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 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 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.

scholarly journals Impact of Diabetes Mellitus on Outcomes after High-Risk Interventional Coronary Procedures

2020 ◽  
Vol 9 (11) ◽  
pp. 3414
Author(s):  
Laura Johannsen ◽  
Julian Soldat ◽  
Andrea Krueger ◽  
Amir A. Mahabadi ◽  
Iryna Dykun ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Survival Rate ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Insulin Dependent ◽  
Artery Disease ◽  
One Year

An increasing number of patients with coronary artery disease are at high operative risk due to advanced age, severe comorbidities, complex coronary anatomy, and reduced ejection fraction. Consequently, these high-risk patients are often offered percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass grafting (CABG). We aimed to investigate the outcome of patients with diabetes mellitus (DM) undergoing high-risk PCI. We analyzed consecutive patients undergoing high-risk PCI (period 01/2016–08/2018). In-hospital major adverse cardiac and cerebrovascular events (MACCEs), defined as in-hospital stroke, myocardial infarction and death, and the one-year incidence of death from any cause were assessed in patients with and without DM. There were 276 patients (age 70 years, 74% male) who underwent high-risk PCI. Eighty-six patients (31%) presented with DM (insulin-dependent DM: n = 24; non-insulin-dependent DM: n = 62). In-hospital MACCEs occurred in 9 patients (3%) with a non-significant higher rate in patients with DM (n = 5/86, 6% vs. n = 4/190 2%; p = 0.24). In patients without DM, the survival rate was insignificantly higher than in patients with DM (93.6% vs. 87.1%; p = 0.07). One-year survival was not significantly different in DM patients with more complex coronary artery disease (SYNTAX I-score ≤ 22: 89.3% vs. > 22: 84.5%; p = 0.51). In selected high-risk patients undergoing high-risk PCI, DM was not associated with an increased incidence of in-hospital MACCEs or a decreased one-year survival rate.

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