Альманах клинической медицины. 2015; : 43-49
ОЦЕНКА КЛИНИЧЕСКОГО СТАТУСА И АНАЛИЗ ВЫЖИВАЕМОСТИ ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА, ПОДВЕРЖЕННЫХ ЭНДОВАСКУЛЯРНОЙ РЕКАНАЛИЗАЦИИ ХРОНИЧЕСКОЙ ОККЛЮЗИИ ПРАВОЙ КОРОНАРНОЙ АРТЕРИИ
https://doi.org/10.18786/2072-0505-2015-38-43-49Аннотация
Актуальность. Несмотря на то что среди чрескожных коронарных вмешательств на долю процедур, выполняемых при хронической окклюзии коронарных артерий, приходится от 10 до 20%, а успех этого вида вмешательства может достигать 90%, его целесообразность при данной патологии все еще является объектом дискуссии.
Цель – оценить эффективность и безопасность интервенционного подхода в сравнении с консервативным у пациентов с хронической окклюзией правой коронарной артерии при ее изолированном поражении.
Материал и методы. Проанализированы результаты лечения 72 пациентов: из них эндоваскулярная реканализация хронической окклюзии правой коронарной артерии выполнялась 39 больным (1-я группа), консервативное лечение получали 33 пациента (2-я группа). Оценивали показатели клинического статуса и частоту неблагоприятных событий. Период наблюдения составил 12 месяцев.
Результаты. Через 1 год в 1-й группе отмечена отчетливая динамика снижения функционального класса стенокардии напряжения (ФК СН). Количество пациентов с I ФК СН увеличилось с 3 (7,7%) до 20 (51,3%) (р < 0,05), а с III ФК СН снизилось с 22 (56,4%) до 6 (15,4%), р < 0,05. Во 2-й (контрольной) группе статистически значимых изменений ФК СН через 2 и 12 месяцев обнаружено не было (р > 0,05 в обоих случаях). Одногодичная «свобода» от неблагоприятных клинических событий составила в 1-й группе 94,9% (95% доверительный интервал 88,2– 99,9%), во 2-й – 100%.
Заключение. При хронической окклюзии правой коронарной артерии проведение чрескожной транслюминальной коронарной ангиопластики в сравнении с консервативной терапией в период наблюдения 2 и 12 месяцев значимо улучшает клиническое течение ишемической болезни сердца, уменьшая функциональный класс стенокардии напряжения. Выявленные неблагоприятные события в группе эндоваскулярной реканализации хронической окклюзии правой коронарной артерии ввиду их малой частоты не являются значимыми с клинической точки зрения.
Список литературы
1. Бабунашвили АМ, Иванов ВА, Бирюкова СА. Эндопротезирование (стентирование) венечных артерий сердца. М.: АСВ; 2001. 704 с. Babunashvili AM, Ivanov VA, Biryukova SA. Endoprotezirovanie (stentirovanie) venechnykh arteriy serdtsa [Endoprosthetics (stent placement) of coronary arteries of the heart]. Moscow: ASV; 2001. 704 p. (in Russian).
2. Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, Johnson WL, Rutherford BD. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38(2):409–14.
3. DeWood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980;303(16):897–902.
4. Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, Giachero C, Di Mario C, Gabrielli G, Spedicato L, Bedogni F; TOASTGISE Investigators. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol. 2003;41(10):1672–8.
5. Choi JH, Chang SA, Choi JO, Song YB, Hahn JY, Choi SH, Lee SC, Lee SH, Oh JK, Choe Y, Gwon HC. Frequency of yocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries. Circulation. 2013;127(6):703–9.
6. Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabate M, Senior R, Taggart DP, van der Wall EE, Vrints CJ; ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Ryden L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.
7. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS; American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539–42.
8. Judkins MP. Percutaneous transfemoral selective coronary arteriography. Radiol Clin North Am. 1968;6(3):467–92.
9. Moher D, Schulz KF, Altman DG; CONSORT. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.
Almanac of Clinical Medicine. 2015; : 43-49
ANALYSIS OF SURVIVAL AND CHANGES IN CLINICAL STATUS OF PATIENTS WITH CORONARY ARTERY DISEASE AFTER ENDOVASCULAR RECANALIZATION OF CHRONIC OCCLUSION OF THE RIGHT CORONARY ARTERY
https://doi.org/10.18786/2072-0505-2015-38-43-49Abstract
Background: Procedures performed in chronic coronary artery occlusion comprise from 10 to 20% of all transcutaneous coronary interventions, and their efficacy can amount to 90%. Despite this, their appropriateness for this type of disease is still a matter of debate.
Aim: To assess efficacy and safety of interventions compared to medical treatment in patients with isolated chronic occlusion of the right coronary artery.
Materials and methods: We analyzed results of treatment of 72 patients. From these, endovascular recanalization of chronic occlusion of the right coronary artery was performed in 39 patients (group 1), the rest 33 patients received medical treatment only (group 2). Clinical state parameters and adverse event rate were assessed during a follow-up of 12 months.
Results: After 1 year, a notable reduction of functional grade (FG) of exertional angina was seen in the group 1. The number of patients with FG I increased from 3 (7.7%) to 20 (51.3%), р < 0.05; and the number of those with FG III decreased from 22 (56.4%) to 6 (15.4%), р < 0.05. No significant changes of FG of angina were seen in the group 2 (control group) after 2 and 12 months (р > 0.05 at both time points). At 1 year, 94.9% (95% CI: 88,2–99,9%) of patients from the group 1 and 100% of patient in the group 2 were free of adverse clinical events.
Conclusion: Transcutaneous coronary angioplasty for chronic occlusion of the right coronary artery significantly improves clinical course of ischemic heart disease at 2 and 12 months, compared to medical treatment, by decreasing FG of exertional angina. From clinical point of view, adverse events reported in the group of endovascular recanalization for chronic occlusion of the right coronary artery are insignificant.
References
1. Babunashvili AM, Ivanov VA, Biryukova SA. Endoprotezirovanie (stentirovanie) venechnykh arterii serdtsa. M.: ASV; 2001. 704 s. Babunashvili AM, Ivanov VA, Biryukova SA. Endoprotezirovanie (stentirovanie) venechnykh arteriy serdtsa [Endoprosthetics (stent placement) of coronary arteries of the heart]. Moscow: ASV; 2001. 704 p. (in Russian).
2. Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, Johnson WL, Rutherford BD. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38(2):409–14.
3. DeWood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980;303(16):897–902.
4. Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, Giachero C, Di Mario C, Gabrielli G, Spedicato L, Bedogni F; TOASTGISE Investigators. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol. 2003;41(10):1672–8.
5. Choi JH, Chang SA, Choi JO, Song YB, Hahn JY, Choi SH, Lee SC, Lee SH, Oh JK, Choe Y, Gwon HC. Frequency of yocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries. Circulation. 2013;127(6):703–9.
6. Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabate M, Senior R, Taggart DP, van der Wall EE, Vrints CJ; ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Ryden L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.
7. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS; American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539–42.
8. Judkins MP. Percutaneous transfemoral selective coronary arteriography. Radiol Clin North Am. 1968;6(3):467–92.
9. Moher D, Schulz KF, Altman DG; CONSORT. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.
