Endovascular surgery in patients with coronary artery disease in combination with cancer

Bagrat G. Alekyan; Alexander A. Gritskevich; Narek G. Karapetyan; Dmitry V. Ruchkin; Aleksey A. Pechetov; Pavel V. Markov; Beslan N. Gurmikov; Natalya L. Irodova; Lilit G. Gyoletsyan; Evgeniy V. Tokmakov; Arthur V. Galstyan; Amiran Sh. Revishvili

South Russian Journal of Cancer. 2024. Vol. 5, No. 3. P. 39-49

https://doi.org/10.37748/2686-9039-2024-5-3-4

https://elibrary.ru/jdwvjw

ORIGINAL ARTICLE

Endovascular surgery in patients with coronary artery disease

in combination with cancer..

B. G. Alekyan1,2, A. A. Gritskevich1, N. G. Karapetyan3, D. V. Ruchkin1, A. A. Pechetov1,

P. V. Markov1, B. N. Gurmikov1, N. L. Irodova1, L. G. Gyoletsyan1, E. V. Tokmakov1,

A. V. Galstyan1 , A. Sh. Revishvili1

1 A. V. Vishnevskiy National Medical Research Center of Surgery, Moscow, Russian Federation

2 Russian Medical Academy of Continous Professional Education, Moscow, Russian Federation

3 Erebuni Medical Center, Yerevan, Republic of Armenia

garturv@gmail.com

ABSTRACT

Purpose of the study. To analyze the long-term results from various strategies of endovascular treatment for coronary artery

disease (CAD) in patients concomitant with cancer.

Patients and methods. 74 patients with both CAD disease and cancer were treated in A. V. Vishnevskiy Center from 01/01/2018

to 12/31/2022. By a multidisciplinary council, patients were divided into three groups: group 1 (n = 39) �

staged treatment:

percutaneous coronary intervention (PCI) is the first stage, the second is surgical treatment of cancer;

group 2 (n = 14) �

staged

treatment: the first

stage was surgical treatment of cancer, and the second stage was PCI; group 3 (n = 21) �

PCI and open

surgery were performed on the same day.

Results. In the immediate period, 3

(4.0

%) deaths were observed: 2

(5.1

%) in group 1, 1 (4.8

%) in group 3, the cause of which

was complications arising after oncological surgical interventions. One (2.6 %) patient from group 1 had acute myocardial

infarction (AMI) due to acute stent thrombosis in the left anterior descending artery (LAD). The patient underwent successful

emergency PCI. In the long-term period, 15 (25.4 %) patients died, out of which 11 (18.7 %) from progression of cancer, and

4 (6.7

%) from other causes. Among the major cardiovascular complications, the following were observed: 1 (3.2

%) AMI in

group 1 and 1 (7.1 %) in group 2.

Conclusion. In the long-term follow-up period, the leading cause of death (73,3 %) was progression of cancer. There were no

detected from deaths AMI, which confirms the importance and feasibility of myocardial revascularization in this severe group

of patients. PCI in patients with coronary artery disease in combination with cancer allows for effective and safe surgical

treatment of malignant pathology without cardiac mortality both in the immediate and long-term follow-up periods.

Keywords: coronary heart disease, oncological disease, percutaneous coronary intervention, malignant neoplasm, cancer,

surgical treatment, coronary artery stenting

For citation: Alekyan B. G., Gritskevich A. A., Karapetyan N. G., Ruchkin D. V., Pechetov A. A., Markov P. V., Gurmikov B. N., Irodova N. L., Gyoletsyan L. G.,

Tokmakov E. V., Galstyan A. V., Revishvili A. Sh. Endovascular surgery in patients with coronary artery disease in combination with cancer. South Russian

Journal of Cancer. 2024; 5(3): 39�49. https://doi.org/10.37748/2686-9039-2024-5-3-4, https://elibrary.ru/jdwvjw

For correspondence: Arthur V. Galstyan � MD, PhD student of Endovascular Surgery Center, A. V. Vishnevskiy National Medical Research Center of Surgery,

Moscow, Russian Federation

Address: 27 Bolshaya Serpukhovskaya str., Moscow 115093, Russian Federation

E-mail: garturv@gmail.com

ORCID: https://orcid.org/0000-0003-1142-6763

SPIN: 1783-8075, AuthorID: 1145819

Compliance with ethical standards: this research has been carried out in compliance with the ethical principles set forth by the World Medical Association

Declaration of Helsinki, 1964, ed. 2013. The study was approved by the Research Ethics Committee of the A.

