[Efficacy of early invasive strategy of diagnostics and treatment of unstable angina at the background of preexisting ischemic heart disease].

Study aim was assessment of efficacy of early invasive tactics of treatment of patients with various forms of unstable angina at the background of preexisting ischemic heart disease. We compared noninvasive and invasive estimation of risk in 354 patients admitted to the N.V.Sklifosofsky Institute of Urgent Aid in 2002 to 2008. Percutaneous coronary interventions on infarct related artery (IRA) during 1 procedure were carried out in 144 patients (41%), indications to coronary artery (CA) bypass surgery were found in 167 patients (47%), 43 patients (12%) were treated conservatively. Coronary angiography performed in the first 48 hours gives an opportunity to determine indications to myocardial revascularization, to avoid discrepancy between choice of treatment tactics and noninvasive assessment of risk. The latter can be used with the aim of optimization of timing of early invasive strategy. In high risk it is expedient to employ it immediately, in medium - without delay allowed in recommended time intervals. Rentgenoendovascular restoration of IRA conducted during one procedure is an optimal type of myocardial revascularization in many patients including those with multiple CA involvement. Method of choice in patients with stenoses of left CA trunk or its equivalents is surgical revascularization of the myocardium. Detection of indications for myocardial revascularization in patients with unstable angina including those at medium and low risk confirms necessity of application of early invasive strategy as conventional strategy ensuring timeliness of pathogenetic treatment. Absence of indications to myocardial revascularization in a limited group of patients gives an opportunity to clarify diagnosis, prescribe drug therapy and prevent unjustified hospitalizations.