Abstract
Aim – to compare outcomes in coronary artery bypass and percutaneous coronary intervention in patients with multifocal
atherosclerosis during NSTEMI.
Material and methods. We have analyzed outcomes in 89 patients with multifocal atherosclerosis and NSTEMI who
underwent coronary artery bypass grafting (group CABG – 37 patients) or primary percutaneous coronary intervention
(group PCI – 52 patients). Early complications (during 30 days after revascularization) included cardiovascular
death, myocardial infarction/unstable angina pectoris, stroke. In long term results (during 41.9±1.78 months) main
point was return of ischemia due to shunt/stent dysfunction or atherosclerosis progression.
Clinical parameters and non-invasive test results (ECG, Echo, stress-Echo) were analyzed before revascularization,
in early and long-term period of time.
Results. Coronary artery flow was restored in 89.1% stenotic arteries: 91.3% in CABG group, 87.3% in PCI group.
Optimal revascularization was done in 78.4% on patients who underwent CABG, in 75% in patients who underwent
PCI. Should be considered that in case of PCI in order to achieve that result, more than one stage of intervention was
needed. It should be emphasized that method or revascularization was chosen concerning coronary artery stenosis
location and clinical profile. Treatment algorithms showed no differences in all periods of observation nor in clinical
outcome, nor in data of non-invasive tests. In CABG group early stage complications were 10.8%, long-term complications
– 25.0% of patients, in PCI group 9.6%/23.5% relatively.
Conclusion. At acute coronary syndrome ↓ST the choice of a method of coronary revascularization is solved in favor
of percutaneous interventions due to early invasive strategy. Equally, the high risk of adverse clinical events in the
coronary bed and other arterial zones, justifies the scheme of the stage-by-stage interventional treatment. Primary
intervention is usually limited to recanalization of clinical depended artery and it conducts to increase of endovascular
procedures. At the optimum choice of medical tactics, expression of clinical implications, parameters of a functional
condition of a myocardium, quantity and structure of negative clinical outcomes don't depend on a myocardium
revascula-rization method.
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About the authors
- Rustam M. Ibragimov, Cand. Med. Sc., Junior Researcher; orcid.org/0000-0003-4164-5051
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Viktoriya I. Ioshina, Dr. Med. Sc., Senior Researcher; orcid.org/0000-0003-4591-2161
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Sergey G. Ambat'ello, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0003-1486-1787
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Yuriy I. Buziashvili, Dr. Med. Sc., Professor, Academician of the RAS, Chief of Clinical-Diagnostic Department
