Многососудистое поражение коронарного русла у больных со стабильной ишемической болезнью сердца: актуальное состояние проблемы и пробелы в доказательности

Мировые статистические данные утверждают, что хирургическая реваскуляризация миокарда при многососудистом поражении коронарного русла предпринимается в 40–60% случаев. Однако определение степени поражения коронарных артерий (КА) зачастую проводится путем сопоставления клиники и данных селективной коронарографии (СКГ) без учета оценки функциональной значимости стеноза. До настоящего времени четко не определены алгоритмы ведения пациентов с многососудистым поражением КА и стабильной ишемической болезнью сердца (ИБС): не ясны объем, срок реваскуляризации и критерии полного отказа от оперативного лечения. Множество факторов влияют на кровоснабжение миокарда при многососудистом поражении: тип кровотока, наличие рубца и коллатералей, диаметр пораженной артерии, наличие микроваскулярной дисфункции, все это требует разумного и осмысленного подхода для определения оптимальной тактики. В настоящей обзорной работе авторы определили вектор для дискуссии и представили свое оригинальное мнение о целесообразности/необоснованности подходов к реваскуляризации у больных с многососудистым поражением КА на основе опубликованных клинических исследований (КИ) и современных рекомендаций. Разобраны уже имеющиеся данные, обозначены недостающие сведения, предложены перспективы возможных новых КИ в данном научном направлении.

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