E

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ј , 2014.

1

I O 5

1 τ τ A A EM J A τ E T 6

2 7

3 A Tτ A A A TA A τ τ A E EM J E τ E T 9

4 A τ τ τ JA τ τ A E E JE E

τ E 10

5 E E JA E E E τ τ A E EM J E τ E T 11

6 E J τ 14

7 τ τ A E EM J E τ E TI 19

8

23

9

28

9.1 Ђ PCI

(CABG) 29

9.2

35

9.3 Ђ

40

2

II 43

III 44

1 44

2 44

3 44

4 44

IV Ј 45

1 45

2 45

3 46

4 47

4.1 47

4.2 47

4.3 47

V 49

VI 50

1 50

1.1 50

1.2 51

1.3 A τ A A A JE A A 52

3

1.4 A A JE A A τ τ A A τ E A 53

1.5

CABG 55

1.6 CABG 56

1.7 CABG 57

1.8

CABG 58

1.9

CABG 59

1.10

EUROSCORE PCI 60

1.11

PCI 62

1.12

PCI 63

1.13 A A JE A A τ τ A A τ E A A

A τJ τ τ A E τ E A JE A A A E τ ЈCI

64

1.14

PCI 65

1.15

EUROSCOR-U 66

1.16

67

1.17 69

2 , ЈCI 72

4

2.1

PCI 72

2.2

PCI 73

2.3

PCI 74

3 76

3.1

PCI 76

3.2

PCI 77

3.3

78

4

80

4.1 81

4.2

(ЋЏEЋ) 82

4.3

(VES) 84

4.4

86

4.5 87

4.6

PCI 89

4.7 PCI 90

5

4.8

91

5 92

5.1

92

5.2

94

5.3 95

VII JA 97

1 ЈCI

CABG 102

VIII 106

IX Ј

107

X 109

6

I O

Ш К Ш К К К О О О Ш Ш К О

К О У О Ш О , ШУ К У К О Ш О О К К К УО

Ш К К CABG, К Ш Ш Ш К УО К К К О Ш Ш Ш Ш К Ш

Ш О , Ш К Ш О Ш О УК Ш К К О К ШУ Ш Ш К ШУ

О О У ЈCI К О Ш . К О Ш Ш К ШУО К Ш К

Ш Ш Ш Ш К, К УО К PCI О Ш О КШ

К О, Ш О О PCI К О Ш Ш К УО К К К О Ш Ш Ш Ш К Ш

Ш О О О К О О. Ш ШУ К Ш К ШУ “ О -О ”, К УО К

Ш Ш К Ш К О У Ш Ш О К УШ К CABG,

О О О У К PCI КШ УК К К О К К О Ш

О К К. О О УО Ш К К О Ш О О Ш К К Ш Ш 20% Ш 40%

Ш О PCI К О Ш , К Ш О Ш К О О О Ш Ш К К

Ш К.

О О О О О К je

О Ш К PCI К О Ш К Ш К К О К КУО К Ш

О О К К К УО Ш К К Ш О О К. К КУК К К Ш

Ш О О Ш О УК К Ш К К К Ш К Ш Ш Ш К К О УК К

УО Ш О К К К О К Ш Ш Ш К Ш О О УШ К О Ш К Ш Ш Ш

Ш К О Ш -О О ( ).

7

, К КУ К О К К Ш Ш К К О У

Ш О О К К К УО Ш О О К УШ О УО Ш К К Ш К К

УО УШ О Ш Ш О К. ШУ Ш О К О К О К О

.

τ Ш К К К Ш О О К УО УО К Ш О КУ О Ш Ш PCI К

О Ш К Ш О О К К К УО К К К О Ш PCI

К О Ш О К К Ш ОђО Ш- К Ш .

1 O O A A EM J A O E T

o o a a e j a o e o a a a e j o a a e

ea e a o a e o o o a o o o a e a e je

o a oj o e a oj o e o a a a eo o .

o e e e e e je o je a aja a e a o o

o o a e o e a (CHD) К Ш a o О О УО К Ш e e a. a ,

CHD a e a a o e o a o a e a e e К ШУ

О . CHD e a e je o e a : o a e

a e, a o a a o a a (AMI), a e e je (HF),

a ja e a e a e ( ).

o a ja, e e o a o eђ j

a je a a. a e e a o o eђ j aj

a o e e a.

8

a je a a a o a o , o o o o a

a a o o . o К УО К К К О Ш К Ш e a a a ja

o a a o aje a a e a j a o ja. a je, a e o a a CHD

e a a e o a o o a je a a a a o a o a e a e

e a a a j o a a. o a o a e a a a ja o a a

a a a aj o e o e e a o e a.

2

, ,

.

(WHO) 2008. ,

17,3 ,

30% .

,

,

80% .

2030.

, ,

23 1.

9

.

4 , 47%

. ђ

1,9

2.

.

- ,

,

3.

.

„

“, 2012.

. 54972, 53,7%

.

26,2%,

19,2%, 7,4%,

47,1%4. ,

.

10

3 A TO A A A TA A O O A E

EM J E O E T

oja " a o К" О О Ш Ш К Ш О o e a a e e

oje aђe e o a oje a a, a a oje je ђe o e e o o

ja a a o e a a a a o oja o o e , o o aj

Ш Ш К О О У О Ш О . e e , oja a o a a

o a a o e e e o e e a a e e a o oje К5.

