Научно-практический журнал
«Клиническая физиология кровообращения»

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


Каталог статей ➤ КФК. 2023; 20 (2): 89-202 ➤ Сочетание ишемической болезни сердца и онкопатологии

Сочетание ишемической болезни сердца и онкопатологии

Авторы: Рахманжанов А.А., Бузиашвили Ю.И., Асымбекова Э.У., Борбодоева Б.М.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2023-20-2-93-106

УДК: 616.12-008.46-006

Библиографическая ссылка: Клиническая физиология кровообращения. 2023; 2 (20): 93-106

Цитировать как: Рахманжанов А.А., Бузиашвили Ю.И., Асымбекова Э.У., Борбодоева Б.М. . Сочетание ишемической болезни сердца и онкопатологии. Клиническая физиология кровообращения. 2023; 2 (20): 93-106. DOI: 10.24022/1814-6910-2023-20-2-93-106

Ключевые слова: ишемическая болезнь сердца, онкопатология, чрескожные коронарные вмешательства, аортокоронарное шунтирование, летальность, острый коронарный синдром, стабильная стенокардия

Поступила / Принята к печати:  06.04.2023 / 03.05.2023

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Аннотация

Сердечно-сосудистые заболевания (ССЗ) – ведущая неопухолевая причина заболеваемости и смертности у пациентов, выживших после злокачественных новообразований. На ССЗ приходится 27% всех смертей выживших онкологических пациентов и 56% случаев смертей, не связанных с онкологическими заболеваниями. Заболеваемость обеими патологиями увеличивается с возрастом, при этом средний возрастной период диагностики распространенных видов злокачественных новообразований, таких как рак молочной железы, легких и колоректальный рак, составляет 63–71 год. Кроме того, ожирение и сахарный диабет в силу их хронического воспалительного характера приводят к раннему возникновению как ишемической болезни сердца (ИБС), так и новообразований. Методы реваскуляризации миокарда в настоящее время играют заметную роль в лечении пациентов с ИБС, и наличие онкологической патологии не должно ограничивать проведение реваскуляризации миокарда, особенно при остром коронарном синдроме. Чрескожные коронарные вмешательства (ЧКВ) были тесно связаны с более низкими скорректированными вероятностями развития серьезных неблагоприятных сердечно-сосудистых и цереброваскулярных событий и смертности от всех причин при онкозаболеваниях по сравнению с популяцией без них. Выбор стента при ЧКВ у пациентов с онкопатологиями и ИБС остается предметом дискуссий. Стенты с покрытием нового поколения обеспечивают более короткий курс антитромбоцитарной терапии (менее 6 мес) и позволяют безопасно возобновить лечение опухоли в короткие сроки (менее 6 мес, но уже через 2 нед). Одним из дискутабельных вопросов у пациентов с онкопатологией является выбор способа реваскуляризации миокарда (ЧКВ или коронарное шунтирование (КШ)). У пациентов с сочетанием онкопатологии и ИБС с хорошим отдаленным прогнозом предпочтительным может быть выполнение КШ, причем наличие рака не приводит к увеличению кардиоваскулярной смертности после проведения КШ. Таким образом, многочисленные факторы, такие как активное прогрессирующее онкологическое заболевание, текущая противоопухолевая терапия и сопутствующие заболевания, связанные с наличием опухоли (слабость, анемия, тромбоцитопения, кахексия), требуют от клинициста персонализации плана ведения пациента с ИБС с привлечением многопрофильной команды, включающей кардиолога, интервенционного кардиолога и онколога.

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Об авторах

  • Рахманжанов Алиер Алишерович, аспирант клинико-диагностического отделения; ORCID
  • Бузиашвили Юрий Иосифович, д-р мед. наук, профессор, академик РАН, заведующий отделением; ORCID
  • Асымбекова Эльмира Уметовна, д-р мед. наук, вед. науч. сотр., кардиолог; ORCID
  • Борбодоева Бактыгуль Матикановна, канд. мед. наук, науч. сотр., кардиолог; ORCID

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