ПРЕДИКТОРЫ ЛЕТАЛЬНОСТИ У БОЛЬНЫХ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА, ПЕРЕНЕСШИХ РЕВАСКУЛЯРИЗАЦИЮ МИОКАРДА (2летнее наблюдение

Purpose of the study: to determine predictors of unfavorable prognosis in patients with coronary artery disease in the long-term period after myocardial revascularization. Material and research methods. The study included 320 patients with coronary artery disease. Thirtyseven (11,56 %) patients underwent surgical revascularization (CABG), 183 patients underwent stenting of the coronary arteries. The study included patients with an eGFR of at least 60 ml/ min. On the second day after the endovascular procedure, patients underwent determination of the concentration of creatinine in the blood to detect contrast-induced nephropathy (CIN). Initially, three months later, at the end of the first and second years after revascularization, all patients underwent echocardiography (EchoCG), determination of the concentration of brain natriuretic peptide (BNUP), parathyroid hormone, phosphorus, uric acid, creatinine in the blood, and calculation of GFR. Research results. In the present study, 22 people (6,88 %) died among patients during a 2-year follow-up. In the group of deceased patients, compared with surviving patients, there were significantly more patients who underwent CABG (7 out of 22–31,82 % and 30 out of 298–10,07 %, chi square = 8,19, p < 0,01), and patients with CIN (17–77,27 % against 57–19,13 %, chi square = 37,52, p < 0,001). In patients who died during the observation period, an initially high blood concentration of BNP (p < 0,001), of creatinine, of parathyroid hormone, and of phosphorus (p < 0,01), and a significantly higher rate of eGFR decline at all stages of observation (p < 0,001) and significantly more pronounced structural and functional remodeling of the heart according by EchoCG were noted. When determining the prognostic significance of risk factors for death in patients with CAD, it was found that the need for surgical revascularization increases the risk of death by 3,75 times, CIN in the early period after endovascular intervention – by 11,3 times, initially low eGFR and rapidly progressing CKD – by 4, 5, initially low LVEF – 8,68 times and high concentration of NP – 23,21 times. Conclusion. Patients with coronary artery disease who died within 2 years after myocardial revascularization had an initial impairment of the functional state of the kidneys and signs of cardiac remodeling. The risk of death was 6.88 %. Predictive markers of a poor prognosis, determined before revascularization, are the need for CABG, the development of CIN, low eGFR, low LVEF, and high serum NUP concentration.