CHOICE OF REVASCULARIZATION METHOD IN ACUTE CORONARY SYNDROME WITH NON-ST-SEGMENT ELEVATION
Background. Questions related to the choice of the optimal revascularization method in patients with non - ST-segment elevation in acute coronary syndromes (NSTE-ACS) do not lose their relevance. The high frequency of repeated unplanned revascularization in these patients after percutaneous coronary intervention (PCI) increases the attractiveness of coronary artery bypass grafting (CABG), despite the risks and trauma of the latter. Aim. To analyze the results of various revascularization techniques in high-risk NSTE-ACS performed during the first 24 hours. Methods. As a part of a single-center retrospective study, 45 cases of CABG were examined in high-risk NSTE-ACS patients during the first 24 hours since their hospitalization for the period from 2017 to 2020. 45 cases of PCI were selected from a similar group of patients with the help of the copy-pair method. Results. The groups were comparable according to such significant factors as age, gender, postinfarction cardiosclerosis, diabetes mellitus, and multifocal atherosclerosis. However, the severity of coronary atherosclerosis according to the Syntax score was significantly higher in the CABG group (p = 0.0004). The groups were comparable in achieving complete revascularization (p = 0.2). In 8.9% (n = 4) of patients in the PCI group, unscheduled repeated revascularization was required, and in 15.6% (n = 7) of cases stent restenosis/thrombosis was detected during the hospital period and between PCI stages, while in the CABG group, congenital malformations and dysfunction were not found. Mortality in the groups did not differ significantly (4 (8.8%) versus 2 (4.4%), p = 0.4). Conclusion. CABG provides freedom from repeated revascularizations, despite the initially more severe coronary lesion.