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Multivessel coronary bed lesion in patients with stable coronary artery disease: Current state of the problem and gap in evidence

https://doi.org/10.29001/2073-8552-2022-37-2-28-34

Abstract

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.

About the Authors

A. A. Obedinskiy
National Medical Research Center named after Academician E.N. Meshalkin
Russian Federation

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

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



N. R. Obedinskaya
International Tomography Center of the Siberian Branch of Russian Academy of Sciences
Russian Federation

Natalya R. Obedinskaya, Radiologist, Junior Research Scientist

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



N. A. Nikitin
JSC Medical Center “AVICENNA”
Russian Federation

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

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



D. A. Sirota
National Medical Research Center named after Academician E.N. Meshalkin
Russian Federation

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



O. V. Krestyaninov
National Medical Research Center named after Academician E.N. Meshalkin
Russian Federation

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



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Review

For citations:


Obedinskiy A.A., Obedinskaya N.R., Nikitin N.A., Sirota D.A., Krestyaninov O.V. Multivessel coronary bed lesion in patients with stable coronary artery disease: Current state of the problem and gap in evidence. Siberian Journal of Clinical and Experimental Medicine. 2022;37(2):28-34. (In Russ.) https://doi.org/10.29001/2073-8552-2022-37-2-28-34

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