Impact of comorbid pathology on the choice of coronary revascularization method

Global mortality statistics give coronary heart disease a leading role. Surgical treatment remains the gold standard for improving prognosis and quality of life in these patients. Comorbid pathology, such as type 2 diabetes mellitus and chronic kidney disease, significantly increases the severity of ischemic heart disease, as well as the incidence of perioperative complications and the duration of the rehabilitation period. There are several methods of coronary artery atherosclerosis surgical treatment, such as: percutaneous coronary intervention, coronary artery bypass grafting, as well as a relatively new method of hybrid myocardial revascularization. The decision on the choice of surgical treatment method is made by the Heart Team, which should also include a specialist in the relevant comorbid pathology. Percutaneous coronary interventions are statistically more likely to result in the need for repeat myocardial revascularization than coronary artery bypass grafting. However, open major intervention is accompanied with a great number of postoperative complications and prolonged patient rehabilitation period. Hybrid myocardial revascularization is an alternative method that reduces the risks of adverse complications of multivessel coronary bypass and balloon angioplasty with coronary artery stenting and combines the advantages of both procedures. The choice of the optimal strategy of surgical treatment in patients with comorbid pathology requires special attention.