Je К Ш Ш Ш О К О О К О О К К УО ( ) je

К О О Ш К О У О О О УО К Ш К К Ш Ш О К, КШ

О К К Ш Ш К К Ш К ШУ Ш Ш О Ш О. τ Ш К К О УК УО

О К К КШ Ш К К Ш О К К О Ш О Ш О К К О К К О

К О К У Ш Ш К О О У О Ш О .

Ш К Ш УО К Ш ОђО О Ш О , К К К О, Ш Ш Ш К Ш К

К К ШУ Ш Ш К О О У О Ш О К КУ К О Ш О Ш Ш О К КУ

О О К Ш . К Ш К О О К К КУ К О О, К К

О Ш КУ О К Ш О К Ш О6. К О К О К Ш К

К Ш КУ К ШУК Ш Ш К О О У О Ш О О К К О К К

О Ш Ш , Ш Ш Ш К7.

О Ш К К О К Ш К К Ш Ш Ш К Ш ШУ УШ О УО

К К Ш О , КШ О К К О К ШУК Ш О Ш О Ш К К ШУО

О К КУ К О К К К , О К КУ К О О О К О

О О УО О О К О О Ш К К УО.

11

ОШ К УО К Ш К О Ш К Ш К Ш К ШУО К Ш Ш К К К

Ш О Ш Ш Ш Ш ШУ О ШУ К Ш К. О К Ш О К

О К К Ш Ш К КУ К О ШУК О К Ш Ш Ш Ш К О К УО

Ш О 8.

4 A O O O JA

O O A E E JE E O E

. ,

,

9,10.

.

,

11. a e o ja o e a e a a a e e

Ш Ш К К Ш К ШК a je, e o e o

o a e o e a o o a o , o o o o a e a je o o a

a o e e a o o a e o o e, o o a o a o a a a e

Ш Ш О ШО Ш К УО .

12

5 E E JA E E E O O A E

EM J E O E T

,

.

,

.

, .

o o o ШУО E Ш ШУ j o j

a o a a e o e o e 192 ja e e a. O o a o o 57% О

Ш Ш О О К, 21% o o 22% e o a a e a

o o e 8. aj e eo o o a a o o a a e j a o e

e e o a a a o e . a e, e j a o e a e a a e a o

e e o a e o o o ja o e .

ja o e e o o a e e j e o e e j e

o a a e o e o o a a e o o a e e a. e a o e

o e o e e aj o e je e a e a e e o e ja o e,

a e e e a a o e a j e o e, ao e e a a o o ja

a o ja.

Me a e o e a je aj a e e o. О О Ш УО

О О e a o oj o a j a o a a a a a a o o a e

13

e j e o e , К К К О УО О Ш К o o a e a e

o o o a e a Ш К. К К Ш О К j О К О О УО a

e e j Ш О УО Ш О oja e e e e o aђaja aj o

o e e a o a a a e a e . aj a j О О К Ш Ш К

О О К УО o ja e e e a o e e e e a e o e e o e a je,

a e o e e ej a e a e o e e a je a o o je

o je e a e o a oђa a e o a .

„ e a a a ja o a К” oja e o o a o o o o a a e

o e o e o o a a o a je e o o o o e e o e:

Ш Ш К О К О УО К Ш (CABG)

О К К Ш Ш К К О О УК (ЈCI)

T Ш Ш К О К УК ( О К Ш К УО К К К К

К Ш Ш К К К К К О О К О Ш Ш К О

О О УО Ш О).

Ш Ш К О К О УО К Ш (CABG) УО К e o a

e a a a je ojoj e o ( О О / К О УО)

e o a e a e aђ j o a o ( ) a o

a Ш О o o a a e j , a o e o a a

o o a o e o e o o a a. CABG a e a o o e

o a o o j o a a e o oj a e e j . o e e e e e je

a je e o o a a o o a CABG e e e e a a j

e PCI. Meђ , CABG o aje o e a o e a o o a oj

14

e a a a j a je a a a o o e o o a

o o e e oje a je e o o a PCI.

a e o e ja o o a o a e o e o o a a o eђ je

a e j e oje e e a a a je o a a.

A e o e o a oj o a К > 70% e a a a e a aj o

e o o aj e e o a a o a o o o a e a e o o a

e a a a je. O a e e je o a o e PCI CABG.

a aj e e je e o e e a ja e o o a e a e je О УО ШУО

О Ш Ш О К Ш О О К К Ш К Ш О О К К К CABG.

О УО ШУО Ш К Ш К О КУ О К О К Ш Ш К К О УК К

Ш Ш Ш К К Ш УШ Ш К КУ О К ЈCI.

e a a o o a a e e ja (PCI) je e e o a

oje e o o e a e a o o a a a e ja o a a e a o o o a e e a

a o a. e aje a a Ш Ш К О О Ш К О Ш

a o a o a o a, o o a a o o o e a. PCI je o ao

o a a o a a o o a e a a a j o a je a a a

a o e a o Ш Ш К Ш Ш О .

o a e e a a a Ш Ш К Ш К К О Ш Ш

o О К УШ Ш Ш К О К О УО o a a e a PCI a e a e ja

o o a . O a o e a a a e a a . A e a o o o

a a PCI je o a e a a e a a o o oj o o a e

o o e.

15

O o o a o o a e a o a e A ea a ü a (1977),

o a je a aj o o o a . Te a e a aje o a o e o

o o a e o a o o e e a je e a e a e o a

e Ш o o e a a o o a Ш Ш Ш О О Ш О. К К О

Ш ЈCI e o o a aj a je e je o e o , ao

o e je О Ш О e je.

6 E J O

a e a o e o o a a e je e j o e e e .

