cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2019-34-2-84-88cardiotomsk-765Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESРЕЗУЛЬТАТЫ ПОШАГОВОЙ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА У БОЛЬНЫХ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ И МНОГОСОСУДИСТЫМ ПОРАЖЕНИЕМ: РАННЕЕ ВЫПОЛНЕНИЕ АОРТОКОРОНАРНОГО ШУНТИРОВАНИЯ ПОСЛЕ СТЕНТИРОВАНИЯ С ИСПОЛЬЗОВАНИЕМ ГОЛОМЕТАЛЛИЧЕСКИХ СТЕНТОВTHE RESULTS OF STEP-BY-STEP MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH ACUTE CORONARY SYNDROME AND MULTIVESSEL CORONARY ARTERY DISEASE: EARLY PERFORMING CORONARY ARTERY BYPASS SURGERY AFTER STENTING USING BARE-METAL STENTShttps://orcid.org/0000-0002-6027-2898БочаровА. В.BocharovA. V.

канд. мед. наук, заведующий отделением рентгенохирургических методов диагностики и лечения

156013, Российская Федерация, Кострома, пр. Мира, 114

Cand. Sci. (Med.), Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment

114, Mira ave., Kostroma, 156013, Russian Federation

bocharovav@mail.ruhttps://orcid.org/0000-0002-0530-3268ПоповЛ. В.PopovL. V.

д-р мед. наук, профессор, заведующий отделением сердечно-сосудистой хирургии

105203, Российская Федерация, Москва, ул. Нижняя Первомайская, 70

Dr. Sci. (Med.), Professor, Head of the Department of Cardiovascular Surgery

70, Nizhnyaya Pervomayskaya str., Moscow, 105203, Russian Federation

popovcardio@mail.ruКостромская областная клиническая больница имени Е.И. КоролеваРоссияKostroma Regional Clinical Hospital named after E.I. KorolevRussian FederationНациональный медико-хирургический Центр имени Н.И. Пирогова Министерства здравоохранения Российской ФедерацииРоссияNational Medical and Surgical Center named after N.I. Pirogov of the Ministry of Healthcare of the Russian FederationRussian Federation2019100720193428488Copyright © Бочаров А.В., Попов Л.В., 20192019Бочаров А.В., Попов Л.В.Bocharov A.V., Popov L.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/765Цель

Цель: сравнить отдаленные результаты аортокоронарного шунтирования (АКШ), проведенного в ранние сроки после стентирования по поводу острого коронарного синдрома (ОКС) клинико-зависимой артерии (КЗА) голометаллическими стентами, с результатами АКШ у больных ишемической болезнью сердца (ИБС).

Материал и методы

Материал и методы. Проанализированы результаты 24-месячного наблюдения пошагового лечения пациентов с ОКС и многососудистым поражением, которым первым шагом выполнено стентирование КЗА голометаллическими стентами, а затем в срок до 90 дней проведена функциональная реваскуляризация миокарда методом АКШ.

Результаты представлены в виде среднего значения и стандартного отклонения (M±SD) при нормальном распределении, медианой с интерквартильным размахом в виде 25- и 75-го процентилей при асимметричном распределении. Тип распределения количественных переменных оценивался по критерию Колмогорова – Смирнова с поправкой Лиллиефорса. Эффективность и безопасность оценивались с применением критериев non-inferiority в сравнении с литературными данными по реваскуляризации миокарда методом стентирования. Различия определялись с использованием значения двустороннего 95%-го доверительного интервала разницы полученных неблагоприятных событий, исходя из выбранного дизайна non-inferiority.

Результаты

Результаты. Хирургическая реваскуляризация коронарного русла в ранние сроки после стентирования КЗА голометаллическими стентами у больных с ОКС и многососудистым поражением эквивалентна АКШ, за исключением показателя повторной реваскуляризации.

Objective: To compare the long-term results of coronary artery bypass grafting performed in the early period after stenting for acute coronary syndrome by bare-metal stents with the results of coronary artery bypass grafting in patients with coronary heart disease.Material and Methods. The results of 24-month follow-up of step-by-step treatment of patients with acute coronary syndrome and multivessel lesion who received stenting of clinical-dependent artery with bare-metal stents as the first step and, then, underwent functional myocardial revascularization by aortocoronary bypass surgery within 90 days were analyzed. Results are presented as mean value and standard deviation (M±SD) in case of normal distribution and median with interquartile range in the form of 25 and 75 percentiles in case of non-normal distribution. The type of distribution of quantitative variables was assessed by the Lilliefors-corrected Kolmogorov–Smirnov test. Efficacy and safety assessments were carried out according to the criteria of non-inferiority in comparison with the literature data of myocardial revascularization by stenting. The differences were estimated using a two-way 95% confidence interval of the difference in adverse events based on the selected noninferiority design.Results. Surgical revascularization of the coronary bed in the early period after stenting of the clinically dependent artery using bare-metal stents in patients with acute coronary syndrome and multivessel lesion was equivalent to coronary artery bypass grafting, except for the rate of repeated revascularization.

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