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2017, vol. 36, br. 4, str. 238-244
Način revaskularizacije miokarda i ishod kod pacijenata sa ishemijskom kardiomiopatijom i višesudovnom koronarnom bolešću
Univerzitet u Novom Sadu, Medicinski fakultet + Univerzitet u Novom Sadu, Medicinski fakultet, Institut za kardiovaskularne bolesti

e-adresailija.srdanovic@mf.uns.ac.rs
Ključne reči: Ishemija miokarda; Angioplastika; Stentovi; Koronarno arterijsko premošćavanje; Miokardnarevaskularizacija; Ishod lečenja
Sažetak
Uvod: Poređenje hirurške revaskularizacije miokarda (CABG) i perkutane koronarne intervencije (PCI) u lečenju višesudovne koronarne bolesti tema je nekoliko velikih studija, međutim nijedno istraživanje nije fokusirano isključivo na bolesnike sa smanjenom ejekcionom frakcijom leve komore (EF). Cilj rada je bilo poređenje ishoda lečenja nakon primenjene neke od revaskularizacionih tehnika CABG ili PCI kod bolesnika sa ishemijskom kardiomiopatijom i višesudovnom koronarnom bolešću. Metodi: Istraživanje je obuhvatilo 178 pacijenata, hospitalizovanih zbog simptomatske višesudovne koronarne bolesti, sa sniženom ejekcionom frakcijom leve komore (EF) ≤50%, kod kojih je učinjena neka od revaskularizacionih tehnika CABG ili PCI. Pacijenti su praćeni tokom dve godine nakon otpusta i u tom periodu su prikupljani podaci o pojavi neželjenih kardiovaskularnih i cerebrovaskularnih događaja (MACCE), koji su podrazumevali smrtni ishod, infarkt miokarda (MI), ponovnu revaskularizaciju ranije tretirane lezije i moždani infarkt. Rezultati: Uočena je veća incidenca MACCE u PCI grupi (18,1% vs. 9,5%, p=0,145). To je pretežno zbog veće učestalosti MI (6% vs. 0%, p=0,021) i ponovne revaskularizacije (6% vs. 0%, p=0,021). Ne postoji razlika u mortalitetu tokom dvogodišnjeg praćenja (9,6% u PCI grupi, a 9,5% u CABG grupi, p>0,05). Životna dob, fibrinogen, C-reaktivni protein su prediktori tromboze stenta, a dilatacija leve komore, EURO skor i SYNTAX skor su prediktori mortaliteta. Zaključak: Ne postoji razlika u stopi mortaliteta tokom dvogodišnjeg praćenja nakon učinjene revaskularizacije miokarda putem CABG i PCI kod pacijenata sa sniženom EF. Incidenca infarkta miokarda i ponovne revaskularizacije je veća nakon učinjene PCI.
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