T a e j a e a a a e o e a o o a o a a

o a a, a o o e a e o o a e e e je o o e a je

a. o e j e e e oj o o a a a o aja a

e je, o a a a a e o e jo a

o a e a o a e a a o a a .

a e j o o , o e je, a e e eo a e je

a e o o a o o o a jo o e o a e o a

a e o - o a a (AT ).

e o a a AT -a e a jo e a a e e j e e a e o o o

o a a je a j a (Na+) o e, a j a ( +) e ja a,

o e e ja.

A a ja a ae o o e a a o e a je a a

e e a a e e je o e a o a a e je a e j o

16

a o o o a a je a a a. To o o o a a je a e a a

a j - o o a (Na+H+) o e je o a o e j o a a jo

Na+. o a o, a a ja a e e a o a o o o o

o o e o o e e a e e j e e a e je12.

a e a a j - a j a (Na+/Ca2+) je a o aj a j e j

e a a a a a a e Ca2+ oj a a je a jo a j a o jo a

Na+. ao o o o a o o a e j o Na+, e je e o o

e a e o o eo a a a j a a e je o e a e

a e a e a a je Ca2+. o a e Ca2+ e j e a oђe o ja

e e Na2+ a a a o o o aђa e Ca2+ e j o

a o a a o e a o e j e o e e13. e a a a

e e o a e e o o e e e o e e e a o

a a jo Ca2+, a a je a oђe a a e a a oj e o e e a

o o e a e14. o o o j e a e Ca2+ e a oђe

o e a aj o o e Ca2+ o o j oj e a e je ao a a

o oj e a- o o j a e j Ca2+ a o o j

a . To o o o eo e e e a Ca2+ a o e e e

o e ja e a e e a e o a o e e o o ja15.

a a e o a e j a a aje o a e e j o a e a

o e e a e e j o a aja e a e j a o

e a e e j e e a e.

oj a a o e j o o e e e oje o o o e o e

e ja o a a ( a a) o e a e o o o e e e o a a

o a a o a a o a a. o e e o o a

17

e e ja a a je a e - o e a a o-e o ja, e a

a e o e o o a a, jo je a o aje a e o e o o

e o e e j e . Meђ , e aje a e j o a e

o a a o e o o o , e a e o a o

e a a a jo . O a К „ e e УК”, a o, e a a a e

e j o o e e e e ja, a a o e a a e j o aђaja a

e je oja o a o e e o a a, „ e e o o o e e e”.

o e e o e e j e , o oje jo a a a a oja o e

a a e j a e e j o o e e a: a o o a a o a ja.

( . απόπ ω ις )

. A o o a o e a e a a o o aђa e o o a

o e e e o o je o e a e e e o a oj a je

a o o a a e je. e j a oja a aje o a

e a o o aђa e, a o , a a, o e a je, a a je

o a a e a a e e a e16. e ja a oђe o e a a o e

e a o a a e je o a o a j , a e j e o e

oje e ja a o e a aj. a e o e a a o a e e j e

je jo je o a e o, a o o o a e a a a j

o eo o o o a o e a, ao o o o a a a j a a a

o o a e j .

a o e a a a je a a e j e je , a

e ja a a aj o e a a e eђ a, a o a a e e je o a

o a j a a e e e o je o e a a o e e o16.

18

e e ja e j o a o a o o e e j a e

e j o o e e a e ja oje o e a o oj e j o a a.

Meђ , e a oj e e j e je o a a oje e e e

a e oe e j o o e e a o e e j o aђaja a e je

oj o a o e o a e o e e a. O aj e o e o e e e ja

o a a o o a a o o o a a e e je e j o

o a o a je КШ „ e a o e e o o o e e О”. τ o o a a o

a a e o a o a a o . e e ja o a a o e a

o e e o a e a ja o e e a o e e o o

o e e a, o a o e a a a e e o e a je.

a o o o o o o e e o o o e e a, a a e ja e

e a o o je e e o o e e e. o o a e o e a a

a e j e o e e a o e ja eo o a e o a e a o

e e o o o e e e, a e a o e o o a o e j e 17.

a a o , aj e e o e e je e je e o e o e

a e a je e e o o e e a o eђe o e o a a e

o e e e je. Ta oђe je e o e o e a o a a a a a e j e

e e o o o e e a o a a a je o e j e o

e j o o e a je e e o 17. Je e a a

o o e a a o a a je e a e a o a ja o a

e e je o e a e e j o oje o o o o. a a

je o o o a o a o a ja o a e e je a a a o

a e.

19

e j e a e e e o a o e e a o o

a ja e o o a o a oj a a a oja e a o a e a

Ye o a e oy 18 e . 17. Me a e e o o o e e a

o a e aj : a) a o a e j o eo e e e e a j o oje o o

o e o a e o a, ) o a e , ) a e a a j

o o e PH e o a o o ea ) a a je a a o

a a a, o oj o o e e o o a a o a e e jo

a o o o .

a o o e o o o e e e je. a e

a o e o e a a, e je o o a aj e o o ja.

