scholarly journals Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery

2021 ◽  
Vol 23 (4) ◽  
pp. 485-491
Author(s):  
О. К. Gogayeva
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
High Risk ◽  
Normal Weight ◽  
High Risk Patients ◽  
Type 2 Dm ◽  
Risk Patients ◽  
Comorbidity Index ◽  
Artery Disease

The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD). Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified. Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %. Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.

scholarly journals The Influence of Obesity on Perioperative Course in High-Risk Patients with Coronary Artery Disease in Cardiac Surgery

2021 ◽  
pp. 20-27
Author(s):  
O. Gogayeva
Keyword(s):  
Coronary Artery Disease ◽  
Body Weight ◽  
High Risk ◽  
Normal Weight ◽  
Blood Transfusions ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease ◽  
Perioperative Course ◽  
Grade Iii

The aim. To analyze the influence of obesity on the perioperative course in high-risk patients with coronary artery disease (CAD) in cardiac surgery. Material and methods. Retrospective analysis of 354 randomly selected high-risk patients with CAD (ES II > 5%) who underwent surgical intervention and were discharged from the Institute in the period from 2009 to 2019. All the patients underwent routine clinical tests, ECG, echocardiography, coronary angiography and surgical revascularization of the myocardium with correction of concomitant cardiac pathology. Among the patients of the experimental group, 194 (54.8%) had CAD, 132 (37.2%) had postinfarction left ventricular aneurysm, 12 (3.3%) suffered from ischemic mitral regurgitation, 16 (4.5%) patients had CAD and aortic valve disease. Results. Among high-risk patients with CAD, 287 (81.07%) had BMI > 25 kg/m2. Carbohydrate metabolism disorders were found in 208 (72.4%) overweight patients. Type 2 diabetes mellitus (DM) was diagnosed in 78 (27.1%) patients, glucose intolerance was found in 130 (45.2%) cases. Risk stratification according to the ES II scale showed maximum risk (9.8%) in patients with normal body weight and the lowest risk (5.23%) in those with grade III obesity: however, the scale does not take into account anthropometric data. With the increase in body weight, the average number of grafts decreased (3.1 at a BMI of 25-35 kg/m2, 2.6 at a BMI > 40 kg/m2) and the use of internal thoracic arteries increased: 53.7% in patients with normal weight, 66.6% in those with grade III obesity. The level of blood transfusions was the highest (55.2%) in patients with normal weight, and in those with grade III obesity no blood transfusions were performed. Postoperative atrial fibrillation occurred in 14 (20.8%) patients with BMI up to 25 kg/m2, in 30 (28.03%) with BMI 30-29.9 kg/m2 and in 8 (34.7%) patients with grade II obesity. Regardless of body weight, there was a trend towards increase in glucose levels on the first postoperative day with subnormalization until discharge. Acute kidney injury was detected in 3 (4.4%) patients with normal weight, 3 (1.94%) overweight patients, 3 (2.8%) patients with grade I obesity and 1 (33.3%) patient with morbid obesity. Conclusions. Timely preventive measures can help to avoid serious complications even in high-risk patients with obesity. Despite the fact that overweight patients have more severe perioperative period, experience of our Institute allows to operate and treat high-risk patients successfully regardless of their body weight.

scholarly journals Analysis of Comorbidity in High-Risk Patients with Complicated Coronary Artery Disease before Cardiac Surgery

2021 ◽  
Vol 6 (2) ◽  
pp. 71-76
Author(s):  
Olena Gogayeva ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
Glomerular Filtration Rate ◽  
Coronary Artery ◽  
High Risk ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

