LONG TERM RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS COMPARING WITH CONSERVATIVE MANAGEMENT IN TREATMENT OF STABLE ISCHEMIC HEART DISEASE PATIENTS UNDER REAL CIRCUMSTANCES

Aim. To evaluate long term results of percutaneous coronary interventions (PCI) in stable ischemic heart disease patients (IHD) under real clinical circumstances.

Material and methods. The PCI group consisted of 150 patients with stable IHD after PCI, randomly selected from the Registry of Coronary Angiography. Comparison group consisted of randomly selected from the Registry 150 patients with stable IHD receiving only drug therapy (DT).

Results. In long term perion it was found that total mortality (4,0% vs. 11,3%, p=0,017) and cardiovascular mortality (3,3% vs. 10,7%, p=0,013) were lower in PCI group. After PCI there was rarer coronary bypass operation need (2,0% vs. 10,0%, p=0,004). By the prevalence of myocardial infarction in compared groups there were no statistically significant differences (6,7% vs. 5,3%, p=0,627). Kaplan-Meier curve analysis showed that positive effect of PCI was fulfilled in 15 months and progressively increased until the end of follow-up. In stepped regression of Cox proportional risks it was revealed that in long term period PCI performing associated with the increase of survival rate 2,8 times (RR=2,81, 95% CI 1,03-7,69, p=0,044). Long term survival showed independent relation with the grade of coronary lesion. In PCI group, as in DT group, there were no positive dynamics of angina functional classes. In MT group during the follow-up functional class of heart failure became harder than in PCI group, and in PCI groupthere were no significant dynamics of heart failure functional class.

Conclusion. Real clinical practice proved the effectiveness of PCI with DT in treatment of stable IHD. In long term results evaluation, PCI for stable IHD associated with the increase of survival 2,8 times comparing with the group with only DT. Positive PCI effect realized after 15 months and progressively increased to the end of follow-up.

1. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. The Lancet 2003; 361: 13-20.

2. Kuznetsov VA, Yaroslavskaya EI, Pushkarev GS, et al. Interrelation of transcutaneous coronary interventions for acute forms of coronary heart disease and mortality parameters in Tyumen region inhabitants. Russ J Cardiol 2014; 6 (110): 42-6. Russian (Кузнецов В.А., Ярославская Е.И., Пушкарев Г.С. и др. Взаимосвязь чрескожных коронарных вмешательств при острых формах ишемической болезни сердца и показателей смертности населения тюменской области. Российский кардиологический журнал 2014, 6 (110): 42-6.)

3. Simoons ML, Windecker S. Controversies in cardiovascular medicine: chronic stable coronary artery disease: drugs vs. revascularization. Eur Heart J 2010; 31: 530-41.

4. Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med 2012; 172: 312-9.

5. Kolh P. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Journal of Cardio-Thoracic Surgery. 2014; 46; 4: 517-92.

6. Kuznetsov VA, Yaroslavskaya EI, Krinochkin DV, et al. The impact of planned percutaneous coronary intervention on mortality population of the Tyumen region. Russ J Cardiol 2015; 12 (128): 14-9. Russian (Кузнецов В.А., Ярославская Е.И., Криночкин Д.В. и др. Влияние плановых чрескожных коронарных вмешательств на показатели смертности населения Тюменской области. Российский кардиологический журнал 2015; 12 (128): 14-9).

7. Kuznetsov VA, Zyryanov IP, Kolunin GV, et al. “Register of coronary angiography.” Certificate of state registration database number 2010620075, registered in the Registry Database February 1, 2010. Russian (Кузнецов В.А, Зырянов И.П., Колунин Г.В., и др. “Регистр проведенных операций коронарной ангиографии”. Свидетельство о государственной регистрации базы данных № 2010620075, зарегистрировано в Реестре базы данных 1 февраля 2010 г).

8. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N. Engl. J. Med. 2007; 356: 1503-16.

9. Pursnani S. et al. Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Circulation: Cardiovascular Interventions. 2012; 5; 4: 476-90.

10. Kuznetsov VA, Gultyaeva EP, Berdinskih SG, et al. Long-term results of coronary stenting in patients with stable coronary artery disease in real clinical practice. Eur. Heart J. 2010; 31: 362.

11. Kuznetsov VA, et al. Should I use intracoronary Tyumen experience in percutaneous interventions in the Far East? Far medical journal. 2012; 2: 33-6. Russian (Кузнецов В.А. и др. Нужно ли использовать тюменский опыт выполнения интракоронарных чрескожных вмешательств на Дальнем востоке? Дальневосточный медицинский журнал. 2012, 2: 33-6).

12. Wijeysundera HC, et al. Comparative-Effectiveness of Revascularization Versus Routine Medical Therapy for Stable Ischemic Heart Disease: A Population-Based Study. Journal of general internal medicine. 2014; 8: 1-9.

13. Hannan EL, et al. Comparative outcomes for patients who do and do not undergo percutaneous coronary intervention for stable coronary artery disease in New York. Circulation. 2012; 125 (15): 1870-79.

14. Bangalore S, Pursnani S, Kumar S, et al. Percutaneous coronary interventionvs.optimal medical therapy for prevention of spontaneous myocardial infarction in subjects with stable ischemic heart disease. Circulation 2013; 127 (7): 769-81.

15. Wijeysundera HC, Machado M, Farahati F, et al. Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994–2005. JAMA. 2010; 303 (18): 1841-47.

16. Wijeysundera HC, Mitsakakis N, Witteman W, et al. Achieving quality indicator benchmarks and potential impact on coronary heart disease mortality. Can J Cardiol. 2011; 27(6): 756-62.