Komorovsky R. Complex approach to the management of patients with atherosclerotic coronary and carotid artery disease associated with co-morbidities

The present thesis creates new insigts into an important scientific and practical problem of internal medicine in terms of improvement of diagnosis and long-term results of management of patients with coronary artery disease (CAD), acute coronary syndrome (ACS) and ischemic cardiomyopathy by means of better prediction of cardiac events, risk stratification and choice of treatment strategy depending on presence or absence of concomitant carotid artery disease and other comorbidities. We have been the first to determine that in a population of patients with CAD the extent and severity of atherosclerotic coronary lesions correlates with the severity of lesions in other vascular beds. We have been to establish, that concomitant atherosclerotic carotid artery disease in patients with ACS is an independent predictor of cardiac events, such as cardiac death, hospitalisations for unstable angina pectoris, as well as of a combined end-point of «hard» events: cardiac death and non-fatal MI. Morphological characteristics of carotid and coronary lesions have been shown to correlate with long-term results of treatment of patients with ACS. In particular, echogenic («hard») carotid plaques as assessed by ultrasound, when associated with coronary atherosclerotic lesions of complex morphology, as assessed on coronary angiography, are associated with worse event-free long-term survival of patients post-ACS. Also, significantly worse survival of patients post-ACS with comorbities is observed after 20th month of follow-up. We have been to determine that older age, higher number of medications, higher index of social health are independent predictors of behavioral compliance of patients to physician’s recommendations. We have been to determine that non-revascularised patients with chronic LV ischemic systolic dysfunction non just merely metabolic-perfusion mismatch but its extension (>20 %) determines mortality.