V.

Vishnevskiy National Medical Research Center

of Surgery (extract from the protocol of the meeting No. 009�2021 dated 11/26/2021). Information consent was obtained from all study participants

Funding: this work was not funded

Conflict of interest: the authors declare that there are no obvious and potential conflicts of interest associated with the publication of this article

The article was submitted 06.05.2024; approved after reviewing 30.06.2024; accepted for publication 01.08.2024

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Galstyan A. V., Revishvili A. Sh., 2024

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INDRODUCTION

In the Russian Federation, primary cancers were

detected in 580,415 patients in 2021: 265,039 men

and 315,376 women.

The most common cancers in men were: tumors

of the trachea, bronchi, lung (16.4 %), prostate

(15.1 %), skin (except melanoma) (9.8 %), stomach

(7.0 %), colon (7.0 %), rectum, rectosigmoid, anus

(5.8

%). The main neoplasms in the females were:

breast cancer (22.1 %), skin neoplasms (except

melanoma) (13.4 %), uterine body (8.1 %), colon

(7.2 %), cervix (4.9 %), rectum, rectosigmoid junction,

anus (4.6 %), lymphatic and hematopoietic tissue

(4.4 %), stomach (4.2 %), ovary (4.2 %), trachea,

bronchi, lung (4.1 %). Compared with 2020, the

growth of primary detected malignant neoplasms

in the Russian Federation amounted to 4.4

% [1].

Morbidity and mortality from both oncological

and cardiovascular diseases, including coronary

artery disease (CAD), increases with age [2]. At

the same time, a combination of both nosologies

is often found. Thus, according to S. G. Al-Kindi

et al., the incidence of coronary artery disease in

patients with lung cancer is 21 %, with breast cancer

� 6 %, with colorectal cancer � 12 %, and with

kidney cancer � 17

%. [3].

The survival results of 3,234,256 cancer patients

showed that in the long-term period 1,228,328

(33 %) patients died directly from cancer, while

from cardiovascular diseases � 365,689 (11.3 %),

while 76.3 % of them were occupied by heart disease

[4].

50.6 % of patients underwent radical treatment

among all malignant neoplasms in oncological institutions

of the Russian Federation. At the same

time, the surgical method was predominant and

amounted to 59.5 %, and the share of combined

treatment was 28.6

% [5].

Complications arising after surgical interventions,

including oncological ones, lead to an increase

in inpatient care, in the cost of treatment,

and an increase in mortality [6].

A major paper by Ramamoorthy et al. presents

the incidence of major cardiovascular complications

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(MACCE) in 2,854,810 patients over 40 years

of age who underwent extensive surgical interventions

for malignant neoplasms. The overall incidence

of major cardiovascular events in the periop

erative period was 2.4 % (67,316). At the same

time, they accounted for 0.7�0.8 %. The highest

incidence of MACCE was in patients who underwent

surgery on the esophagus (6,706 per 100,000

oncological operations), followed by surgery on the

liver (5,284 per 100,000 oncological operations),

pancreas (4,820 per 100,000 oncological operations),

colon (4,038 per 100,000 oncological operations).

Of the 2,854,810 patients treated, 400,063

(14 %) had coronary artery disease, of which 31,423

(7.8

%)

had a major cardiovascular event

in the

preoperative period [7].

The purpose of the study: to analyze the longterm

results of various strategies for endovascular

treatment of coronary artery disease (CAD) in patients

with concomitant cancers.

PATIENTS AND METHODS

In the period from 01/01/2018 to 12/31/2022,

74 patients with severe coronary artery disease

in combination with cancers were treated at the

A. V. Vishnevskiy National Medical Research Center

of Surgery, the Russian Federation Ministry of

Health. The cardiovascular council determined PCI

by revascularization in connection with direct indications

for endovascular interventions, or the

refusal of cardiac surgeons to perform coronary

bypass surgery (CABG) due to the impossibility of

myocardial revascularization or concomitant pathology.

All patients were discussed at a multidisciplinary

consultation with oncologists, surgeons,

cardiovascular surgeons, endovascular surgeons,

cardiologists, anesthesiologists and intensive care

specialists. Based on the stage and degree of prevalence

of the oncological process, its manifestations

and complications, as well as the severity of

coronary artery lesions and the clinical picture of

coronary artery disease, the stages and sequence

of surgical interventions were determined.

