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Неотложные меры в диагностике и лечении хронических форм ишемической болезни сердца
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Boytsov SA, Provatorov SI, Shestova II, Nikulina NN. Emergency measures in the diagnosis and treatment of chronic forms of ischemic heart disease. Terapevticheskii Arkhiv (Ter. Arkh.). 2025;97(1):5–10. DOI: 10.26442/00403660.2025.01.203125
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Ключевые слова: ишемическая болезнь сердца, предтестовая вероятность, реваскуляризация, диспансерное наблюдение, прогноз
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Coronary heart disease (CHD) is one of the most common cardiovascular diseases and the most common cause of death in Russia. Primary diagnostics of CHD involves assessing the pre-test probability of CHD. Thereafter, myocardial ischemia should be verified by visualization technique: stress echocardiography or stress single-photon emission computed tomography of the myocardium. Myocardial revascularization improves the prognosis in patients with stable CHD who have three-vessel coronary disease or significant stenosis of the left main coronary artery. Outpatient monitoring and free provision of medications can significantly reduce mortality among patients with stable high-risk CHD.
Keywords: coronary heart disease, pre-test probability, revascularization, outpatient monitoring, prognosis
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3. Deev IA, Kobiakova OS, Starodubov VI, et al. Zabolevaemost' vsego naseleniia Rossii v 2023 g.: statisticheskie materialy. Moscow: TsNIIOIZ, 2024 (in Russian).
4. Barbarash OL, Karpov YuA, Panov AV, et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024;29(9):6110 (in Russian). DOI:10.15829/1560-4071-2024-6110
5. Foldyna B, Udelson JE, Karády J, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019;20(5):574-81. DOI:10.1093/ehjci/jey182
6. Wsol A, Wydra W, Chmielewski M, et al. Increased sensitivity of prolonged P-wave during exercise stress test in detection of angiographically documented coronary artery disease. Cardiol J. 2017;24(2):159-66. DOI:10.5603/CJ.a2016.0099
7. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40(8):1531-40. DOI:10.1016/s0735-1097(02)02164-2
8. Singh T, Bing R, Dweck MR, et al. Exercise Electrocardiography and Computed Tomography Coronary Angiography for Patients With Suspected Stable Angina Pectoris: A Post Hoc Analysis of the Randomized SCOT-HEART Trial. JAMA Cardiol. 2020;5(8):920-2. DOI:10.1001/jamacardio.2020.1567
9. Christman MP, Bittencourt MS, Hulten E, et al. Yield of downstream tests after exercise treadmill testing: a prospective cohort study. J Am Coll Cardiol. 2014;63(13):1264-74. DOI:10.1016/j.jacc.2013.11.052
10. Heijenbrok-Kal MH, Fleischmann KE, Hunink MG. Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J. 2007;154(3):415-23. DOI:10.1016/j.ahj.2007.04.061
11. Picano E, Molinaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovasc Ultrasound. 2008;6:30. DOI:10.1186/1476-7120-6-30
12. Cortigiani L, Lombardi M, Michelassi C, et al. Significance of myocardial ischemic electrocardiographic changes during dipyridamole stress echocardiography. Am J Cardiol. 1998;82(9):1008-12. DOI:10.1016/s0002-9149(98)00552-9
13. Nihoyannopoulos P, Kaski JC, Crake T, Maseri A. Absence of myocardial dysfunction during stress in patients with syndrome X. J Am Coll Cardiol. 1991;18(6):1463-70. DOI:10.1016/0735-1097(91)90676-z
14. Sicari R, Nihoyannopoulos P, Evangelista A, et al. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr. 2008;9(4):415-37. DOI:10.1093/ejechocard/jen175
15. Peteiro J, Bouzas-Mosquera A, Estevez R, et al. Head-to-head comparison of peak supine bicycle exercise echocardiography and treadmill exercise echocardiography at peak and at post-exercise for the detection of coronary artery disease. J Am Soc Echocardiogr. 2012;25(3):319-26. DOI:10.1016/j.echo.2011.11.002
16. Koretskiy SN, Drapkina OM, Shukurov FB, Vasiliev DK. Quantitative Assessment of Myocardial Ischemia in Multi-Vessel Coronary Artery Disease by Multimodal Stress Echocardiography with Semi-Supine Bicycle Ergometry. Rational Pharmacotherapy in Cardiology. 2019;15(6):813-9 (in Russian).