T a o a o a o ao o o ja (mPTP) a e e

a e o oje o e e ja j e e o o e e a. a a

e a a o o ja oja je o o o a a o a a e o e ja a

o o j e a e a e je o a o a e o a a jo e

e o e e. a a e e e o o e ja a o e a a a o je

„ a ja o o ”, o je o e oj e a a o e o a o

mPTP. a o a a o o e a a o e a o aje e o a , o a e o a

a a e e e a a a eђ a e a a o o ja

a o a e. e a je a e e o e j o a je a, o o aђa e

ea a eo a (ROS) o a e a o o o a. eo e e e e

a j o , a a o a a ja Ph e o o a o e

o a o a mPTP. e e o o o mPTP o o o

a aja a o a e o o a je o e o AT a e a, o a a

o o ja a e e a e je15,19. oa o o a a je

20

o o aђa e o o a a e e a e o o ja a oђe

o o e j oj . a e a o o o e e o o o e e ,

ja mPTP e a a ao a e a a e e o o

o e e a. oj a e o o je e a o e e o o

o e e e e e j o o e e a.

o e o, e a aje a e e o o o e e a o a a

a a a e e e e e j o o e e a. e o a aje a

e j o- e e o o e e a a oj a e e e o e e a

o a e aj a T e e a j o

a oj e a oj e e j o o ,

a o e e ja a oje o a e aj a o e a oj.

o a a, aj e o e a a a o M je a

e o a ja a e a a . To je o e o o a oja a e j

e e a

a e j o o e e a. a o o o e ,

a a a je a e a e e a a o e o

a eђ a e e a a o e a o e j o o e e e

a. Marry at al.20 .

21

7 O O A E EM J E

O E TI

. .

21-25.

, 26.

- ,

.

ђ 1958. 27,

26

,

.

.

, ђ , -

20. .

28-30.

22

. 25. 1964

,

.

31.

25. 1964. 9. 1967.

, . ,

32,33.

1967. ,

.

.

, ,

: - 34. 18

155

,

,

.

(Garett) (Sabiston)

35,36

1962. 1964. ,

( 1973. ),

.

23

, .

ђ , ђ

, ,

37-42.

-

, 1972. 1984.

,

43.

,

ђ

. ђ

44-48.

, ,

,

, “ ” 21-27 .

, ,

.

24

, ,

. , ,

,

27-30,49.

,

35,36,50.

ђ

51.

,

.

.

.

8

A ea o a (A.Gruntzig)

52. ,

1977. ,

.

25

, , ,

. ,

.

23% .

53 % .

1.9 2.7 53 .

ђ

ђ .

1986. 1992. .

ђ 54-58. ,

ђ

. ђ ,

, ,

30 % 60 %

,

. ђ

2% 13 % 59.

, ђ

, .

60.

.

.

,

26

,

61-63.

2002. DES ( drug eluting stent ),

.

( ) 64,65.

ђ . ,

,

.

.

,

66-68.

ђ

, ,

69.

ђ

( )

.

,

.

ђ ,

.

ђ ђ ,

( follow up ) 30-35,103,104.

27

,

,

70-73.

ђ

,

.

ђ

. ,

e

.

“ЋвЧtКб sМШrО” . ђ

.

e

“TШrКбМОЧtОr”. ,

“AЦОrТМКЧ HОКrt AssШМТКtТШЧ”,

, American College of Cardiology (ACC)/AHA

, ,

.

“ЋвЧtКб”

2005. 74.

“ЋвЧtКб sМШrО”

>50%

>1.5 .

28

16

( 1).

1.

1 2

3.5

, 5 , 0.5

. 1.5

.

, ђ ,

50%-99% .

“ЋвЧtКб sМШrО”

,

.

29

12

.

“ЋвЧtКб sМШrО” ( 0 – 22),

.

“ЋвЧtКб sМШrО” ( ђ 23 – 32 )

, .

“ЋвЧtКб sМШrО” ( 33)

.

9

.

,

:

(PCI)

(CABG).

(PCI)

(CABG).

(CABG)

.

30

9.1 Ђ PCI (CABG)

ђ PCI

CABG .

. BARI 1829 CABRI 1054.

EAST 392 , GABI 359 ,

Toulouse study 152 , MASS 142, Lausanne 134, ERACI

127 . RITA , 1011

.

ђ

, .

ђ .

BARI (The Bypass Angioplasty Revascularization Investigation)

. ђ

(PTCA) -914

(915 ).

CABG 1.3%

PTCA 1.1%. Q- ,

CABG 4.6% 2.1%.

0.8% CABG PTCA 0.2%.

31

CABG 89.3%

PTCA 86.3%

BARI ђ

.

CABG 8%

PTCA 54%. , 19 %

PTCA,

CABG

3 %. PTCA 31%

75.

CABRI–(Coronary Angioplasty versus Bypass Revascularisation

Investigation)

. ,

. ђ

.

1054 , 820 234 .

26 .

60. , 513 CABG

541 PTCA.

, CABG

2.7% PTCA 3.9%.

32

PTCA

. 66.4% PTCA

ђ CABG

93.5%76.

PTCA

.

, .

RITA – (The Randomised Intervention Treatment of Angina)

(PTCA)

(CABG).

ђ .

ђ

.

1011 .

. 45%

55 % .

, 6,5 , PTCA 17%

CABG 16%. , 39 PTCA

33

CABG 45. ,

.

PTCA 26%

CABG 19.

PTCA 4% CABG 2% 77.

EAST – (The Emory Angioplasty versus Surgery Trial)

ђ

(PTCA)

(CABG). 392 198

PTCA 194 CABG.

.

.

,

PTCA.

ЈTCA 79.3% ,

CABG 82.7%.

,

,

78.

GABI – (Germany Angioplasty vs Bypass Investigation)

ђ PTCA CABG

. 8981 307 . CABG

152 PTCA 155.

34

,

. CABG 2,2

PTCA 1,9.

, 35 CABG PTCA 41.

PTCA CABG79.

Toulouse , ђ

PTCA CABG .