The criteria for inclusion in the study were the

following:

a combination of active cancer

and angiographically

significant

(more

than

75

%)

coronary

artery damage; consent of the patient or his legal

representative to participate in the study after receiving

relevant information about the study.

The criteria for exclusion from the study were:

the presence of contraindications to receiving dou

ble disaggregated therapy; acute renal and hepatic

South Russian Journal of Cancer 2024. Vol. 5, No. 3. P. 39-49

Alekyan B. G., Gritskevich A. A., Karapetyan N. G., Ruchkin D. V., Pechetov A. A., Markov P. V., Gurmikov B. N., Irodova N. L., Gyoletsyan L. G., Tokmakov E. V.,

Galstyan A. V. , Revishvili A. Sh. Endovascular surgery in patients with coronary artery disease in combination with cancer

insufficiency, acute coronary syndrome (ACS) at the

time of hospitalization.

Based on the chosen treatment strategy, the pa

tients were divided into three groups:

� group 1 (39�52.7

%

of patients)

� stage-bystage

treatment: PCI was performed in the first

place, surgical treatment of oncological disease

in the second;

� group 2 (14�18.9

%

of patients)

� staged

treatment: the first stage was surgical treatment

of cancer, and the second stage � PCI;

�

group 3

(21�28.4

% of patients)

� PCI and

open surgery were performed on the same day.

The expediency of performing an early oncological

operation on the same day with PCI (group

3)

was

due

to severe

damage

to the

coronary arteries

and a malignant process complicated by bleeding,

or in

a

situation

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where

it

is

impossible

to postpone

the oncological stage of treatment even for

one month, since a delay in treatment could lead

to the unresectability of malignant formation. On

the scheduled day, patients in the catheterization

Table 1. Clinical characteristics of patients

laboratory first

underwent

endovascular myocardial

revascularization, after which they were immediately

transferred to the surgical operating unit to

perform oncological intervention.

As

a

preoperative

examination, all

patients

underwent

computed tomography, electrocardiography,

echocardiography, ultrasound, MRI, and selective

coronary angiography.

There were 63 men (85 %) and 11 women (15 %)

out of the 74 patients. The average age of the patients

was

68.8

� 7.2

years

(95

% confidence

interval

� 95 % CI 67.1�70.5). MI in the anamnesis occurred

in 29 (39.1 %) patients, angina of functional

class III�IV � in 20 (27 %) patients.

As shown in Table 1, the patients of the three

groups did not differ statistically in the main clinical

characteristics.

All 74

patients had angiographically significant

coronary artery lesions: at the same time, a singlevessel

lesion

occurred in

25

(33.8

%), a two-vessel

lesion in 25 (33.8

%),

and a three-vessel lesion in

24

(32.4

%)

patients. Lesion

of the left

main

cor-

Parameters

Group 1

(PCI + ONCO stages)

(n = 39)

Group 2

(ONCO + PCI stages)

(n = 14)

Group 3

(simultaneous PCI

and ONCO)

(n = 21)

abs. % abs. % abs. % �

Male sex

Female sex

35

4

89.7

10.3

11

3

78.6

21.4

17

4

81.0

19.0

0.457

Age. years old 68.08 � 6.86

� 67.5 � 6.51

� 71.00 � 8.10

� 0.25

BMI 26.57

(23.59�28.56) � 27.20

(25.90�32.81) � 25.00

(23.25�31.38) � 0.239

Arterial hypertension 30 76.9 12 85.7 19 90.5 0.434

Angina functional classes

Classes III�IV 12 30.8 3 21.4 5 23.8 0.827

Painless form 19 48.7 5 35.7 13 61.9 0.329

Postinfarction

cardiosclerosis 17 43.6 8 57.1 4 19.0 0.059

Arrythmia 7 18.4 0 0.0 6 28.6 0.076

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Diabetes mellitus 9 23.1 5 35.7 7 33.3 0.610

Chronic Kidney Disease.

GFR . 59.9 ml/min/1.73 m2 8 20.5 5 35.7 6 28.6 0.493

��-�� 2024. �. 5, � 3. �. 39-49

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onary artery (LMCA) was observed in 8 (10.8 %),

chronic occlusion of the coronary arteries was detected

in 18 (23.3 %) patients.

