Management Tactics for Patients High Risk With Acute Coronary Syndrome Without ST Segment Elevation and Multivessel Coronary Artery Disease (NSTE-ACSMT)

Federal State Budgetary Institution National Medical Research Center named after academician E.N. Me

Status

Enrolling

Conditions

Coronary Syndrome, Acute, Non-ST Elevation, High Risk Patients

Treatments

Procedure: Revascularization

Study type

Interventional

Funder types

Other

Identifiers

NCT06279663

NSTE-ACS Multivessel Trial

Details and patient eligibility

About

The study will include patients with acute coronary syndrome without ST segment elevation and multivessel CA lesion, who are subject to surgical treatment according to KG data (Syntax Score 23 - 32 points with significant damage to the anterior descending artery and/or trunk of the left coronary artery). The patient should be suitable for both CABG and PCI (confirmed by an X-ray surgeon and a cardiac surgeon). An X-ray surgeon and a cardiac surgeon, within the framework of planning the volume of revascularization, strives for the fullest feasible volume. Complete myocardial revascularization (that is, the desire for the absence of hemodynamically significant coronary arteries after revascularization, with a diameter of > 2.5 mm, that is, residual coronary artery stenosis of no more than 60%). Thus, patients will be randomized into groups in a ratio of 1:1. Each group will need to include 230 patients (a total of 460). In the main group, revascularization will be performed by PCI, in the control group by CABG.

Enrollment

460 estimated patients

Sex

All

Ages

18+ years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

Acute coronary syndrome without ST segment elevation of high risk: unstable angina pectoris or myocardial infarction requiring revascularization within 24 hours based on the risk of an unfavorable outcome (increase or decrease in the concentration of cardiac troponin in the blood that meet the criteria of MI; dynamic ST segment displacement or changes in T; risk on the GRACE scale >140 points)
The patient is suitable for both CABG and PCI, confirmed by an interventional cardiologist and surgeon (multivessel lesion with a Sintax score of 23-32 points with significant damage to the anterior descending artery and/or trunk of the left coronary artery).
Complete myocardial revascularization (that is, the desire for the absence of hemodynamically significant coronary arteries after revascularization, with a diameter of > 2.5 mm, that is, residual coronary artery stenosis of no more than 60%).
Signed informed consent
Age over 18 years.

Exclusion criteria

Myocardial infarction with ST segment elevation
Stable angina pectoris
Patients with OSN Killip II-IV class
Patients required an immediate PCI procedure (e.g. electrical instability)
A history of hemorrhagic stroke one year before the procedure
Ischemic stroke or TIA in the last 6 weeks
The final stage of chronic renal failure requiring dialysis.
Preliminary PCI for any other coronary artery lesion within 1 year prior to randomization.
Pre-CABG at any time prior to randomization.
The need for concomitant cardiac surgery, except for CABG (for example, valve surgery, aortic repair, etc.). Patients who require additional surgery (cardiological or extra-cardiac) for 1 year.
Non-cardiac concomitant diseases with a life expectancy of less than 1 year (for example, oncological diseases).
The left ventricular ejection fraction is less than 40%. 14. Severe degree of COPD