Abstract

Background. Cardio-renal-metabolic syndrome (CRMS) is the most dangerous combination of heart failure, chronic kidney disease, and type 2 diabetes mellitus, as it combines comorbidities, each of which is a powerful proatherogenic factor. Aim. Was to improve the management of patients with ischemic heart disease (CAD) and cardio-renal-metabolic syndrome (CRMS). Materials and methods. In a retrospective study, we included 243 patients with CAD and CRMS. Patients underwent invasive coronary angiography. In case of insignificant coronary lesions, the coronary flow reserve index was determined to establish microvascular angina, which was treated with medications. In case of single-vessel stenosing coronary lesion, PCI was performed. In case of two- or three-vessel disease, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) was performed, depending on the decision of the council. Patients were followed up for 5 years from the moment of initial hospitalization and the number of major cardiovascular events or recurrence of CAD was assessed depending on the Syntax Score. Results. Out of 243 patients, 52 (21.4%) cases had no hemodynamically significant coronary lesions according to invasive coronary angiography. In the remaining 191 (78.6%) cases, stenosing atherosclerosis of the coronary arteries was detected. Of these, 49 (25.7%) had a single-vessel lesion (anterior interventricular branch in 35 patients, right coronary artery in 9 patients, circumflex branch - in 5 cases). PCI with implantation of drug-eluting coronary stents was performed. Of the 243 patients, 142 (58.4%) had multivessel coronary lesions. Of these, 70 (49.3%) had three-vessel and 72 (50.7%) had twovessel coronary lesions. By decision of the Heart Team, 80 (56.3%) of 142 underwent PCI, while 62 (43.7%) underwent CABG. Thus, with Syntax Score I <19.5 there was no significant difference in the frequency of major cardiovascular events or recurrence of CHD with the need for repeated revascularization, while in patients with CRMS, CHD with two- and threevessel coronary artery disease with Syntax Score I ≥19.5 there is a progressive divergence of the curves with a significant difference in the prognosis for reaching the endpoint. Conclusion. In patients with coronary artery disease and cardio-renal-metabolic syndrome, the cause of myocardial ischemia in 21.4% of cases is microvascular angina, in 20.2% - single-vessel, in 58.4% - two- and three-vessel coronary artery disease. In the presence of two- and three-vessel coronary artery disease in patients with CRMS with Syntax Score I values ≥ 19.5, the choice of CABG as a method of revascularization may have advantages over PCI due to the lower number of major cardiovascular events and the need for repeated revascularization during the 5-year follow-up period