Purpose: based on the analysis of the hospital results of various treatment strategies for patients with simultaneous atherosclerotic lesions of the coronary and carotid arteries, create a model for choosing the optimal revascularization strategy.
Materials and methods. From 2011 to 2015 the study included 330 patients. Depending on the applied surgical tactics, 4 groups of patients were formed: 1 group (n = 104) – phased coronary artery bypass grafting and then carotid endarterectomy (CABG-CEE); Group 2 (n = 116) – simultaneous CABG + CEE; Group 3 (n = 64) – hybrid (percutaneous coronary intervention + CEE); Group 4 (n = 46) – phased CEE – CABG.
Results. All cardiovascular complications were recorded in groups 1 and 2, however, intergroup differences were detected only in the frequency of the combined endpoint (death + myocardial infarction + stroke): death – p = 0.21 (column 1: 4 (3.8%), column 2:
2 (1.7%), column 3: 0%; column 4: 0%); myocardial infarction – p = 0.79 (1: (0.1%), 1 (0.9%), 0% and 0% respectively); stroke – p = 0.19 (4 (3.8%), 5 (4.3%), 0% and 0%); hemorrhagic complications – p = 0.29 (3 (2.9%), 9 (7.8%), 3 (4.7%), 1 (2.2%), combined end point – p = 0.02 (9 (8.6%), 8 (6.9%), 0% and 0%). Further, a prognostic coefficient was calculated for each patient's risk factor, eflecting his contribution to the development of complications. All prognostic coefficients were grouped into three groups: clinical-namnestic, coronary and cerebrovascular. Using the derived formulas for each of the groups, the integrated indices were calculated, which made it possible to determine the level of risk of complications for each specific patient using any of the four strategies of revascularization. The calculations made the basis for creating a mathematical model and a computer program for choosing the optimal tactics for surgical treatment of patients with multifocal atherosclerosis.
Conclusion. The created model and program can be applied by a multidisciplinary team in determining a personalized revascularization strategy for each individual patient.
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About the authors
- Anton N. Kazantsev, Cardiovascular Surgeon, ORCID
- Roman Yu. Leader, Student, ORCID
- Konstantin P. Chernykh, Vascular Surgeon, ORCID
- Nonna E. Zarkua, Cand. Med. Sc., General Surgeon, ORCID
- Kubach G. Kubachev, Dr. Med. Sc., Professor, General Surgeon, ORCID
- Vladimir P. Volchik, Acting Head of Department, ORCID
- Goderzi Sh. Bagdavadze, Resident, ORCID
- Evgeniy Yu. Kalinin, Cand. Med. Sc., Head of Department, ORCID
- Tat'yana E. Zaytseva, Cand. Med. Sc., Deputy Chief Physician in the Medical Field, ORCID
- Aleksandr E. Chikin, Cand. Med. Sc., Deputy Chief Physician for Surgical Care, ORCID
- Yuriy P. Linets, Dr. Med. Sc., Chief Physician, ORCID