The most common oncological diseases were:

kidney cancer in 12 (16.2 %) patients, stomach cancer

in 12 (16.2 %), prostate cancer in 11 (14.9 %),

colorectal cancer in 10 (13.5 %), lung cancer in

9

(12.2

%) (Fig. 1). The distribution of patients by

stages of the tumor process was as follows: stage

I was detected in 18

(24.3

%) patients, stage II in

19 (25.7 %), stage III in 29 (39.2 %), stage IV in

8

(10.8

%) (Fig. 2). Distant metastases They were

observed in 7 (9.5 %) patients.

In 74 patients, 150 primary surgical interventions

were performed: 75

� PCI (one patient in group 1,

Kidney cancer 16.2 %

Stomach cancer 16.2 %

Prostate cancer 14.9 %

Colon cancer 13.5 %

Lung cancer 12.2 %

Esophageal cancer 8.1 %

Other localizations 18.9 %

Fig. 1. Cancer localization

Table 2. Distribution of completed PCI

due to the severity of the clinical condition, PCI

was performed in two stages: stenting of the LAD

and Circumflex Artery (CA), and then stenting of

the Right Coronary Artery (RCA)) and 75 � surgical

operations for cancer (one patient was treated with

primary multiple cancer in two stages: the first is

mastectomy, the second is kidney resection).

From the table. 2 it can be seen that in groups

1 and 3 there were patients with more severe coronary

artery lesion. In group 1, 48.7 % of patients

underwent two� and three-vessel PCI, and 2.6 %

underwent stenting of the LMCA. While in group 3,

47.6 % of patients underwent two- and three-vessel

PCI and in 9.5 % of cases PCI of the LMCA.

Of the 75 oncological surgical interventions, the

I Stage 25.7 %

II Stage 25.7 %

III Stage 37.8 %

IV Stage 10.8 %

Fig. 2. Cancer stages

PCI Group 1 (PCI + ONCO stages)

(n = 39)

Group 2 (ONCO + PCI stages)

(n = 14)

Group 3 (Simultaneous PCI and

ONCO) (n = 21)

n % n % n %

One vessel 20 51.3 12 85.7 11 52.4

Two vessel 17 43.6 2 14.3 8 38.1

Three vessel 2 5.1 0 0 2 9.5

LMCA 1 2.6 0 0 3 14.3

South Russian Journal of Cancer 2024. Vol. 5, No. 3. P. 39-49

Alekyan B. G., Gritskevich A. A., Karapetyan N. G., Ruchkin D. V., Pechetov A. A., Markov P. V., Gurmikov B. N., Irodova N. L., Gyoletsyan L. G., Tokmakov E. V.,

Galstyan A. V. , Revishvili A. Sh. Endovascular surgery in patients with coronary artery disease in combination with cancer

most frequent were: prostatectomy

� 11 (14.9 %),

gastric resection � 8 (10.8 %), lung lobectomy �

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8

(10.8

%), hemicolectomy

� 6 (8.1 %), gastrectomy

� 6 (8.1 %), nephrectomy � 6 (8.1 %), resection

kidneys � 6 (8.1 %). (Fig. 3).

The median time interval between the stage of

myocardial revascularization and surgical oncological

intervention was 56.0 (41.5�107.0) days

in group 1 and 42.5 (29.0�76.0) days in group

2 (p = 0.338).

To describe quantitative variables, the data

were combined into a series of variations and the

arithmetic averages (M) and standard deviations

(SD) or medians (Me) and confidence interval (CI)

were calculated depending on the normality of the

distribution. The normality of the distribution was

calculated using the Shapiro-Wilk criterion. Nominal

data were marked using absolute values and

percentages. In comparing independent samples

in the presence of a normal distribution, one-factor

analysis of variance (ANOVA) was used, in the ab

sence of a normal distribution, the Kruskal-Wallis

criterion was used. The nominal data were compared

using the .2-Pearson criterion or the exact

Fisher criterion, depending on the number of ob

Prostatectomy 15 %

Gastric resection 11 %

Lung lobotomy 11 %

Hemicolectomy 8 %

Gastrectomy 8 %

Nephrectomy 8 %

Kidney resection 8 %

Other 31 %

Fig. 3. The structure of oncological interventions

served phenomena less than 5. The results were

evaluated as statistically significant at p < 0.05.

STUDY RESULTS

During the hospital period, when 74 patients underwent

two-stage treatment (150 interventions),

3

(4.0

%) deaths were noted as follows: 2

(5.1

%)

in group 1, 1 (4.8 %) in group 3, caused by complications

arising after oncological surgical interventions

(Table 3).

