Подходы к лечению больных инфарктом миокарда с элевацией сегмента ST при многососудистом поражении коронарного русла

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Abstract

Objective. To compare hospital and long-term outcomes of different revascularisation strategies in STEMI patients with multivessel coronary artery disease (MVCD).

Material and methods. The manuscript presents hospital and long-term outcomes of 163 consecutive STEMI+MVCD patients treated with different revascularisation strategies. All the patients were divided into three groups. Group 1 (primary percutaneous coronary intervention (PPCI) of the infarct related artery (IRA) only without of staged revascularization in follow-up period (PPCI IRA) (n=70). Group 2 (multivessel (MV) stenting during PPCI) (MV stenting) (n=30). Group 3 (staged PPCI-PCI) (n=63). The study endpoint was the composite of death, myocardial infarction (MI), target vessel revascularisation (TVR).

Results. There was no significant differences between the groups on such endpoints as death, myocardial infarction, target vessel revascularization, stent thrombosis (p>0.05). The cohort of PPCI IRA patients was characterized by the worst outcomes of all the endpoints. The strategy of multiple stenting and staged revascularization demonstrated benefits over PPCI IRA in frequency of combined endpoint (death, myocardial infarction and target vessel revascularization), 10 and 14.3% vs 35.7%, respectively (p<0.05).

Conclusion. Current guidelines for STEMI patients with MV disease suggest a revascularization strategy with staged approach: PPCI IRA and delayed treatment of non-culprit lesions by PCI. In real life a significant proportion of patients do not receiving the second stage of revascularization for various reasons. The strategy of mul tiple stenting for patients without cardiogenic shock in the current recommendations is denied, but in our study obtained comparable results between the group of multiple stenting and staged revascularization and clearly better results in comparison with the group of patients receiving PPCI IRA only, who are encouraged to stage revascularization but did not get it. So our analyses challenge the current guideline recommendations regarding the choice of revascularization strategy in STEMI patients with MV disease.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery