Усовершенствование чрескожного коронарного вмешательства у пациентов с ишемической кардиомиопатией: систематический обзор литературы
Аннотация
Цель. Оценить эффективность чрезкожного коронарного вмешательства (ЧКВ) у пациентов с ишемической кардиомиопатией и определить возможности его совершенствования, а также провести сравнительный анализ с аортокоронарным шунтированием (АКШ).
Материалы и методы. Использованы данные медицинской литературы, опубликованной в 2017–2025 годах, с применением баз данных PubMed, Scopus, Web of Science и Google Scholar. Проанализировано 110 источников из журналов с высоким импакт-фактором, включая ключевые рандомизированные контролируемые исследования (STICH, REVIVED-BCIS2), метаанализы и систематические обзоры по ишемической кардиомиопатии и методам реваскуляризации.
Результаты. Ишемическая кардиомиопатия является ведущей причиной сердечной недостаточности во всем мире, и наряду с четырёхкомпонентной фармакотерапией реваскуляризация занимает важное место в её лечении. ЧКВ демонстрирует преимущество перед АКШ в снижении риска инсульта, тогда как АКШ обладает преимуществом в уменьшении необходимости повторной реваскуляризации и улучшении долгосрочной выживаемости. У пациентов, достигших полной реваскуляризации, риск смерти снижается на 34%, а риск повторной реваскуляризации — на 33%.
Вывод. При выборе между ЧКВ и АКШ у пациентов с ишемической кардиомиопатией необходимо учитывать клинические особенности пациента, коронарную анатомию и сопутствующие заболевания. Степень реваскуляризации и жизнеспособность миокарда являются ключевыми факторами, определяющими клинические исходы.
Об авторах
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