Saratov JOURNAL of Medical and Scientific Research

Genkal E.N.

Saratov State Medical University n.a. V.I. Razumovsky Department of Polyclinic Therapy, Post-graduate

Drug treatment of stable coronary artery disease in the context of guidelines on myocardium revascularization

Year: 2019, volume 15 Issue: №3 Pages: 812-817
Heading: Cardiology Article type: Original article
Authors: Posnenkova О.М., Genkal E.N., Popova Yu.V., Kiselev A.R., Gridnev V.I.
Organization: Saratov State Medical University
Summary:

Purpose: to assess the quality of medical treatment in patients with stable coronary artery disease (CAD) based on 2018 European guidelines on coronary revascularization (ESC 2018) and 2017 Appropriate Use Criteria (AUC 2017) using the data from Russian multicenter registry. Material and Methods. The data from 1531 patients with stable CAD (mean age 61.7±9.8 yrs, 76% men) were studied. The source of data was Russian multicenter registry of hypertension, CAD and chronic heart failure. Administration of optimal medical therapy (OMT) in terms of ESC 2018, maximal antiischemic therapy (MAT) in terms of AUC 2017 and agreement with both criteria were evaluated. OMT included at least one antiischemic drug + antiplatelet agent + statin + short acting nitrate + RAAS blocker in patients with hypertension, diabetes and heart failure. MAT included at least two antiischemic grugs. Correspondence with these criteria was determined in the groups of patients who underwent coronary revascularization and who received only medical treatment. The criteria were also determined in the groups of patients, for whom invasive treatment were indicated primarily, for whom it could be delayed and among patients who did not need revascularization according to ESC 2018 and AUC 2017 Results. In patients treated conservatively (n=924) OMT was administered in 18% of cases, in the group of revascularization — in 9% of cases (p<0.001). MAT was also administered significantly more frequently in the group of medical treatment (34% vs 24% in the group of revascularization, p=0.001). Medical treatment met ESC 2018 and AUC 2017 criteria in the groups with and without intervention in 7 and 3% of cases correspondingly (p<0.001). Conclusion. The data of Russian multicenter registry have shown that medical treatment of stable CAD fit with European and American clinical guidelines on myocardium revascularization in only insignificant part of patients independently from selected treatment strategy.

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Perspectives of anatomical and clinical criteria use in revascularization of patients with stable coronary artery disease

Year: 2015, volume 11 Issue: №3 Pages: 280-286
Heading: Internal Diseases Article type: Author's opinion
Authors: Genkal E.N., Posnenkova О.М., Kiselev A.R., Korotin A.S., Gridnev V.I., Dovgalevsky P.Ya.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

The aim of the study is to describe the development of the algorithm for the data analysis of Russian coronary artery disease (CAD) Registry. The algorithm allows determining the need in percutaneous coronary intervention (PCI) and evaluation the validity of PCI in patients with stable CAD on the basis of appropriate use criteria for coronary revascularization by the American College of Cardiology. Two measures propose for clinical decision support and automated assessment of PCI appropriateness «The need in PCI in patients with stable CAD» and «PCI validity in patients with stable CAD».

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