EVALUATION OF MYOCARDIAL REVASCULARIZATION IN STABLE CORONARY HEART DISEASE PATIENTS AND FACTORS ASSOCIATED WITH INVASIVE STRATEGY CHOICE

Abstract

Aim . To investigate on clinical recommendations on revasculariztion in stable coronary heart disease patients, and to reveal factors associated with the choice of invasive strategy. Material and methods . The analysis of 1522 stable coronary heart disease patients was performed, mean age 53,0±8,5 y.o., 76,15% males, underwent in 2012-15 coronary arteriography. Patients were selected to 2 groups: those underwent myocardial revascularization (n=591; 38,8% of total), and patients only on drug treatment (n=931; 61,2% of total). The indications for revascularization were formulated according to European Society of Cardiology Guidelines 2014. For the factors selection that are associated with invasive strategy choice, a discriminant model was built-up. Factor were ranged by the grade of influence and relation sign. Results . Patients from surgery group had indications for revascularization more oftenly: 83,1% vs 76,8% (p<0,001). Most influencing factors were significant stenosis of some coronary arteries, typical angina, chronic heart failure functional class. Also, the presence of typical angina pain and worsening of heart failure were associated with refusal from the intervention, and hemodynamically significant stenosis was associated with revascularization. Conclusion . The mismatch was found, of real clinical situation and actual clinical guidelines. Most patients included into the study and having indications for myocardial revascularization were not operated. At the same time some operations are done not strictly following indications. In selection of candidates for coronary intervention there is tendency for the surgery in post myocardial infarction patients and with significant stenosis of coronary arteries regardless symptoms.