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Chronic mesenteric ischemia (CMI) is an urgent public health problem. The long asymptomatic course of the disease, sudden onset and an unfavorable prognosis in the absence of treatment make it necessary to pay closer attention to this pathology. There are currently two competitive treatments for CMI: surgical and endovascular revascularization. Despite numerous studies comparing these methods, the question of which one is more effective and reliable remains open. The review includes current data from clinical trials and meta-analyses demonstrating the advantages and disadvantages of both methods.

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<p><strong>Aim.</strong> The article looks at the effect of the program "Confidence" to increase the proportion of patients’ therapy in patients with coronary heart disease for two years after successful revascularization using thrombolytic or stenting of the coronary arteries on the myocardial infarction.<br /><strong>Methods.</strong> This is a prospective, randomized, controlled, parallel-group trial including 4.000 patients. They will be divided into two groups: patients receiving standard outpatient observation (n=2000) and those enrolled for the program "Confidence" (n=2000). The total duration is 24 months. The trial will take place in two stages. In the first stage (0-12 months) the impact of the program "Confidence" on therapy adherence and outcomes of cardiovascular diseases will be assessed. In the second stage (after the change of groups in 12 months, 12-24 months) the effect of changing the way to remind patients of therapy adherence will be evaluated.<br /><strong>Conclusion.</strong> The trial was designed in such a way as to show that the proposed program "Confidence" increases the proportion of patients who adhere to therapy in the cohort of those with coronary heart disease for two years after successful revascularization by using thrombolytic or stenting of the coronary arteries against the background of myocardial infarction.</p><p>Received 13 February 2017. Accepted 9 March 2017.</p><p><strong>Financing:</strong> KRKA company’s grant. Sponsorship had no effect on data acquisition, analysis and interpretation.</p><p><strong>Conflict of interest:</strong> Kretov E.I. served as executive editor of “Endovascular surgery” section. All other authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Study conception and design: Kretov E.I., Grazhdankin I.O., Baystrukov V.I., Zubarev D.D. <br />Statistical data processing: Krestyaninov O.V., Kozyr K.V., Obedinskiy A.A., Prokhorikhin A.A.<br />Drafting the article: Tarkova A.R., Anisimova V.D.<br />Critical revision: Tarkova A.R., Anisimova V.D., Kretov E.I.</p>

World statistics data suggest that the surgical revascularization of the myocardium in multivessel coronary artery disease is performed in 40 to 60% of cases. However, severity of coronary artery disease is often evaluated through the analysis of clinical presentation and selective coronary angiography (ICA) data without an assessment of the functional significance of stenosis. A precise algorithm for the treatment of patients with multivessel coronary artery disease and stable coronary artery disease is still unavailable, i.e. extent of revascularization, its time, and criteria for complete withholding of surgical treatment remain unclear. Many factors affect myocardial blood supply in multivessel disease including the type of blood supply to the heart, presence of scar and collaterals, diameter of the affected artery, and presence of microvascular dysfunction. All these factors require rational and intelligent approach to establishing the optimal tactics. In this review, the authors identified discussion vector and presented their original opinion on the advisability/unreasonableness of approaches to revascularization in patients with multivessel coronary disease based on published clinical trials and current recommendations. In addition, we analyzed the existing data, identified the missing information, and proposed the prospects for possible new clinical studies in this scientific field.