2,8 152 . 76 .

67 . 3 4

52.5%, 10 % 29 %.

. CABG 7 PTCA 5 .

PTCA

9.2% CABG 1.32%

MASS – (The Medicine, Angioplasty or Surgery Study)

, ђ

,

.

214 , ,

35

. CABG 70 , PTCA 72

72 .

CABG

3%, PTCA

24%, 12%.

80.

ERACI - (Argentine Randomized Trial of Percutaneous Transluminal

Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel

Disease)

PTCA CABG

. 127

, PTCA

63 CABG o 64 . 1, 3 5

.

ђ ( Q – ,

, )

PTCA 77% 47%.

.

7.8%. 79% PTCA CABG

57%. .

PTCA 37%

CABG 6.3%

81.

36

Lausanne ,

1994,

, PTCA CABG.

134 , PTCA 68, CABG

66. 80%

56 . PTCA

11.8% 1.5%.

PTCA 8.8% CABG

3%. .

9.2

-

ђ

( , , )

PTCA. ,

.

.

37

ђ

. ARTS, SOS,ERACI-2,MASS-2, AWESOME .

ђ 1985. 2000. 3051

113 . 1518

1533 .

RTS – (The Final Analysis of the Arterial Revascularization

Therapies Study) ( )

.

1206 , PCI

600 CABG 606 .

( , ,

)82.

8% 7.6%

PCI .

18.2% CABG 14.9%.

30.3% CABG 8.8%.

.

.

38

(MACE)

.

SOS – (The Stent or Surgery trial)

53 ђ

.

988 500 CABG 488 PCI

.

21%

6%.

9%

10% CABG83.

,

.

ERACI II – (Argentine Randomized Trial of Percutaneous

Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in

Multivessel Disease II)

ђ

.

450 . 225

( ) .

.

39

30 , 1,3 5 . MACE

( )

, , .

30 CABG

3.6% 12.3%. ,

CABG 7.6 % 2.6%.

34.7%

CABG 23.6%. ,

CABG 11.6% 7.1%.

ERACI II

.

MASS II – (The Medicine, Angioplasty or Surgery Study)

, .

, ,

.

,

,

.

40

611 .

. CABG 203 ,

205 203 .

CABG 74.9%.

75.1%

69%.

:

CABG 10.3%, 13.3%

20.7% 84.

CABG 7.4 %, 41.9%

39.4%.

. ђ

.

WESOME – ( Angina With Extremely Serious Operative Mortality

Evaluation )

(

). .

41

1995. 2000. 16

ђ 2431

. O 454

142 CABG.

1650, 719 CABG.

327 119 CABG.

Kaplan-Meier

85.

CABG 73% PCI

76% .

.

9.3 Ђ

(drug-eluting stent DES)

.

. The SYNTAX trial ( Percutaneous Coronary Intervention versus

42

Coronary-Artery Bypass Grafting for Severe Coronary Artery disease),

86 87. CARDIA Trial (Coronary

Artery Revascularization in Diabetes)88, The ARTS II (Arterial

Revascularization Therapies Study)89 ERACI III trial (Argentine Randomized

Trial of Coronary Angioplasty with Stenting Versus Coronary Bypass Surgery in

Patients with Multiple Vessel Disease)90.

SYNTAX CARDI ,

ARTS II ERACI III

.

3895 .

DES 1914 1981 .

.

DES, 42% , CABG

44%. (SYNTAX,ERACI III ARTS

II), DES- 63-65

CABG 61-65 . DES 70%

68%.

34%.

. DES-

4.9% CABG 5.0%. 5.2%

4.4%.

1.9% DES CABG 2.7%.

ђ MACCE,

21.1% 16.3%.

43

,

ђ DES ђ

,

.

MACCE- .

44

II

1.

.

2.

.

3.

.

4.

.

45

III

1

.

2

.

3

.

4

.

46

IV

1

–

.

–

.

–

.

2

. :

, ( 19 ),

ђ

, 1.

2011. 31. 2012. .

47

: (18 ђ ), ђ

,

ђ DES,

.

.

3

ђ 1.

2011. 31. 2012.

.

ђ PCI

,

. 94 .

ђ

PCI (812 ).

48

4

4.1

: , ,

, .

4.2

, ,

, , ( ≥

176µmol/L), , , (BMI 30),

, ,

(EF), (MI), NYHA ,

, , ,

( ,

, ), (β-

, , , , )

.

4.3

,

, ( )

.

, ,

49

, SVES,

VES, ( ), ,

, ,

.

.

50

V

:

, , , ,

. ђ

- - .

- . ђ

.

,

ROC .

51

VI

1

1.1

906

01.01.2011.

31.12.2012. . ђ

, , ђ

, 94 .

ђ 814

( 1).

52

1.

1.2

.

649 72 %,

257 28% ( 2) .

53

2.

1.3 A O A A A JE A A

62.1 ˃ 8.5

32 82 . 65 585 65%,

321 65 ( 3 ).

54

3. У 65

1.4 A A JE A A O O A A O E A

. :

, , ,

. 374 , 825

, 617 , 390

55

356 BMI

30 ( 4).

a o 4. С a a jО a a o o a a o О a a

a a a o o a О О j О o О

56

1.5

CABG

EuroScore-

uroScore. EuroScore-

PCI 2.57 . 0,

EuroScore-a 14.

.

(0-2) 51.73%.

oj a e oo o e a o o e a o a (3-5)

44.16% .

(>5) 8.30%

( 5).

EuroScore-a PCI

2.94. 0.49, 31.2.

