farmaecFARMAKOEKONOMIKA. Modern Pharmacoeconomics and PharmacoepidemiologyФАРМАКОЭКОНОМИКА. Современная фармакоэкономика и фармакоэпидемиология2070-49092070-4933IRBIS LLC10.17749/2070-4909/farmakoekonomika.2021.051farmaec-532Research ArticleREVIEW ARTICLESОБЗОРНЫЕ ПУБЛИКАЦИИComparative effectiveness of simultaneous and staged operations in patients with atherosclerotic lesions of carotid and coronary arteriesСравнительная эффективность симультанных и этапных операций у пациентов с атеросклеротическим поражением сонных и коронарных артерийИсмоиловаА. Б.IsmoilovaA. B.

Исмоилова Азиза Бахтиёр кизи – студентка 1-го курса магистратуры по направлению «Организация и управление фармацевтическим делом»

ул. Ойбека, д. 45, Ташкент 100015, Республика Узбекистан

Aziza B. Ismoiliva – 1st year Master's Student in Organization and Management of Pharmaceutical Business

45 Oybek Str., Tashkent 100015, Republic of Uzbekistan

https://orcid.org/0000-0002-1658-7972CултанбаеваН. М.У.SultanbaevaN. M.U.

Cултанбаева Наргиза Мухамед Умаровна – ассистент кафедры организации фармацевтического дела

ул. Ойбека, д. 45, Ташкент 100015, Республика Узбекистан

Nargiza М.U. Sultanbaeva – Assistant Professor, Chair of Pharmaceutical Business Organization

45 Oybek Str., Tashkent 100015, Republic of Uzbekistan

nargiz6985@gmail.comhttps://orcid.org/0000-0003-0813-9333АбдурахмановА. А.AbdurakhmanovA. A.

Абдурахманов Абдусалом Абдулагзамович – к.м.н., заведующий отделением кардиохирургии. WoS ResearcherID: AAR-5024-2021

ул. Нурхон, д. 2, Ташкент 100081, Республика Узбекистан

Abdusalom А. Abdurakhmanov – MD, PhD, Head of Department of Cardiac Surgery.  WoS ResearcherID: AAR-5024-2021

2 Nurkhon Str., Tashkent, Republic of Uzbekistan

https://orcid.org/0000-0003-4106-0395УмароваШ. З.UmarovaSh. Z.

Умарова Шахноз Зиятовна – к.фарм.н., профессор, заведующая кафедрой организации фармацевтического дела

ул. Ойбека, д. 45, Ташкент 100015, Республика Узбекистан

Shakhnoz Z. Umarova – PhD (Pharm.), Professor, Chief of Chair of Pharmaceutical Business Organization

45 Oybek Str., Tashkent 100015, Republic of Uzbekistan

ДжалаловаД. Х.DzhalalovaD. Kh.

Джалалова Дилфуза Хамидовна – заведующая научной лабораторией оценки технологии здравоохранения и фармакоэкономики

ул. Ойбека, д. 45, Ташкент 100015, Республика Узбекистан

Dilfuza Kh. Dzhalalova – Head of Scientific Laboratory of Health Technology Assessment and Pharmacoeconomics

45 Oybek Str., Tashkent 100015, Republic of Uzbekistan

ДжалаловС. Ч.DzhalalovS. Ch.

Джалалов Санджар Чингизович – д.э.н., профессор кафедры организации фармацевтического дела

ул. Ойбека, д. 45, Ташкент 100015, Республика Узбекистан

Sandzhar Ch. Dzhalalov – Dr. Econ. Sc., Professor, Chair of Pharmaceutical Business Organization