1 (2.6 %) patient of group 1 had acute coronary

syndrome (ACS) with ST segment elevation on the

10th day after gastrectomy. This patient was initially

scheduled for simultaneous PCI and oncological

surgery. However, during the stenting of permanent

residence with a bare-metal stent, pulmonary edema

arose, which required the transfer of the patient

to the intensive care unit. After stabilization of the

condition, after 3 days, he underwent a gastrectomy

on the background of dual antiplatelet therapy.

After the onset of ACS, the patient was immediately

transported to

the catheterization laboratory,

a coronary

angiography was performed, the results of

which revealed thrombosis of the stent of the LAD.

Successful recanalization and repeated stenting

of the artery was performed to achieve an optimal

angiographic result [8].

Long-term treatment results were evaluated in

59 (83 %) of 71 patients discharged from the Center.

The analysis was carried out on the basis of

outpatient examinations, repeated hospitalizations,

and survey data. The duration of the follow�up

period in group 1 averaged 36.9 � 18.7 months (median

29.3 [20.6�54.8];

95

%

CI 30.8�43.7),

in group

2�42.5

� 12.8

months

(median

41.6

[34.8�53.3];

95

% CI

35.1�49.9), in

group

3�36.7

� 14.1

months

(median

31.1

[25.3�46.0]; 95

% CI

28.6�44.9),

(p = 0.387).

In total, 15 (25.4 %) patients died in the long-term

period (Table 4), of which 11 (18.7 %) died from

the oncological process, and 4 (6.7 %) from other

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causes. In group 1, there were 8 (25.8 %) deaths,

5 (16.1 %) of which were from the cancer progression,

1 (3.2 %) � from acute cerebral circulatory disorders

of hemorrhagic type against the background

of a prolonged

hypertensive

crisis, 1

(3.2

%)

� from

complications

of a new coronavirus

infection, to establish

the cause of death is still one patient failed.

��-�� 2024. �. 5, � 3. �. 39-49

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In group 2, 2 (14.3 %) deaths from the progression

of cancers were recorded. In group 3, 5 (25.4

%)

deaths occurred: 4 (28.6

%)

� from the progression

of cancer, 1 (1.7 %) � from bleeding due to complications

after surgery for urolithiasis.

Among the major cardiovascular complications,

there were: 1 (3.2

%) AMI in group 1

and 1 (7.1

%)

AMI in group 2. In both cases, the patients were

admitted to the hospital, where they underwent

successful PCI. It is worth noting that in the long-

Table 3. Hospital complications after two stages of treatment

Parameter

Group 1

(PCI + ONCO stages)

(n = 39)

Group 2

(ONCO + PCI stages)

(n = 14)

Group 3

(simultaneous PCI

and ONCO)

(n = 21)

�n % n % n %

Cardiovascular complications

MACCE 1 2.56 0 0.0 0 0.0 �

AMI 1 2.56 0 0.0 0 0.0 �

Stroke 0 0.0 0 0.0 0 0.0 �

Surgical complications

Bleedings 1 2.56 1 7.1 4 19.0 0.073

Organ dysfunction 2 5.1 0 0.0 3 14.3 �

Infectious complications 3 7.7 1 7.1 2 9.5 1.0

Repeated surgical intervention 2 5.1 2 14.3 3 14.3 0.365

Minor complications:

arrhythmia, hypotension,

bradycardia, anemia

10 25.6 2 14.3 9 42.9 0.177

Lethal outcomes 2 5.1 0 0.0 1 4.8 �

Table 4. Long-term treatment results

Group 1

(PCI + ONCO stages)

(n = 39)

Group 2

(ONCO + PCI stages)

(n = 14)

Group 3

(simultaneous PCI

and ONCO)

(n = 21)

Overall

n = 59�n % n % n % n %

All-cause deaths:

iНе можете найти то, что вам нужно? Попробуйте сервис подбора литературы.