17. Yang K, Yu SQ, Lu MJ, Zhao SH. Comparison of diagnostic accuracy of stress myocardial perfusion imaging for detecting hemodynamically significant coronary artery disease between cardiac magnetic resonance and nuclear medical imaging: A meta-analysis. Int J Cardiol. 2019;293:278-85. DOI:10.1016/j.ijcard.2019.06.054
18. Ob utverzhdenii standarta meditsinskoi pomoshchi vzroslym pri stabil'noi ishemicheskoi bolezni serdtsa (diagnostika, lechenie i dispansernoe nabliudenie). Prikaz Minzdrava Rossii ot 28 aprelia 2021 g. №410n Ob. Available at: http://publication.pravo.gov.ru/Document/View/0001202105240046. Accessed: 19.11.2024 (in Russian).
19. Knuuti J, Ballo H, Juarez-Orozco LE, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J. 2018;39(35):3322-30. DOI:10.1093/eurheartj/ehy267
20. Celeng C, Leiner T, Maurovich-Horvat P, et al. Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease: A Meta-Analysis. JACC Cardiovasc Imaging. 2019;12(7 Pt. 2):1316-25. DOI:10.1016/j.jcmg.2018.07.022
21. Balfour PC Jr, Gonzalez JA, Kramer CM. Non-invasive assessment of low- and intermediate-risk patients with chest pain. Trends Cardiovasc Med. 2017;27(3):182-8. DOI:10.1016/j.tcm.2016.08.006
22. Russian Society of Cardiology. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103 (in Russian). DOI:10.15829/29/1560-4071-2020-4103
23. Sumin AN, Korok EV, Sinkov MA, et al. The Problem of Minimally Changed Coronary Arteries at Elective Coronary Angiography. Kardiologiia. 2017;57(4):10-8 (in Russian). DOI:10.18565/cardio.2017.4.10-18
24. Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994;344(8922):563-70. DOI:10.1016/s0140-6736(94)91963-1
25. Bittl JA, He Y, Jacobs AK, et al. Bayesian methods affirm the use of percutaneous coronary intervention to improve survival in patients with unprotected left main coronary artery disease. Circulation. 2013;127(22):2177-85. DOI:10.1161/CIRCULATIONAHA.112.000646
26. Long-term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris. European Coronary Surgery Study Group. Lancet. 1982;2(8309):1173-80.
27. Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med. 2020;382(15):1395-407. DOI:10.1056/NEJMoa1915922
28. Xaplanteris P, Fournier S, Pijls NHJ, et al. Five-Year Outcomes with PCI Guided by Fractional Flow Reserve. N Engl J Med. 2018;379(3):250-5. DOI:10.1056/NEJMoa1803538
29. Hochman JS, Anthopolos R, Reynolds HR, et al. Survival After Invasive or Conservative Management of Stable Coronary Disease. Circulation. 2023;147(1):8-19. DOI:10.1161/CIRCULATIONAHA.122.062714
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1ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия;
2ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия;
3ГУЗ «Тульский областной кардиологический диспансер», Тула, Россия;
4ФГБОУ ВО «Рязанский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Рязань, Россия
*semaver@yandex.ru
________________________________________________
Sergey A. Boytsov1,2, Sergei I. Provatorov*1, Irina I. Shestova3, Natalia N. Nikulina4
1Chazov National Medical Research Center of Cardiology, Moscow, Russia;
2Russian University of Medicine, Moscow, Russia;
3Tula Regional Clinical Cardiology Dispensary, Tula, Russia;
4Pavlov Ryazan State Medical University, Ryazan, Russia
*semaver@yandex.ru