45 Oybek Str., Tashkent 100015, Republic of Uzbekistan

Ташкентский фармацевтический институтУзбекистанTashkent Pharmaceutical InstituteUzbekistanРеспубликанский научный центр экстренной медицинской помощиУзбекистанRepublican Scientific Center of Emergency Medical CareUzbekistan202127072021142263–269Copyright © Ismoilova A.B., Sultanbaeva N.M., Abdurakhmanov A.A., Umarova S.Z., Dzhalalova D.K., Dzhalalov S.C., 20212021Исмоилова А.Б., Cултанбаева Н.М., Абдурахманов А.А., Умарова Ш.З., Джалалова Д.Х., Джалалов С.Ч.Ismoilova A.B., Sultanbaeva N.M., Abdurakhmanov A.A., Umarova S.Z., Dzhalalova D.K., Dzhalalov S.C.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmacoeconomics.ru/jour/article/view/532Objective

Objective: comparative systematic analysis of clinical trials of staged and simultaneous approaches in the surgical treatment of combined carotid and coronary stenosis based on the literature search.

Material and methods

Material and methods. A systematic literature search was performed in PubMed/MEDLINE, Google Scholar and Scopus using predefined acceptance criteria. To compare data of simultaneous and staged surgery cumulative indicators of heart attack, stroke and mortality, expressed as percentages and absolute numbers, were analyzed; the Mantel–Hensel formula and the χ2 method were used to assess the relative risk of major adverse cardio-cerebral events development and mortality.

Results

Results. The analysis included 7 studies containing one intervention (4 simultaneous and 3 stage methods). The risk of developing myocardial infarction was RR 0.13 (95% CI 0.02–0.67) for simultaneous tactics, and RR 7.79 (95% CI 1.5–40.43) for staged tactics (p˂0.005). The risk of stroke developing was RR 1.29 (95% CI 0.56–2.99) for a simultaneous approach, and RR 0.78 (95% CI 0.33–1.8) for stage approach (p˃0.05). The risk of mortality was RR 0.77 (95% CI 0.31–1.88) for simultaneous procedures, and RR 1.3 (95% CI 0.53–3.18) for staged procedures (p˃0.05).

Conclusion

Conclusion. Staged tactics for combined carotid and coronary stenosis may be accompanied by a significantly higher risk of myocardial infarction. There was no statistically significant difference between the groups in terms of the risk of stroke and mortality, but there was a trend towards a higher risk of stroke in the simultaneous group and a higher risk of death from all causes in the staged group.

Цель

Цель: сравнительный анализ клинических исследований этапного и симультанного подходов в хирургическом лечении сочетанных поражений каротидного и коронарного русла по данным литературы.

Материал и методы

Материал и методы. Был выполнен систематический поиск литературы в базе данных PubMed/MEDLINE, Google Scholar и Scopus с помощью предварительно определенных критериев приемлемости. Сравнивая данные симультанной хирургии с этапной хирургией, анализировали кумулятивные показатели частоты инфаркта, инсульта и летальности, выраженные в процентах и абсолютных цифрах. Для оценки относительного риска (related risk, RR) развития осложнений использовали формулу Мантеля–Хензеля и критерий χ2.

Результаты

Результаты. В анализ вошли 7 исследований, которые содержали одно вмешательство (4 симультанных и 3 этапных метода). Риск развития инфаркта миокарда: при симультанной тактике – RR 0,13 (95% ДИ 0,02–0,67), при этапной – RR 7,79 (95% ДИ 1,5-40,43) (р˂0,005). Риск развития инсульта: при симультанном подходе – RR 1,29 (95% ДИ 0,56–2,99), при этапном – RR 0,78 (95% ДИ 0,33–1,8) (р˃0,05). Риск летальности: при симультанных операциях – RR 0,77 (95% ДИ 0,31–1,88), при этапных – RR 1,3 (95% ДИ 0,53–3,18) (р˃0,05).

Заключение

Заключение. Этапная тактика при сочетанных стенозах каротидного и коронарного русла может сопровождаться достоверно более высоким риском развития инфаркта миокарда. В отношении риска развития инсульта и летальности статистически достоверной разницы между группами выявлено не было, но отмечена тенденция к более высокому риску инсульта в симультанной группе и более высокому риску смерти от всех причин в этапной группе.

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The authors declare that there are no conflicts of interest present.