8 25.8 2 14.3 5 35.7 15 25.4 0.387

AMI � � � � � � � � �

Stroke 1 3.2 � � � � 1 1.7

�

Cancer 5 16.1 2 14.3 4 28.6 11 18.7

0.667

COVID-19 1 3.2 � � � � 1 1.7

�

Bleeding � � � � 1 7.1

1 1.7

�

Other causes 1 3.2 � � � � 1 1.7

�

MACCE:

2 6.5 1 7.1 1 7.1 4 6.8 1.0

AMI 1 3.2 1 7.1 � � 2 3.4 �

Stroke 1 3.2 � � 1 7.1 2 3.4 �

South Russian Journal of Cancer 2024. Vol. 5, No. 3. P. 39-49

Alekyan B. G., Gritskevich A. A., Karapetyan N. G., Ruchkin D. V., Pechetov A. A., Markov P. V., Gurmikov B. N., Irodova N. L., Gyoletsyan L. G., Tokmakov E. V.,

Galstyan A. V. , Revishvili A. Sh. Endovascular surgery in patients with coronary artery disease in combination with cancer

term period, not a single fatal outcome from AMI

was recorded.

There were no significant differences detected

between the groups, when analyzing the overall sur

vival

rate

with

the

Kaplan-Meier method

(Fig. 4)

and

when conducting a Log-rank test (p = 0.366).

DISCUSSION

As

a rule, patients

with

malignant

neoplasms

were most often excluded from most large randomized

cardiac trials and registries. In view of

this, there

is

currently insufficient

information

about

the effect of coronary artery disease on cancer

patients. Therefore, the treatment of this group of

patients is based on the experience of individual

specialists and clinics.

Early detection, followed by the prescribed special

treatment of cancer,

is a fundamental factor

in increasing the survival rate of these patients [9].

However, in patients with combined severe coronary

artery disease, performing surgical oncological

intervention

in

the

first

stage

is

associated

with

the risk of developing cardiovascular complica-

Survival rate

1.0

0.8

0.6

0.4

0.2

0

Survival functions

0 20 40 60

Follow-up time, mon.

Group 1

Group 2

Group 3

Group 1 censored

Group 2 censored

Group 3 censored

Fig. 4. Kaplan-Meier patient survival curves

tions. At the same time, performing early oncological

surgery after percutaneous coronary intervention

against the background of patients receiving

dual antiplatelet therapy (DAPT) is associated with

the risks of intra- and postoperative bleeding. Recent

generations of stents have made it possible

to solve this problem to a greater extent by safely

reducing the intake of DAPT

to 1 month [10, 11].

A recently published study by Yun

T., et al., compared

the results of stage-by-stage treatment of

patients with lung malignancy and combined coronary

artery disease. The patients were divided into

two groups according to the timing of the interventions

performed: group 1

� patients who underwent

PCI in

the

iНе можете найти то, что вам нужно? Попробуйте сервис подбора литературы.

first

stage, and lobectomy in

the

second

stage for up to 3 months; group 2

� patients who

underwent PCI in the first stage, and lobectomy in

the second stage after 3 months. The analysis of

hospital results showed that the time of surgery,

hospital

stay and blood loss

did not

significantly

differ between the groups (p >

0.05). However,

evaluating the long-term results, the authors found

that survival for 5

years was significantly higher in

patients who underwent lobectomy up to 3 months

after PCI (p < 0.05). The

authors

concluded

that

lobectomy is more appropriate to perform in the

early period after PCI [12].

Indeed, untimely treatment of cancer can reduce

long-term survival. The

results

of a

meta-analysis

by T.

P.

Hanna et al., confirmed that a delay in

the treatment of malignant neoplasms, even by

4 weeks,

increases mortality

with surgical,

systemic

and radiological methods of treatment [13].

In our study, the start of the planned special

treatment, including surgical treatment, was carried

out as early as possible. In patients with mildly

aggressive forms of cancers and without complications

(bleeding), who had the opportunity to delay

radical treatment for 4 weeks, PCI was performed

using bare-metal stents (at the initial stage of our

research), and subsequently polymer-free stents of

the latest generation (CRE8, CID, Italy) and stents

with

a

bioresorbable

polymer (Synergy, Boston

Scientific,

USA)

(group 1). This

made

it

possible

to safely

reduce the intake of DAPT to 1 month and shorten

the time before performing oncological surgery.

In

the

case

when

a

delay in

performing

oncological

surgery was associated with the risk of rapid

progression and metastasis of the tumor process,

��-�� 2024. �. 5, � 3. �. 39-49

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or there was

a cancer with recurrent

bleeding,

which in turn did not allow the appointment of

DAPT, PCI and surgical treatment of cancers were

performed on the same day (group 3). These patients

were predominantly (84 %) implanted with

standard drug-coated stents (Resolute Integrity,

Xience Xpedition, Promus Premier).

