cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2018.7.10137cardio-157Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАISCHEMIC HEART DISEASEОтдаленные исходы плановых эндоваскулярных вмешательств на коронарных артерияхLong-Term Outcomes of Elective Percutaneous Coronary InterventionsВершининаЕ. О.VershininaElena O.oliver@cardio.tsu.ruРепинА. Н.RepinA. N.noemail@neicon.ruФГБНУ «НИИ кардиологии», Томский национальный исследовательский медицинский центр РАНРоссияCardiology Research Institute, Tomsk National Research Medical CentreRussian Federation201818112018587513Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/157

Цель исследования. Определить частоту, выявить предикторы и разработать модель стратификации риска развития отдаленных сердечно-сосудистых осложнений после плановых чрескожных коронарных вмешательств (ЧКВ). Материалы и методы. У 148 пациентов со стабильной ишемической болезнью сердца (ИБС), направленных на плановое ЧКВ, с 2009 по 2011 г. через 6 лет после индексного ЧКВ путем анализа медицинской документации и телефонного опроса оценена частота MACCE (комбинированной конечной точки исследования, включающей сердечно-сосудистую смерть - ССС, острый коронарный синдром - ОКС, острое нарушение мозгового кровообращения - ОНМК). Результаты. ССС была зарегистрирована у 10,6% пациентов, ОКС развился у 34,4%, ОНМК - у 6,6%. В целом события МАССЕ произошли у 40,4% пациентов. Пациенты, у которых развились МАССЕ, исходно статистически значимо чаще страдали хронической обструктивной болезнью легких (16,4% против 4,4%; р=0,02), мультифокальным атеросклерозом (32,8% против 17,8%; р=0,034), им чаще была диагностирована фибрилляция предсердий (23% против 7,8%; р=0,016), а также чаще имелась отягощенная наследственность по сердечно-сосудистым заболеваниям (ССЗ) - 50,8% против 24,4% (р=0,0009). Они имели статистически значимо более высокий уровень С-реактивного белка перед ЧКВ - 6 (5-11,5) мг/л против 5 (4-7) мг/л (р=0,034) и рестенозы ранее установленных стентов (8,2% против 1,1%; р=0,04). Наиболее значимыми предикторами МАССЕ, выявленными с помощью пошаговой логистической регрессии и включенными в разработанную модель, являются наследственная предрасположенность к развитию ССЗ, прием статинов в период выполнения ЧКВ, исходный постпрандиальный уровень глюкозы в крови, высокий риск развития контраст-индуцированной нефропатии (11-15 баллов по шкале R. Mehran). Значение площади под кривой (AUC) для полученной модели составило 0,852 (при 95% доверительном интервале от 0,749 до 0,956). Заключение. Использование предложенной модели стратификации риска развития сердечно-сосудистых осложнений в отдаленном периоде у пациентов с ЧКВ позволяет на основе использования простых клинических характеристик выделять группы больных, требующих своевременного применения более активных стратегий последующего наблюдения.

Objective: to analyze long-term outcomes and to develop a model for determining the risk of long-term adverse сardiovascular events after elective percutaneous coronary interventions (PCI). Materials and Methods. We included in this study 148 patients, sent from 2009 to 2011 for routine endovascular intervention for chronic ischemic heart disease on the background of stenotic coronary artery atherosclerosis. Outcomes of interventions were assessed over 6 years after the index PCI by analyzing medical records and telephone interviews. The primary composite endpoint of the study was major adverse cardiovascular event (MACE), including cardiovascular death, acute coronary syndrome (ACS), acute cerebrovascular accident (CVA). Results. Cardiovascular death was registered in 10.6%, acute coronary syndrome occurred in 34.4%, stroke - in 6.6% of patients. Overall МАСЕ occurred in 40.4% of patients. Patients with MACE were initially significantly more likely to have chronic obstructive pulmonary disease (16.4 vs. 4.4%, p=0.02), multifocal atherosclerosis (32.8 vs. 17.8%, p=0.034). They were initially more often diagnosed with atrial fibrillation (AF) (23 vs. 7.8%, p=0.016) and were more likely to have family history of cardiovascular disease (50.8 vs. 24.4%, p=0.0009). They had significantly higher levels of CRP before PCI (6 (5-11.5) vs. 5 (4.7) mg/L, p=0.034) and restenosis of previously installed stent (8.2 vs. 1.1%, p=0.04). Most significant predictors of MACE identified using stepwise logistic regression and included in the developed model were: family history of cardiovascular disease, treatment with statins at time of PCI, initial level of postprandial blood glucose, high risk of contrast induced nephropathy (CIN) (11-15 points on Mehran CIN risk score). AUC values for the found model was 0.852 [95% CI 0.749-0.956]. Conclusion. The use of our model in patients with the upcoming PCI with the aim of stratifying the risk of long-term adverse cardiovascular events allows to identify groups of patients, who require the timely administration of more active follow-up strategies, through the use of simple clinical characteristics.

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