2017

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2017/№3

Outcomes of myocardial revascularization in patients with severe CHF of ischemic origin

Mironkov A. B.1, Gendlin G. E.2, Reznik E. V.2, Nikitin I. G.2, Sakhovsky S. A.1, Mironkov B. L.1, Gautier S. V.1
1 – Federal State Budgetary Institution "Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs" of the Ministry of Health of the Russian Federation, Shchukinskaya 1, Moscow 123182
2 – Federal State Budgetary Educational Institution of Higher Education, "Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Ostrovityanova 1, Moscow 117997

Keywords: coronary heart disease, chronic heart failure, transcutaneous coronary intervention, optimal drug therapy, treatment efficacy

DOI: 10.18087/rhfj.2017.3.2361

Background. Ischemic heart disease is the cause of CHF in almost 60% of patients in the Russian Federation while a combination of IHD and AH – in almost a half of such patients. Therefore, an important issue is a possibility of improving the condition and life span of such patients using myocardial revascularization. However, there is no consensus on efficacy and safety of procedures and surgeries for restoring coronary blood flow in patients with LV ejection fraction (EF) <35%. Aim. To evaluate the efficacy of myocardial revascularization with transcutaneous coronary interventions (TCI) in patients with severe CHF of ischemic origin compared to similar patients receiving the optimal drug therapy (ODT). Materials and methods. The study included 244 patients with FC II–IV CHF aged 24 to 85 (median age, 62 (55; 68); mean age, 61.6; 204 men). 106 patients (101 men and 5 women) underwent myocardial revascularization. All patients received ODT for CHF. Results. Comparing the cumulative survival rate in two study groups showed that the survival of CHF patients after TCI was significantly higher than the survival of patients receiving ODT alone. Analysis of pooled data showed that revascularization stronger influenced the fate of CHF patients than the baseline LV EF. In this model, the significance of age and FC was statistically non-significant. Conclusion. In patients with ischemic CHF, myocardial revascularization was beneficial for their fate. Apparently, ischemic episodes can limit the life expectancy of patients with rather severe CHF, and revascularization is capable of reducing the frequency and degree of ischemic exposure. Further studying this issue may enhance the efficacy of treatment of ischemic CHF.
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Mironkov A. B., Gendlin G. E., Reznik E. V., Nikitin I. G., Sakhovsky S. A., Mironkov B. L. et al. Outcomes of myocardial revascularization in patients with severe CHF of ischemic origin. Russian Heart Failure Journal. 2017;18(3):163–171

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