Each Thursday, at the conference hall of Cardiology Center of MC Erebouni the Seminars devoted to the problems and contemporary achievements of modern cardiology are held and the ways of introduction into practical activities of the clinic are discussed.
In 24. 11. 2016 hosted another seminar on topic “The discussion of the results of international multi-centered studies of Excel and Noble”, which was devoted to American and European guidelines for choosing the method of revascularization in patients with stenosis of the left main coronary artery.
The seminar was leaded by Director of Cardiology & Cardiovascular Surgery Services H.H. Hayrapetyan MD; PhD who presented the guest - President of the Armenian Cardiologists Association academician Prof. K.G. Adamyan. The presentations were made by the leading specialists of MC Erebouni - invasive cardiologists Dr. Sh. Torozyan (MD), Dr. A. Tzaturyan (MD) and Head of Cardiovascular Surgery Department Dr. V. Gasparyan (MD, PhD).
Dr. Shahen Torozyan pointed out that in recent years two large randomized studies (Excel and Noble) have been carried out, the results of which have been published recently.
It was noted, that in the last 1-2 decades the choice of the method of myocardial revascularization i.e. coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) has been discussed many times, particularly, in case of left main coronary artery lesion. Repeatedly were carried out comparative studies in order to identify the safety and efficacy of these methods, which led to conclusions, represented in the last recommendations of the European and American Cardiologists Association (2014). However, considering the last achievements in the interventional cardiology – the introduction of a new generation of drug –eluted stents, continuously improving tools for PCI and increasing skills of intervention cardiologists was generated new investigation in this sphere, that compare both techniques.
The essence of the report of Dr. A. Tzaturyan – is the comparison of stenting of the left main coronary artery disease and CABG results. As the speaker noted the Excel studies were carried out in 2010-2014 and were published at the end of October 2016.
In study were included approximately 2900 patients with stenosis of the left main coronary artery, out of which 1900 - were randomized, and 950 patients were included in the group for stenting, 950 -for CABG. Everolimus-eluted stents (Xience) were used. 30-day overall mortality, stroke, myocardial infarction rate was higher in patients group with CABG, and three-year results in the same group - had no statistical significance. All this proves that in a selected group of patients with stenotic left main coronary artery (Syntax score ≤32) stenting is not only allowed, but also is preferred method of revascularization.
The report of the Head of Cardiovascular Surgery Department Dr. V.Gasparyan, PhD was devoted to a prospective randomized Noble study dedicated to the results of comparative analysis of CABG and stenting in patients with stenosis of the left main coronary artery. The study showed that CABG provides more preferred results as the need to repeat an intervention within 5 years after the surgery, especially at the distal localization of the plaques, as well as in combination of stenosis of the left main coronary artery with double or triple –vessel disease. Other indicators (mortality, major cardiovascular complications) didn`t reveal significant differences between two groups of patients.
In conclusion Professor H.H. Hayrapetyan and Academician K.G. Adamyan expressed their willingness to support the colleagues in their new undertakings and in the process of introduction of new, modern and perspective treatment methods in cardiology in MC Erebouni in order to achieve more effective results in the treatment of patients.