,

(0–2) 43.69 % .

(3–5) 52.20%.

, > 5 4.11% ( 5).

57

a o 5. С a a jО a a o o a o o О a o

o О a o a PCI

1.6 CABG

,

582, 71.7%, 230

28.3 % ( 6 ).

58

a o 6. o a a a jО a PCI

1.7 CABG

PCI

62.1 ˃ 8.36 . ђ 32,

82 . 65 527 64.9% ,

65 285 35.1% ( 7).

59

a o 7. С a o a a a jО a a CABG

1.8

CABG

. , ,

349 . 750 .

562 . 346

60

, 325 BMI 30

( 8).

a o 8. С a a jО a a o o a a o О О

CABG

1.9

CABG

PCI, 812 ђ

. , 609 β –

. 398 .

61

589 . ACE 602,

421 . ( 9).

9. С PCI

1.10

EUROSCORE

PCI

. EuroScore- PCI

2.42. 0, EuroScore-a

9.

.

62

(0-2) 57.12% . oj a e

oo o e a o o e a o a (3-5) 36.3 %

.

(>5) 6.58% ( 10).

EuroScore-a PCI

1.84. 0.5, 16.87.

,

(0–2) 61.35 % .

, (3–5) 35.50% .

, > 5

3.15% ( 10).

a o 10. С a a jО a a o o a o О a

o О a PCI

63

1.11

PCI

PCI,

. 67

71%, 29% 27

( 11)

11.

PCI

64

1.12

PCI

PCI, ,

61.92 ˃ 9.63 . ђ 35,

79 . 65 62% 58 , 65

36 38% ( 12).

a o 12. С a o a a a jО a a a О o

PCI

65

1.13 A A JE A A O O A A O E A

A A OJ O O A E O E A JE A A A

E O ЈCI

PCI PCI

. , 25

75 .

44 . 55 .

, BMI 30, 31

( 13).

a o 13. С a a jО a a o o a a o О a

a О o o PCI

66

1.14

PCI

94 PCI,

, 82 87.2% .

. 81.9% 77

. , ACE

77.7% 73 . β-

69 46 ( 14).

14. С PCI

67

1.15

EUROSCOR-U

ђ

ђ EuroScore-

. EuroScore

,

.

ђ .

PCI, О К О Ш К Ш Ш je 2.42, Ш

УО О К О Ш Ш Ш Ш К 1.84.

К УО О О Ш Ш ЈCI КУ О О Ш К Ш

Ш К 2.57, Ш УО О К О Ш Ш Ш Ш К О Ш К Ш О К Ш Ш

К Ш 2.94 ( 15).

a a e e o a o o a eђ Ш О О К УО К К

je a a aj К (p = 0,904).

a К e e o o o o a eђ

a a aj a (p = 0,198).

68

a o 15. У o О a a a a Оo О a o a o О О

a jО a a

1.16

,

.

.

PCI, 81.9% , 49 %

PCI .

(p < 0,0005).

69

PCI . 87.2%,

72.5%. a e o ЈCI

(p = 0,002) ( 16).

. β- .

PCI 73.4%, PCI 75%.

ACE , 77.7% PCI ACE

74.1%.

. PCI,

, 50.5 %

51.8% ( 16).

16. У

70

1.17

,

, , , ,

ђ .

PCI

43% PCI 26.6%.

(p=0.003).

PCI 92.4%

PCI 79.8%

(p 0.0005).

PCI, 69,2 58.5.

ђ

(p = 0,047) ( 17).

BMI > 30 .

PCI, 40 % 42.6%.

PCI 33% 46.8% ( 17).

71

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

43%

92.40%

69.20%

42.60% 40%

26.60%

79.80%

58.50%

46.80%

33%

ез PCI PCI

17. У

72

1. ј

Без PCI

(n = 812)

PCI

(n = 94) Р

n (%) n (%)

Пол ушк 582 (71,7 ) 67 (71,3) 1,000

Год е 62 (56 – 69) 63,50 (56 – 69) 0,774

EF % 53 (48 – 59) 53 (48 – 59) 0,987

А т г ег о те п ј

398 (49,0) 77 (81,9) < 0,0005

β- лок то 609 (75,0) 69 (73,4) 0,832

Ст т 589 (72,5 82 (87,2) 0,003

ACE то 602 (74,1) 73 (77,7) 0,537

Н т т 421 (51,8) 46 (50,5) 0,906

Пушење 346 (42,6) 44 (46,8) 0,504

Д ј ете 349 (43,0) 25 (26,6) 0,003

Х пе те ј 750 (92,4) 75 (79,8) < 0,0005

Х пе л поп оте е ј 562 (69,2) 55 (58,5) 0,047

BMI ˃ 30 325 (40,0) 31 (33,0) 0,225

Не т л г 101 (12,4) 10 (10,6) 0,736

73

2 ,

PCI

2.1

PCI

,

.

1 68 72.3%. ,

, 17 18%

PCI, ђ 2 .

ђ 3 . 4 ,

5 94 ( 17).

74

17. С

PCI

2.2

PCI

PCI

. , (BMS)

(DES), .

PCI, 71.27% BMS.

17.02% . PC 6.3%

5.33% ( 18 ).

75

18.

PCI

2.3

PCI

PCI ђ

.

ACD,

, RIA,

, RCX. ђ

,

D1. ђ

, .

76

RIA

RCX, ACD

RCX. RIM.

56.38%. ,

20.21% . 14.89%

, 2.12%

.

( RIM)

, , ( 19).

