Характер поражения коронарного русла и эффективность реваскуляризации миокарда у пожилых пациентов с ишемической болезнью сердца

Aim: To evaluate the lesion character of coronary arteries and efficiency of revascularization in elderly patients, taking into account the choice of various treatment strategies. Methods: We investigated 102 patients with coronary heart disease who were over 65 years old and were hospitalized in the RSSPMCK. Patients were divided into 3 groups taking into account the therapy: 1st group PCI (n = 35), 2nd group OMT (n = 33), 3rd group CABG (n = 34). The volume and character of damage of coronary arteries, number, types of stents and bypass, as well as outcomes of revascularization were evaluated. The follow-up period was 1 year. Following endpoints were registered: death, repeated MI (nonfatal), progression of coronary insufficiency, development and progression of heart failure, repeated hospitalizations, and need for surgical intervention. Statistical data processing was performed using the Statistica 6.0 software package. Results: It was revealed that in the CABG group LCA stem (p = 0,05), branch of the blunt edge (p = 0,05) and intermediate artery damage was more often observed (p = 0,02). The highest percentage of stenosis of the intermediate artery was observed in the PCI group – 85 %, in contrast to 73.7 % in the CABG group and 50 % of the OMT group, p = 0,00001. Repeated hospitalization due to progression of coronary and heart failure was observed in 52.9 % of cases in the CABG group, in 2.9 % of cases in the OMT group, and in 30.3 % of cases in the PCI group, p = 0,007. When comparing successful outcomes, the best results were shown by the PCI group (82,3 %) compared with the OMT group (63.6 %) and the CABG group (47.1 %), p = 0,01. When studying the degree and character of revascularization in the PCI and CABG groups taking into account the endpoints, the subgroups that reached and did not reach the endpoints did not significantly differ. Conclusion: In elderly patients with coronary artery disease, more often there is a multivascular lesion of coronary arteries with a predominance of damage of left coronary artery stem and its branches. The decision on the method and tactics of revascularization should be taken individually for each patient, taking into account factors affecting the prognosis. Complete or functionally adequate myocardial revascularization with PCI or CABG is effective method for treating patients with coronary heart disease with multivascular lesion