjcard.2017.04.038.Collet J.-P., Thiele H., Barbato E., Berry C., Escaned J., Maas A.H.E.M. et al. ESC Scientific Document Group, 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The 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. 2021;42(14):1289–1367. https://doi.org/10.1093/eurheartj/ehaa575.Collet J.-P., Thiele H., Barbato E., Berry C., Escaned J., Maas A.H.E.M. et al. ESC Scientific Document Group, 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The 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. 2021;42(14):1289–1367. https://doi.org/10.1093/eurheartj/ehaa575.Lawton J.S., Tamis-Holland J.E., Bangalore S., Bates E.R., Beckie T.M., Bischoff J.M. et al. 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2022;79(2):197–215. https://doi.org/10.1016/j.jacc.2021.09.006.Lawton J.S., Tamis-Holland J.E., Bangalore S., Bates E.R., Beckie T.M., Bischoff J.M. et al. 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2022;79(2):197–215. https://doi.org/10.1016/j.jacc.2021.09.006.Cavalcante R., Sotomi Y., Mancone M., Lee C.W., Ahn J.M., Onumaet Y. et al. Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials. Eur. Heart J. 2017;38(25):1969–1977. https://doi.org/10.1093/eurheartj/ehx138.Cavalcante R., Sotomi Y., Mancone M., Lee C.W., Ahn J.M., Onumaet Y. et al. Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials. Eur. Heart J. 2017;38(25):1969–1977. https://doi.org/10.1093/eurheartj/ehx138.Head S.J., Milojevic M., Daemen J., Ahn J.M., Boersma E., Christiansen E.H. et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet. 2018;391:939–948. https://doi.org/10.1016/S0140-6736(18)30423-9.Head S.J., Milojevic M., Daemen J., Ahn J.M., Boersma E., Christiansen E.H. et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet. 2018;391:939–948. https://doi.org/10.1016/S0140-6736(18)30423-9.Sousa-Uva M., Neumann F.J., Alfonso A.A.F., Banning A.P., Benedetto U. Byrne R.A. et al. ESC Scientific Document Group, 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. J. Cardiothorac. Surg. 2019;55(1):4–90. https://doi.org/10.1093/ejcts/ezy289.Sousa-Uva M., Neumann F.J., Alfonso A.A.F., Banning A.P., Benedetto U. Byrne R.A. et al. ESC Scientific Document Group, 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. J. Cardiothorac. Surg. 2019;55(1):4–90. https://doi.org/10.1093/ejcts/ezy289.Palmerini T., Genereux P., Caixeta A.,Cristea E., Lansky A., Mehran R. et al. 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. https://doi.org/10.1016/j.jacc.2011.02.032.Palmerini T., Genereux P., Caixeta A.,Cristea E., Lansky A., Mehran R. et al. 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. https://doi.org/10.1016/j.jacc.2011.02.032.Mehran R., Rao S.V., Bhatt D.L., Gibson C.M., Caixeta A., Eikelboom J. et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. 2011;123(23):2736–2747. https://doi.org/10.1161/CIRCULATIONAHA.110.009449.Mehran R., Rao S.V., Bhatt D.L., Gibson C.M., Caixeta A., Eikelboom J. et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. 2011;123(23):2736–2747. https://doi.org/10.1161/CIRCULATIONAHA.110.009449.

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