Стратификация риска сердечно‑сосудистых осложнений при стабильной ишемической болезни сердца

С. Н. Толпыгина, С. Ю. Марцевич
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Abstract

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.
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稳定型缺血性心脏病心血管并发症的风险分层
尽管包括冠状动脉疾病(CAD)在内的心血管疾病死亡率逐渐下降,但它们仍然是世界上的主要死亡原因。在未来几十年中,预计冠状动脉疾病的发病率将会增加。虽然诊断冠状动脉疾病的方法更加灵敏,高科技治疗方法也降低了急性冠状动脉疾病的死亡率,但慢性冠状动脉疾病的发病率却在逐渐上升。根据现代临床指南,对特定的稳定型 CAD 患者的检查和治疗取决于其预后,因为只有对高危患者进行心肌血管重建才能改善预后,但大多数患者接受的是统一疗法。尽管有许多对预后有重要意义的因素、模型和指数被用来评估 CAD 患者死亡和心血管并发症的风险,但目前还不存在统一的风险分层方法。本文从文学角度回顾了历史上如何确定具有重要预后意义的主要体征(包括临床症状和社会心理特征、合并症、心电图、超声心动图等非侵入性仪器检查数据、定量体力活动测试、侵入性冠状动脉造影以及一些现有的预后模型和指数),这些预后模型和指数可以帮助医生对稳定型 CAD 患者的心血管并发症风险进行分层。
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