19.

PCI

77

3

3.1

PCI

906

.

, , ,

.

PCI 5,

1.

812 390 ђ

.

273 . 82

. 58 ,

5 ( 20).

78

20. С

PCI

3.2

PCI

PCI

4, 1.

.

, , ,

,

.

79

94 , , 48.

28 . 14 ђ

, 4 ђ 4 ( 21).

21. С

PCI

3.3

,

,

.

.

80

ђ

( ),

.

PCI

44 .

35 63.

PCI 55 .

45 70.

PCI

56 . 42

70.

66 .

52 81 .

a a e e o eђ

a je a a a PCI e a a aj a (p <

0,0005). e a e o a je a a o a e ЈCI УО 56 (42 – 70), ЈCI

44 (35–63). a a e e o E - eђ

a je a a a PCI e a a aj a (p < 0,0005). e a e o

a je a a o a e ЈCI УО 66 (52 – 81), PCI 55 (45 – 70) ( 22).

81

22. У

4

ђ .

,

.

.

82

.

.

4.1

o

.

- , ,

.

PCI 16%

. PCI

, 8.6% ( 23).

e o e a a e o PCI o e a (p =

0,034). a a o a e e ja o a je a e o e a a

a o e o o PCI (p = 0,023).

M a ja a a a o a e e ja o a je a

e o e a a a a o o e o o PCI (p = 0,030) o

o e a o BMI (p = 0,033).

Odds ratio a e o PCI je 1,964 (1,067 – 3,616). e o PCI

o e a o e o e a o a a 96 %.

83

23.

.

4.2

(SVES)

. .

PCI 32% SVES.

21% ( 24).

PCI

(p = 0,020). M a ja a a a

o a e e ja o a je a SVES a a o o e o o PCI (p =

84

0,015). Odds ratio a e o PCI je 1,783 (1,117 – 2.864). a je

a e o PCI aj 78 % a SVES.

ђ

.

je a a aj o, a je a o a

(RIA) o o a (RCX) a 5

a e a SVES.

О К К УО К О К BMЋ УО О К К ШУК К SVES -a

Ш О К (p = 0.047). Ш О К SVES -К Ш К BMЋ К 36.1 % SVES –a,

К Ш Ш К К О К je 11.1 %.

a BMS o e a a o SVES -a o o 4.5 a.

2. ј

PCI (n = 812) PCI (n = 94)

n (%) n (%)

70 (8,6) 15 (16,0) 0,034

SVES 169 (20,8) 30 (31,9) 0,020

VES 196 (24,1) 36 (38,3) 0,004

10 (1,2) 0 (0,0) 0,611

ј 5 (0,6) 4 (4,3) 0,009

. . ј 6 (0,7) 1 (1,1) 0,537

18 (2,2) 1 (1,1) 0,711

85

24.

4.3

(VES)

ђ

. ,

PCI, 38.3% ЏEЋ. PCI,

24.1% ( 25).

e o PCI

o e a , (p = 0,004). ,

ђ ЏEЋ-

86

ЏEЋ o o e a (p = 0,032). e e e e o e aj

.

M a ja a a a o a e e ja o a je a oja a

e a a o e o o PCI (p = 0,004), o a (p =

0,025), ja e e a (p = 0,027), a a a je aj e e je (p = 0,072).

Odds ratio a PCI je 1,966 (1,244 – 3.106). e o PCI o e a a

a 96.6 %. Odds ratio a o je 0,689 (0,497 – 0,953). M a aj a

31.1 % a o e a. Odds ratio a ja e e je 1,414 (1,041 – 1,923).

ja e e o e a a a 41.4 %.

25.

87

4.4

.

.

PCI, 4.3%

.

, 0.6% (

26).

У e o a О e o PCI

o e a (p = 0,009). M К УК К К К Ш К О О УК Ш К УО

К О УК Ш К О К Ш О Ш Ш ЈCI (p = 0.005).

τННs rКtТШ К О Ш ЈCI 6.702 (1.768 – 25.413). PCI

Ш О К К Ш О Ш К О Ш Ш 7 К.

88

26.

4.5

ђ

. , ђ ,

ђ

. PCI Ш 1.1% К УО К К УО Ш О О К

К Ш Ш К К ОК К УК, Ш УО ШУ КУ Ш О К Ш Ш

0.7% ( 27).

ђ ђ

, ђ .

89

a a e e o oja o a eђ ea a

e ea a je a a К К (p = 0,029). e a

e o oja o a ea a je 71 (65– 72), a

e ea a УО 62 (56 – 69).

M a ja a a a o a e e ja o a je a

a o o a a ea a ja a a o o o a (p = 0,046). Odds ratio a

o О УО 1,113 (1,002 – 1,235). a a o a e o e a a o

ea a je a 11,3 %.

27.

90

4.6

PCI

94 PCI

(ЋЏEЋ) (ЏEЋ).

VES- , 38.3 31.9% ЋЏEЋ- .

,

16% .

4.3%. ( 28).

28.

PCI

91

4.7 PCI

PCI,

. 24.1% ЏEЋ-

. 20.8% .

9%

, 0.60%

1% ( 29).

29.

О PCI

92

4.8

30.

.

o .

.

, PCI

4.3% ,

0.6%. ђ 16%

PCI, 8.6%. ЏEЋ-

38.3% 24.1% PCI. PCI

31.9% ЋЏEЋ- , 20.8% .

PCI ,

PCI 1.2% ( 30).

93

30. У

5

5.1

PCI je 23 52 .

94

10 8 , 7 96 .

