RESULTS OF MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN MULTIVESSEL CORONARY ATHEROSCLEROSIS

Purpose. Selection of the optimal revascularization strategy for patients with acute coronary syndromes without ST-segment elevation (Non-STE-ACS) and multivessel coronary disease (MVD) remains open. The purpose of the study is to evaluate the results of treatment in this group of patients depending on the strategy of revascularization.

Materials and methods. In the study within the prospective registry with 2012–2015 362 patients were included with Non-STE-ACS and MVD. Patients were divided into three groups: staged PCI (PCI – PCI) in 266 (73.4 %) patients, CABG – 72 patients (19.9 %), first step PCI and second step CABG (PCI – CABG) – 24 (6.6 %) patients. Endpoints were major cardiovascular events: death, MI, repeated revascularization, bleeding of BARC score (Bleeding Academic Research Consortium). Endpoints were assessed in the time period from the start until the end of hospitalization with Non-STE-ACS only revascularization (PCI or CABG) or second phase stage (CABG).

Results. Maximum value of GRACE score was in groups of PCI – PCI and PCI – CABG 145.81±18.61, maximum value of SYNTAX was in PCI – CABG 30.94±2.42. Mortality from 2.8 % in groups of CABG to 8.3 % in groups of PCI – PCI (р=0.5). MI rate from 1.4 % in groups of CABG to 8.3 % in PCI – CABG (р=0.5). Rate of bleeding 3–5 type BARC score was 1.1 % in groups of PCI – PCI to 37.5 % in PCI – CABG (р=0.003).

Conclusions. The lack of clear guidelines for choice of optimal strategy of revascularization in these patients results in a substantial number of adverse cardiovascular events. Choice of strategy should be based on the use of stratification scores (GRACE, SYNTAX, EuroScoreII). CABG may be optimal revascularization strategy to a much larger number of patients than is currently used. 

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