Yepanchintseva O. Changes of structural and functional state of myocardium and quality of life in patients with coronary heart disease after myocardial revascularization

The author provided a theoretical explanation and a new solution of the scientific problem to improve the results of myocardial revascularization in patients with stable coronary heart disease (CHD) by substantiating the choice of the method of revascularization, determining the predictors of complications, monitoring the changes of structural and functional state of myocardium and patients' health-related quality of life (HRQoL) at long-term follow-up. We conducted a prospective single-center study and analyzed clinical and instrumental data of 728 patients with stable CHD, consequtively enrolled and selected for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) (608 (83,5 %) males and 120 (16,5 %) females aged 29 to 92 years, mean age (61,5±9,1) years). The history of myocardial infarction was in 537 (73,8 %) patients; 686 (94,2 %) patients presentd with with stable angina of different functional classes, 675 (92,7 %) - hypertension, 244 (33,5 %) - diabetes mellitus (DM) type 2. PCI was performed in 81 (11,1 %) patients, CABG - 647 (88,9 %), including 600 (92,7 %) patients with isolated CABG. It has been established, that the choice of the method of myocardial revascularization in routine clinical practice is determined not only by the anatomy of coronary lesions. CABG group, as compared to PCI one, was characterized by the higher frequency of obesity (43,6 % vs. 29,4 %, respectively; p = 0,047), DM (34,8 % vs. 17,6 %, respectively; p = 0,006), stable angina of III and IV functional classes (87,9 % vs. 69,1 %, respectively; p <0,001). The changes of HRQoL were also more pronounced in CABG group, as compared to PCI group. In patients with comparable anatomy of coronary lesions, the important criteria for choosing the method of myocardial revascularization were clinical symptoms, concomitant diseases and previous treatment of CНD. As compared to patients without late events, the group of patients with major adverse events at long-term follow-up was characterized by the lower rates of continuation of basic CHD treatment, recommended at discharge, namely with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II receptors blockers (ARBs), statins and aldosterone antagonists, as well as triple (ACEIs or ARBs/statin/antiplatelet) therapy (74,2 % vs. 38,1 %, respectively; p<0,001) and quadriple (ACEIs or ARBs/beta-blocker/statin/antiplatelet) therapy (69,1 % vs. 37,5 %, respectively; p<0,001).