Роль чрескожного коронарного вмешательства при лечении пациентов высокого хирургического риска с многососудистым поражением коронарного русла (обзор литературы)

Зайнобидинов Ш.Ш., Хелимский Д.А., Баранов А.А., Бадоян А.Г., Цыденова А.Ю., Найденов Р.А., Крестьянинов О.В. Роль чрескожного коронарного вмешательства при лечении пациентов высокого хирургического риска с многососудистым поражением коронарного русла (обзор литературы). Consilium Medicum. 2025;27(10):577–583. DOI: 10.26442/20751753.2025.10.203401

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Zaynobidinov ShSh, Khelimskii DA, Baranov AA, Badoian AG, Tsydenova AYu, Naydenov RA, Krestyaninov OV. The role of percutaneous coronary intervention in the treatment of patients with multivessel coronary artery disease who are turned down for coronary artery bypass grafting (literature review). Consilium Medicum. 2025;27(10):577–583. DOI: 10.26442/20751753.2025.10.203401

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Аннотация

Несмотря на развитие современных технологий в сфере здравоохранения и широкое применение современных методов диагностики и лечения, смертность от ишемической болезни сердца занимает лидирующее место среди причин смерти. Аортокоронарное шунтирование в сочетании с оптимальной медикаментозной терапией считается «золотым стандартом» лечения пациентов с многососудистым поражением коронарного русла. Тем не менее вот уже несколько десятилетий чрескожное коронарное вмешательство зарекомендовало себя в качестве альтернативного метода реваскуляризации миокарда у пациентов с многососудистым поражением коронарного русла низкого и/или среднего риска. Однако, несмотря на накопленный опыт лечения пациентов с ишемической болезнью сердца, вопрос выбора оптимальной (консервативной или инвазивной) тактики лечения у пациентов с комплексным поражением коронарного русла и высоким хирургическим риском аортокоронарного шунтирования остается дискутабельным. В настоящей обзорной статье авторы описали основные факторы, влияющие на выбор стратегии реваскуляризации миокарда, и продемонстрировали результаты клинических исследований, посвященных этой проблеме.

Ключевые слова: ишемическая болезнь сердца, многососудистое поражение, высокий риск, чрескожное коронарное вмешательство, аортокоронарное шунтирование

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Despite the development of modern technologies in the field of healthcare and the wide application of modern diagnostic and treatment methods, mortality from ischemic heart disease remains the leading cause of death among diseases. It is known that coronary artery bypass grafting in combination with optimal medical therapy is the gold standard for treating patients with multivessel coronary artery disease. However, for several decades now, percutaneous coronary intervention has proven to be an alternative method of myocardial revascularization for patient with multivessel coronary artery disease and low or intermediate risk. Nevertheless, despite accumulated experience in treating patients with ischemic heart disease, the choice of revascularization method for patients with complex coronary artery disease and high surgical risk (not eligible for CABG) remains debatable. In this review article, the authors described the main factors influencing the choice of myocardial revascularization strategy and demonstrated the results of clinical studies dedicated to studying this issue.

Keywords: ischemic heart disease, multivessel disease, high risk, percutaneous coronary intervention, coronary artery bypass graft

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26. Hoffmann G, Friedrich C, Huenges K, et al. Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease. Thorac Cardiovasc Surg. 2021;69(7):607-13. DOI:10.1055/s-0041-1723845
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Авторы

Ш.Ш. Зайнобидинов*¹, Д.А. Хелимский¹, А.А. Баранов¹, А.Г. Бадоян¹, А.Ю. Цыденова^1,2, Р.А. Найденов¹, О.В. Крестьянинов^1,2

¹ФГБУ «Национальный медицинский исследовательский центр им. акад. Е.Н. Мешалкина» Минздрава России, Новосибирск, Россия;
²ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия
*shaxboz.zaynobiddinov95@mail.ru

________________________________________________

Shokhbozbek Sh. Zaynobidinov*¹, Dmitrii A. Khelimskii¹, Aleksei A. Baranov¹, Aram G. Badoian¹, Aryuna Yu. Tsydenova^1,2, Roman A. Naydenov¹, Oleg V. Krestyaninov^1,2

¹Meshalkin National Medical Research Center, Novosibirsk, Russia;
²Novosibirsk State Medical University, Novosibirsk, Russia
*shaxboz.zaynobiddinov95@mail.ru

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