Despite the differences in the timing of oncological

interventions in each group for deaths from all

causes, including from the progression of malignant

neoplasms,

there were no

significant differences

between the groups (p = 0.387 and p = 0.667,

respectively).

In the treatment of patients with cancer in combination

with coronary artery disease, it is important

not only to carefully perioperative management of

such patients, but also their subsequent rehabilitation

and curation after surgical interventions,

especially in the immediate postoperative period.

In the work of Guo W. et al., the development of

large cardiovascular events in the long-term period

in oncological and non-oncological patients

who underwent PCI was investigated. The analysis

showed that AMI was more common in oncological

patients

over 5

years

(16.1

% vs. 8.0

%; p

< 0.001),

stent thrombosis (6.0

%

vs. 2.3

%;

p <

0.001), repeated

revascularization

(21.2

% vs. 10.0

%; p < 0.001).

It should be noted that late stent thrombosis occurred

most often (52 %), which determines the

significance of the

first

year after PCI in

this

group

of patients

[14].

In our study, there were two cases

of AMI: the

first

� a patient 601 days after

PCI had ACS with ST

segment elevation due to thrombosis

of a previously

implanted drug-coated stent of the LAD against

the background of a new

coronavirus infection

(COVID-19). As an emergency, the patient underwent

recanalization and stenting of the LAD. The

second patient had ACS without ST segment eleva

tion after 867 days. This patient underwent balloon

angioplasty and stenting of stenosis "de novo" of

the LAD. It is important to emphasize that in our

study, not

a

single

patient

died from AMI

in

the

long term, which once again emphasizes the need

for myocardial revascularization in this group of

patients.

CONCLUSION

1. In the long-term follow-up, 15 (25.4 %) deaths

were detected, 11 (73.3 %) of which were associated

with the progression of cancer

2. In the long-term follow-up, only 1 (1.7 %) of

71 patients had a fatal outcome associated with

a cardiovascular event (acute cerebral circulatory

disorder of the hemorrhagic type). Acute myocardial

infarction occurred in only 2 (3.4 %) patients

and was successfully treated with stenting of the

infarct-related artery.

3. There was no significant difference between

the three groups in terms of such indicators as

death from all causes (p = 0.387) and oncological

mortality (p = 0.667).

4. In the long-term follow-up, no deaths from

myocardial infarction were recorded, which confirms

the importance and expediency of performing

myocardial revascularization in patients with

significant

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damage

to the

coronary arteries

and

concomitant cancer.

5. Percutaneous coronary intervention in patients

with oncological diseases makes it possible

to perform surgical treatment of cancer effectively

and safely without cardiac mortality both at the

hospital and in the long-term follow-ups.

6. The stage-by-stage treatment of patients

with coronary artery disease in combination with

cancers should be determined by the decision of

a multidisciplinary team consultation.

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Information about authors:

Bagrat G. Alekyan � Dr. Sci. (Med.), MD, professor, Academician of Russian Academy

of Sciences, head of Endovascular Surgery

Center,

A. V. Vishnevskiy National Medical Research Center of Surgery, Moscow, Russian Federation; professor of the Department of Angiology,

Cardiovascular, Endovascular Surgery and Arrhythmology named after Academician A. V. Pokrovsky, Russian Medical Academy of Continous

Professional Education, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0001-6509-566X, SPIN: 1544-2818, AuthorID: 681349, ResearcherID: F-2662-2014, Scopus Author ID: 6603583917

Alexander A. Gritskevich � Dr. Sci. (Med.), MD, head of the Urology

department, A. V. Vishnevskiy

National Medical Research Center of Surgery,

Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-5160-925X, SPIN: 2128-7536, AuthorID: 816947, Scopus Author ID: 57194755867

Narek G. Karapetyan � Cand. Sci. (Med.), MD, docent, Endovascular Surgeon of the Endovascular Surgery

Center, Erebuni Medical Center, Yerevan,

iНе можете найти то, что вам нужно? Попробуйте сервис подбора литературы.