Aim: To analyze comorbidity in high-risk patients with complicated forms of coronary artery disease before cardiac surgery. Materials and methods: Retrospective analysis of 160 randomly selected high-risk patients with complicated coronary artery disease who underwent open-heart surgery and were discharged from the Institute in the period from 2009 to 2019. The average age of patients was 59.06±9.8 years. All the patients underwent routine clinical and laboratory tests, electrocardiography, echocardiography, coronary angiography and cardiac surgery. Before cardiac surgery was performed risk stratification of patients on EuroSCORE II scale, according to the calculation, the severity of patients averaged 10.08%, which indicates a high risk of surgical death. The severity on the EuroSCORE II scale for patients with postinfarction left ventricular aneurysms was in average 9.9%, in patients with ischemic mitral regurgitation - 12.4%, and among patients with a combination of coronary artery disease with aortic valve disease, the risk of surgical death was in average 9, 2%. Results: When analyzing the baseline status of 160 high-risk patients with complicated forms of coronary artery disease, it was found that the average body mass index of patients was 28.9±4.04 kg/m2 [range 20.76-40.5 kg/m2], the level of glucose on admission was in average 6.8±2.6 mmol/l [range 3.4-21.6 mmol/l], serum creatinine averaged 107.2±25.2 μmol/l [range 56-207 μmol/l], and the estimated glomerular filtration rate averaged 67.9±18.03 ml/min/1.73 m2 [range 28-120 ml/min/1.73 m2]. Thus, 68 (42.5%) patients were overweight, 60 (37.5%) had obesity I-III st., 40 (25%) - type 2 diabetes mellitus, 79 (49.3%) - impaired glucose tolerance. 57 (35.6%) patients had chronic kidney disease with glomerular filtration rate <60 ml / min / 1.73 m2. Atherosclerotic stenosis of the carotid arteries >50% was diagnosed on Doppler study of brachiocephalic arteries in 35 (21.8%) patients. Varicose veins of the lower extremities C4-C6 stages had 42 (26.2%) patients. For 124 (77.5%) patients atherosclerosis of lower extremities arteries of different stages. Chronic obstructive pulmonary disease had 130 (81.2%) patients. 122 (76,2%) patients had a bad habit in the form of smoking, among which 20 (12.5%) continued smoking during hospitalization. 10 (6.25%) patients had gouty arthritis. Despite a high predicted mortality of 10.08% on the EuroSCORE II scale, all patients were discharged after successful surgery. Conclusions: Management of cardiac surgery patients with high-risk coronary artery disease in the perioperative period has its own characteristics and requires a personalized approach, taking into account not only cardiac features, but also comorbidity that have a great prognostic value

scholarly journals Analysis of the endocrine status of patients with coronary artery disease in cardiac surgery

2021 ◽  
Vol 28 (1) ◽  
pp. 26-33
Author(s):  
O. K. Gogayeva ◽  
A. V. Rudenko ◽  
V. V. Lazoryshynets ◽  
L. S. Dzakhoieva
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Type 2 Dm ◽  
Endocrine Status ◽  
Risk Patients ◽  
Artery Disease

The aim – to analyze the endocrine status of high-risk patients with coronary artery disease in cardiac surgery.Materials and methods. Retrospective analysis of data from random 354 high-risk patients who were operated on and discharged from M.M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine in the period from 2009 to 2019. The mean age of patients was 61.9±9.7 years. All patients underwent ECG, ECHO, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology, if necessary. In the perioperative period all patients underwent general clinical and biochemical blood tests. Stratifying the risk according to the EuroSCORE II scale, patients belonged to the high risk group and had > 5 % probability of mortality.Results and discussion. All patients had hemodynamically significant stenosis of the coronary arteries that required surgical revascularization of the myocardium. The analysis showed that 287 (81.07 %) patients were overweight, 281 (79.3 %) – had metabolic syndrome, 90 (25.4 %) – type 2 diabetes mellitus (type 2 DM), 161 (45.45 %) – impaired glucose tolerance. Thyroid disease was diagnosed in 37 (10.4 %) patients, 11 (3.1 %) patients had hypothyroidism. In the postoperative period, paroxysms of atrial fibrillation occurred in 83 (23.4 %) patients, of whom 70 (84.3 %) had type 2 DM and impaired glucose tolerance. Deep sternal infection occurred in 4 (4.4 %) patients with type 2 DM, for 3 (3.3 %) of them sternoplasty performed. Neurological complications – stroke and transient ischemic attack had 10 (2.8 %) patients among which 9 (90 %) had glucose metabolism disturbance. Acute renal failure occurred in 10 (2.8 %) patients, of whom 8 (80 %) had type 2 DM and pre-DM.Conclusions. Despite the high predicted mortality on the EuroSCORE II scale – 8.82 %, the operative mortality in the study group was 0 %, which indicates a coordinated highly skilled Heart-team work, timely verification of comorbid conditions and the involvement of related specialists.

scholarly journals Cardiac Surgery of Complicated Forms of Coronary Artery Disease: Features of the Perioperative Period in High-Risk Patients