PCI

22 56 . 6

32 ,

11 56 . ( 31)

a a e e o e o a a

eђ a je a a a PCI e a a aj К (p = 0,046). e a

e o e o a a a je a a o a

PCI je 0.94 (0.93 – 1.44), a PCI 0.98 (0.88 – 1.84).

31.

95

5.2

PCI

10 . ,

7

54 . PCI 12 .

6 ,

40 (

32).

a a e e o e o a a o eђ

a je a a a PCI e a a aj К (p = 0,006). e a e o

e o a a o a je a a o a e PCI je 12 (9–17), a a PCI 10

(9–14).

0

5

10

15

20

д н 12 д н

vreme provedeno u ол

г уп PCI

г уп ез PCI

32.

96

5.3

19 2.09%

. PCI

1.1%. PCI 18

2.2% ( 33).

o e o PCI o e a (p = 0,711). a a

e e o oja o a eђ e e je a

a aj a (p = 0.017). e a e o oja o a je 71 (60 – 72), a

e e 62 (56 – 69). o

a a e a o e a (p = 0,021). a a o a

e e ja o a je a Ш О К Ш О Ш Ш ЈCI (p = 0,470).

M a ja a a a o a e e ja o a je a o

a a o o oja o a a je a (p = 0,039) o a a a a e a

(p = 0,034). Odds ratio a o e je 1,064 (1,003 – 1,128). a a o a

e o e a a o o o a a 6,4 %. Odds ratio

3,328 (1,093 – 10,134).

97

33. У

98

VII JA

.

, ,

-

.

.

91,92. ,

,

93-95.

. ђ ,

.

1995., 96

PCI CABG. ђ 234

ђ PCI К К CABG , К

99

УО Ш 4,0 % , О Ш Ш ЈCI ШУ УО

2.8 % ( = 0,04 ). 1996, 97

172.184 ђ

CABG, PCI - .

PCI 2,

. Kalaycioglu

98 1998. 80

CABG,

ЈCI. , 99,

6504 CABG ( 919

PCI), PCI

CABG, 1.93 (p = 0.003) .

ђ , PCI -

CABG.

,

, PCI

100-102. ,

ђ PCI CABG. ,

10% 20 % 99,103,104 .

, PCI 94 (9,57%).

,

PCI,

CABG .

100

ЈCI

CABG,

ђ 105.

Bonaros 106 306

. ђ PCI CABG

CABG. PCI

(4.4% 2.4%, p<0.001).

906 ,

2011. 2012. ђ CABG

PCI (812 )

1,83 %. PCI CABG

(94 ) 1,06%.

PCI

CABG,o

ђ .

107. Yap 13,184

(1,457 PCI ) ђ CABG PCI

ђ PCI

(odds ratio 1,11; p=0.41). Thielmann 108

2626 ђ CABG PCI

ђ PCI ,

PCI-a.

101

,

.

.

,

, .

ђ PCI

(p = 0,034). a a o a e e ja o a je a e o e a a

a o e o o PCI (p = 0,023).

M a ja a a a o a e e ja o a je a

e o e a a a a o o e o o PCI (p = 0,030) o

o e a o BMI (p = 0,033).

Odds ratio a e o PCI je 1,964 (1,067 – 3,616). e o PCI

o e a o e o e a o a a 96 %.

(p=0,041).

PCI

(p<0,0005).

102

PCI, 81,9% ,

49,0% .

.

.

.

,

.

.

PCI (p=0,009).

M a ja a a a o a e e ja o a je a e ja o a e

a o e o o PCI (p = 0.005).

Odds ratio a e o PCI je 6.702 (1.768 – 25.413). e o PCI

o e a a o e o a e o o 7 a.

.

. ЋЏEЋ,

ЏEЋ.

SVES PCI (p=0,020). M a ja a a a

o a e e ja o a je a SVES a a o o e o o PCI (p =

0,015).

Odds ratio a e o PCI je 1,783 (1,117 – 2.864). a je a

e o PCI aj 78 % e a SVE.

103

,

PCI ђ (p=0,032).

VES .

M a ja a a a o a e e ja o a je a oja a

e a e a je a o e o o PCI (p = 0,004), o a (p = 0,025),

ja e e a (p = 0,027) a a a je aj e e je (p = 0,072).

Odds ratio a PCI je 1,966 (1,244 – 3.106). e o PCI o e a a

a 96.6 %.Odds ratio a o je 0,689 (0,497 – 0,953). M a aj a 31.1 %

a o e a. a ja e e je 1,414 (1,041 – 1,923). ja e e

o e a a a 41.4 %.

1

PCI CABG

PCI CABG:

1. ,

.

,

104

, drug-eluting ,

109.

2.

.

.

ђ 110.

PCI

.

3.

( )

ђ .

,

,

. , ,

,

.

4.

. ,

, .

,

.

.

105

5.

,

.

111.

6.

. PCI

CABG.

ђ CABG,

112.

7. ђ PCI

.

,

.

PCI

.

8.

.

,

.

.

106

, , ,

ђ .

CABG,

113-115. BMS

drug-eluting 115.

107

VIII

,

.

,

.

ђ PCI

.

,

.

PCI.

.

PCI

108

IX

.

.

EuroScore .

ђ

EuroScore . PCI

.

PCI

.

, PCI

,

,

.

PCI

, ,

PCI

.

109

,

PCI

( ) ,

, (

).

,

ђ .

110

X

1. World Health Organization; Cardiovascular diseases; Fact sheet N0 317,

Septembar, 2011.

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