Abstract
Coronary heart disease (CHD) is the most common disease and in most economically developed countries occupies a leading place among all causes of morbidity, mortality, tem-porary and permanent disability. In our country, CHD leads among the cardiovascular causes of death, accounting for about 49% of Russian cardiovascular mortality. Coronary artery bypass grafting (CABG) is the preferred method of revascularization in patients with multivessel coronary artery disease in the elderly patients. Percutaneous coronary intervention (PCI), in contrast to CABG, is more often complicated by stroke, myocardial infarction and death. In numerous studies, a significant advantage of coronary bypass surgery over PCI in multivessel coronary artery disease has been convincingly proven. Patients after CABG demonstrate a relatively lower mortality and the need for repeated revascularization. A clinical case of successful myocardial revascularization in an octogenarian patient with severe multivessel coronary artery disease is presented.
References
- Cardiovascular surgery – 2018. Cardiovascular diseases and congenital anomalies of circulatory system. Moscow: 2019 (in Russ.).
- Maslennikova G.Ya., Oganov R.G. Prevention of noncommunicable diseases as an opportunity to increase life expectancy and healthy longevity. Cardiovascular Therapy and Prevention. 2019; 18 (2): 5–12 (in Russ.). DOI: 10.15829/1728-8800-2019-2-5-12
- Assey M.E. Heart disease in the elderly. Heart Dis. Stroke. 1993; 2 (4): 330–4.
- Guidelines for myocardial revascularization (Russian consensus paper). Moscow; 2011 (in Russ.).
- 2014 ESC/EACTS guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Russian Journal of Cardiology. 2015; 2 (118): 5–81 (in Russ.). DOI: 10.15829/1560-4071-2015-02-5-81
- Sokolova N.Yu., Golukhova E.Z. Myocardial revascularization in patients with stable coronary artery disease: the stratification of perioperative and long-term risks. Creative Cardiology. 2016; 10 (1): 5–12 (in Russ.). DOI: 10.15275/kreatkard.2016.01.03
- Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet. 2001; 358 (9286): 951–7. DOI: 10.1016/S0140-6736(01)06100-1
- Madhavan M.V., Gersh B.J., Alexander K.P., Granger Ch.B., Stone G.W. Coronary artery disease in patients ≥ 80 years of age. J. Am. Coll. Cardiol. 2018; 71 (18): 2015–40. DOI: 10.1016/j.jacc.2017.12.068
- Roberts W.C., Shirani J. Comparison of cardiac findings at necropsy in octogenarians, nonagenarians, and centenarians. Am. J. Cardiol. 1998; 82 (5): 627–31. DOI: 10.1016/s0002-9149(98)00385-3
- Paneni F., Diaz Canestro C., Libby P., Luscher T.F., Camici G.G. The aging cardiovascular system: understanding it at the cellular and clinical levels. 2017; 69 (15): 1952–67. DOI: 10.1016/j.jacc.2017.01.064
- Graham M.M., Ghali W.A., Faris P.D., Galbraith P.D., Norris C.M., Knudtson M.L.; Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Investigators. Survival after coronary revascularization in the elderly. 2002; 105 (20): 2378–84. DOI: 10.1161/01.cir.0000016640.99114.3d
- Bangalore S., Maron D.J., Stone G.W., Hochman J.S. Routine revascularization versus initial medical therapy for stable ischemic heart disease. A systematic review and meta-analysis of randomized trials. Circulation. 2020; 142 (9): 841–57. DOI: 10.1161/CIRCULATIONAHA.120.048194
- McKellar S.H., Brown M.L., Frye R.L., Schaff H.V., Sundt T.M. 3rd. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. 2008; 5 (11): 738–46. DOI: 10.1038/ncpcardio1348. Epub 2008 Sep 30
- Nicolini F., Contini G.A., Fortuna D., Pacini D., Gabbieri D., Vignali L. et al. Coronary artery surgery versus percutaneous coronary intervention in octogenarians: long-term results. Ann. Thorac. Surg. 2015; 99 (2): 567–74. DOI: 10.1016/j.athoracsur.2014.09.019. Epub 2014 Dec 10.
- Graham M.M., Norris C.M., Galbraith P.D., Knudtson M.L., Ghali W.A., for the AP-PROACH Investigators. Quality of life after coronary revascularization in the elderly. Eur. Heart J. 2006; 27: 1690–8. DOI: 10.1093/eurheartj/ehl038
- Merrill W.H., Stewart J.R., Frist W.H., Hammon Jr J.W., Bender H.W.Jr. Cardiac surgery in patients age 80 years or older. Ann. Surg. 1990; 211 (6): 772–6. DOI: 10.1097/00000658-199006000-00017
- Оzen A., Unal E.U., Songur M., Kocabeyoglu S.S., Hanedan O., Yilmaz M. et al. Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be? J. Geriatr. Cardiol. 2015; 12 (2): 147–52. DOI: 10.11909/j.issn.1671-5411.2015.02.005
- Alexander K.P., Anstrom K.J., Muhlbaier L.H., Grosswald R.D., Smith P.K., Jones R.H., Peterson E.D. Outcomes of cardiac surgery in patients 80 years: results from the National Cardiovascular Network. J. Am. Coll. Cardiol. 2000; 35 (3): 731–8. DOI: 10.1016/s0735- 1097(99)00606-3
- Peterson E.D., Cowper P.A., Jollis J.G., Bebchuk J.D., DeLong E.R., Muhlbaier L.H. et al. Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older. Circulation. 1995; 92 (9 Suppl.): II85–91. DOI: 10.1161/01.cir.92.9.85
- Likosky D.S., Dacey L.J., Baribeau Y.R., Leavitt B.J., Clough R., Cochran R.P. et al.; Northern New England Cardiovascular Disease Study Group. Long-term survival of the very elderly undergoing coronary artery bypass grafting. Ann. Thorac. Surg. 2008; 85 (4): 1233–7. DOI: 10.1016/j.athoracsur.2007.12.066
- Cane M.E., Chen C., Bailey B.M., Fernandez J., Laub G.W., Anderson W.A., McGrath L.B. CABG in octogenarians: early and late events and actuarial survival in comparison with a matched population. Ann. Thorac. Surg. 1995; 60 (4): 1033–7. DOI: 10.1016/0003-4975(95)00429-o
About the authors
- Zalina F. Kudzoeva, Cand. Med. Sci., Researcher, Cardiologist;
- Atabi Sh. Iraskhanov, Postgraduate; ORCID
- Davlet Sh. Zhuginisov, Cand. Med. Sci., Cardiovascular Surgeon;
- Merab K. Sanakoev, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
- Leo A. Bockeria, Academican of Russian Academy of Sciences and RAMS, President of Center; ORCID