2021 ◽  
pp. 14-22
Author(s):  
O. K. Gogayeva
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
High Risk ◽  
Perioperative Period ◽  
Left Ventricular ◽  
Average Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

The aim. To analyze the features of the perioperative period in high-risk patients with complicated forms of coronary artery disease (CAD). Material and methods. Retrospective analysis of 160 patients with CAD who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine in the period from January 2009 to December 2019. All the patients underwent electrocardiography, echocardiography, coronary ventriculography and surgical revascularization with correction of concomitant cardiac pathology. Results. One hundred thirty two (37.2%) patients were diagnosed with postinfarction left ventricular aneurysm (LVA), 12 (3.3%) with mitral regurgitation of ischemic origin, 16 (4.5%) patients had combination of CAD with aortic valve stenosis. Risk stratification by the ES II scale revealed the average risk of death of 10.08%. Surgery was performed in all the patients on day 5.7±4.7 of hospitalization. In 159 (99.3%) patients the operations were on-pump. There weak was direct correlation (r =0.29) between the dependence of the length of stay in the intensive care unit and the initial severity of the patient’s condition by the ES II scale. A weak direct correlation was found between the severity of the patient’s condition by the scales ES II (r =0.24, p=0.0022), STS (r =0.16, p=0.0325) and the time of discharge which was on 9.5±5.06 days in average. All the interventions were performed by experienced cardiac surgeons, with 25.3±14.1 years of experience in surgical treatment of CAD. Conclusions. Despite the high predicted mortality, 10.08% by the ES II scale, mortality in the studied group was 0%. In order to prevent complications, the management of patients in the perioperative period requires a clear algorithm of action and timely compensation of comorbidity at all stages of the patient’s stay in the cardiac surgery facility.

scholarly journals Predictors of coronary artery disease progression among high-risk patients with recurrent symptoms

Heart Views ◽  
2018 ◽  
Vol 19 (2) ◽  
pp. 45
Author(s):  
MouazH Al-Mallah ◽  
Iyad Farah ◽  
AmjadM Ahmed ◽  
Raed Odeh ◽  
Eltayyeb Alameen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Disease Progression ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease ◽  
Coronary Artery Disease Progression

scholarly journals P976 Can calcium score predict the appropriate treatment for high risk patients? (a 5 years follow up study)

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Stanciu ◽  
M Gurzun ◽  
S Dumitrescu ◽  
F Naftanaila ◽  
A Spanu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Bypass Graft ◽  
Calcium Score ◽  
Agatston Score ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

Abstract Coronary artery calcium score (CAC) measures the calcium contained in the artery wall and it is evaluated using multi-slice cardiac CT and CAC represents a useful tool for appreciating the burden of coronary atherosclerosis and for determining the risk for cardiovascular events. The purpose of this study is that CAC can be use for guiding treatment strategy in patients classified as high risk based on Framingham score . We prospectively enrolled 64 pts (79% male), 62,7+/-5 year, between 2002-2017. All included patients were considered high risk based on EuroSCORE model. A multislice heart CT scan was performed for every patient with CAC score determination quantified with the Agatston score and expressed as Agatston Units (AU). The patients were divided in 3 groups according to the treatment that they received during the 5 years follow up: optimal medical treatment for coronary artery disease (OMT) – 35.9% (23), percutaneous coronary angioplasty (PCA) – 29.7% (19) and coronary artery bypass graft (CABG) – 34.4%. The CAC score for pts treated by OMT vs CABG +/_ PCA were compared using the ROC curves. CAC score was statistically significantly superior in CABG+ PCA patients versus OMT (AUC: 0.96, p &lt; 0.001 vs AUC 0.42, p = 0.212). Also, a comparison of CAC score score for CABG vs OMT revealed the same results (AUC: 0.96, p&lt; 0.001 vs AUC: 0.42, p = 0.264). OMT vs CABG + PCA presented a cut-off value of 382 AU with a specificity of 90% and a sensitivity of 95%. OMT vs CABG presented a cut-off value of 530 AU with a specificity of 89% and a sensitivity of 95%. In conclusion, CAC score has a good predictability and sensitivity in determining the outcome and can be a promising tool to guide therapy in high risk patients, mainly regarding medical vs surgical treatment for coronary artery disease.

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