kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2017-2-6-18kpccz-276Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESВЫЖИВАЕМОСТЬ ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ С МУЛЬТИФОКАЛЬНЫМ АТЕРОСКЛЕРОЗОМ В РАЗЛИЧНЫХ ВОЗРАСТНЫХ ГРУППАХSURVIVAL AFTER SURGICAL TREATMENT OF MULTIFOCAL ATHEROSCLEROSIS IN DIFFERENT AGE GROUPSГайфулинР. А.GajfulinR. A.

650002, г. Кемерово, Сосновый бульвар, д. 6

6, Sosnoviy blvd., Kemerovo, 650002, Russian Federation

rus_gayf@mail.ruСуминА. Н.SuminA. N.

Кемерово, Россия

Kemerovo, Russia

ИвановС. В.IvanovS. V.

Кемерово, Россия

Kemerovo, Russia

БарбарашЛ. С.BarbarashL. S.

Кемерово, Россия

Kemerovo, Russia

Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияFederal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular DiseasesRussian Federation20170307201702618Copyright © Гайфулин Р.А., Сумин А.Н., Иванов С.В., Барбараш Л.С., 20172017Гайфулин Р.А., Сумин А.Н., Иванов С.В., Барбараш Л.С.Gajfulin R.A., Sumin A.N., Ivanov S.V., Barbarash L.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/276

Цель. Проведение анализа выживаемости после хирургических вмешательств и изучение факторов, ассоциированных со временем наступления летального исхода у больных с мультифокальным атеросклерозом (МФА) в различных возрастных группах.Материал и методы. Включено 764 последовательных больных в возрасте от 39 до 84 лет с МФА, которым выполнялось изолированное коронарное шунтирование (КШ), либо КШ в сочетании с одномоментными или этапными хирургическими вмешательствами на некоронарных сосудистых бассейнах. Выбор тактики лечения определялся мультидисциплинарным консилиумом. В зависимости от возраста пациентов сформировано 4 группы: 1-я группа – больные до 60 лет (n=338), 2-я группа – 60-64 года (n=185), 3-я группа − 65-69 лет (n=137) и 4-я группа – больные 70 лет и старше (n=104).Результаты. Анализ госпитальной летальности после проведенной операции КШ не выявил значимой разницы между группами, несмотря на ее увеличение среди больных старше 65 лет (р=0,373). Подобная тенденция наблюдалась и по отдаленным показателям смертности без статистической достоверности между группами. Анализ выживаемости выявил отсутствие различий между группами по времени до наступления летального исхода (р=0,205), доля выживших за указанный период наблюдения во всех группах составила более 75%. Регрессионная модель выживаемости Кокса показала, что со временем наступления летального исхода после реваскуляризирующих вмешательств были достоверно связаны женский пол (р=0,009), наличие сахарного диабета (р=0,003), перенесенное ОНМК (р=0,002), риск оперативного вмешательства по шкале EuroScore (р=0,011) и ФВЛЖ (р=0,008).Заключение. Пожилой возраст в сочетании с МФА является маркером повышенной смертности после реваскуляризирующих операций, тем не менее, у данной категории больных могут быть получены благоприятные показатели по отдаленной выживаемости после хирургических операций.

The purpose: Conducting the analysis of survival after surgery and the study of factors associated with mortality in patients with multifocal atherosclerosis (MFA) in diferent age groups.Material and methods. It were included 764 consecutive patients aged 39 to 84 years with the MFA, who underwent isolated coronary artery bypass grafting (CABG) or CABG in combination with simultaneous or staged surgical interventions in the non-coronary vascular beds. The treatment procedure was determined by the heart team. Depending on the age of patients formed 4 groups: Group 1 - patients up to 60 years (n = 338), 2 group - 60-64 years (n = 185), 3 group - 65-69 years (n = 137) and group 4 - patients 70 years and older (n = 104).Results. Analysis of hospital mortality after CABG surgery showed no signifcant diference between the groups, despite its increase among patients older than 65 years (p = 0.373). A similar trend was observed for remote mortality rates without statistical signifcance between the groups. Survival analysis showed no diference between groups in the time to onset of death (p = 0.205), the proportion of survivors over the period of observation in all groups was more than 75%. The regression survival Cox model showed that, in time before the fatal outcome after revascularization surgery were signifcantly associated female gender (p = 0.009), presence of diabetes mellitus (p = 0.003), stroke history (p = 0.002), the risk of surgical intervention on a scale EuroSCORE (p = 0.011) and left ventricular ejection fraction (p = 0.008).Conclusion. Advanced age in combination with the MFA is a marker of increased mortality after revascularization surgery; however, these patients have favorable results on the long-term survival after staged surgery

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The authors declare that there are no conflicts of interest present.