Republic of Armenia

ORCID: https://orcid.org/0000-0002-7623-8635, SPIN: 6308-9349, AuthorID: 686595, Scopus Author ID: 57211659097

Dmitry

V. Ruchkin � Dr. Sci. (Med.), MD, head of the Department of Reconstructive Surgery

of the Esophagus of the Stomach, A. V. Vishnevskiy

National Medical Research Center of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0001-9068-3922, SPIN: 2587-8568, AuthorID: 187888, Scopus Author ID: 7003463000

��-�� 2024. �. 5, � 3. �. 39-49

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Aleksey

A. Pechetov � Cand. Sci. (Med.), MD, head of the Department of Thoracic Surgery, A. V. Vishnevskiy

National Medical Research Center

of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-1823-4396, SPIN: 8705-6005, AuthorID: 750726

Pavel V. Markov � Dr. Sci. (Med.), MD, head of the Abdominal Surgery

Department, A. V. Vishnevskiy

National Medical Research Center of Surgery,

Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-9074-5676, SPIN: 6808-9492, AuthorID: 378246, Scopus Author ID: 23473992600

Beslan N. Gurmikov � Dr. Sci. (Med.), MD, head of the Oncological Department of Surgical Methods

of Treatment, A. V. Vishnevskiy

National Medical

Research Center of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0001-5958-3608, SPIN: 1322-3629, AuthorID: 727742, Scopus Author ID: 57211081722

Natalya L. Irodova � Cand. Sci. (Med.), MD, cardiologist of Endovascular Surgery

Center, A. V. Vishnevskiy

National Medical Research Center

of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-1372-5639, SPIN: 1750-6982, AuthorID: 940973, Scopus Author ID: 6507158989

Lilit G. Gyoletsyan � Cand. Sci. (Med.), MD, cardiologist of Endovascular Surgery

Center, A. V. Vishnevskiy

National Medical Research Center

of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-4023-4317, SPIN: 8875-6000, AuthorID: 887078, Scopus Author ID: 57869351700

Evgeniy

V. Tokmakov � MD, anesthesiologist-resuscitator of the Department of Anesthesiology

and Resuscitation, A. V. Vishnevskiy

National

Medical Research Center of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0002-2821-0865, SPIN: 6851-2389, AuthorID: 963361

Arthur V. Galstyan � MD, PhD student of Endovascular Surgery Center, A. V. Vishnevskiy National Medical Research Center of Surgery, Moscow,

Russian Federation

ORCID: https://orcid.org/0000-0003-1142-6763, SPIN: 1783-8075, AuthorID: 1145819

Amiran Sh. Revishvili � Dr. Sci. (Med.), MD, professor, Academician of Russian Academy

of Sciences; director, A. V. Vishnevskiy

National Medical

Research Center of Surgery, Moscow, Russian Federation

ORCID: https://orcid.org/0000-0003-1791-9163, SPIN: 8181-0826, AuthorID: 419879, Scopus Author ID: 7003940753

Contribution of the authors:

Alekyan B. G. � scientific leadership, conducting the endovascular stage of treatment, participation in the development and design of the study,

obtaining and interpreting study data, drafting articles, correction of the article, approving the final version for publication;

Gritskevich A. A. � scientific leadership, conductiong the surgical stage of treatment, contribution to the concept and design of the study, correction

of the article, approval of the final version for publication;

Karapetyan N. G. � performing the endovascular stage of treatment, contribution to the concept and design of the study, obtaining and interpreting

study data, correction of the article;

Ruchkin D. V. � performing the surgical stage of treatment, correction of the article;

Pechetov A. A. � performing the surgical stage of treatment, correction of the article;

Markov P. V. � performing the surgical stage of treatment, correction of the article;

Gurmikov B. N. � performing the surgical stage of treatment, correction of the article;

Irodova N. L. � patient management, contribution to the concept and design of the study, correction of the article, approval of the final version for publication;

Gyoletsyan L. G. � patient management, contribution to the concept and design of the study, correction of the article, approval of the final version

for publication;

Tokmakov E. V. � provision of anesthesia at the endovascular stage of treatment, correction of the article;

Galstyan A. V. � assisting at the endovascular stage of treatment, obtaining, analyzing and interpreting research data, writing the article;

Revishvili A. Sh. � contribution to the concept and design of the study, correction of the article, approval of the final version for publication.

Endovascular surgery in patients with coronary artery disease in combination with cancer Текст научной статьи по специальности «Клиническая медицина»

Аннотация научной статьи по клинической медицине, автор научной работы — Bagrat G. Alekyan, Alexander A. Gritskevich, Narek G. Karapetyan, Dmitry V. Ruchkin, Aleksey A. Pechetov

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