scholarly journals Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part I

2021 ◽  
pp. 10-17
Author(s):  
Olena K. Gogayeva ◽  
Mariia A. Drobnich ◽  
Natalia O. Lytvyn ◽  
Oleksandra O. Nastenko ◽  
Roman I. Salo
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Kidney Disease ◽  
Myocardial Revascularization ◽  
Comorbidity Index ◽  
Artery Disease

Every year we see an increase in the number of patients with indications for surgical treatment of coronary artery disease. In addition to the difficulties of the cardiac surgery process, no less important is the therapeutic support of patients, which in addition to cardiac subtleties requires guidance in concomitant nosologies. As the age of patients increases, there is a higher comorbidity which is associated with difficult management of patients, extensive prescription of drugs and higher cost of medical care. The aim. To analyze the current literature data on comorbidity in patients hospitalized for coronary artery bypass grafting. Results. According to the literature data, there is a high Charlson comorbidity index, in average 5.7 ± 1.7, in the baseline status of patients with coronary artery disease. High comorbidity index is known for its negative effect on the functioning of grafts in the long-term period after surgical myocardial revascularization. Among patients who underwent surgical revascularization of the myocardium, 22.8–46.9% had diabetes mellitus, 37.5% had obesity, 1.1% had rheumatoid arthritis and 10–12% suffered from chronic kidney disease. There is no statistical data on preoperative status of gastrointestinal tract, but the main complications and predictors of death were identified. Due to the increase in the occurrence of autoimmune diseases on the background of the COVID-19 pandemic, an increase in the number patients with connective tissue diseases in cardiac surgery is predicted, and perioperative management of such patients has its own characteristics and requires further in-depth study. Conclusions. Searching for comorbidity in cardiac surgery patients with coronary artery disease is an important component of their preoperative preparation and risk stratification. The influence of type 2 diabetes mellitus, obesity, autoimmune diseases, chronic kidney disease on the occurrence of postoperative complications and the result of surgical myocardial revascularization has been proven. SARS-CoV-2 infection in the surgical treatment of coronary artery disease is another challenge of today that requires further observation and research to help address prognosis, complications, and mortality.

Influence of chronic kidney disease on coronary plaque components in coronary artery disease patients with both diabetes mellitus and hypertension

2019 ◽  
Vol 34 (7) ◽  
pp. 1065-1075 ◽  
Author(s):  
Eiji Shigemoto ◽  
Atsushi Iwata ◽  
Makito Futami ◽  
Yuta Kato ◽  
Motoki Yamashita ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Coronary Plaque ◽  
Artery Disease

Abstract 15044: Impact of Chronic Kidney Disease on the Pharmacodynamic and Pharmacokinetic Effects of Ticagrelor in Patients With Diabetes Mellitus and Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Francesco Franchi ◽  
Fabiana Rollini ◽  
Latonya Been ◽  
Naji Maaliki ◽  
Patrick Abou Jaoude ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Platelet Reactivity ◽  
Artery Disease ◽  
Trough Levels

Background: Diabetes mellitus (DM) is a key risk factor for the development of chronic kidney disease (CKD) and patients having both risk factors have increased risk of atherothrombotic events, underscoring the importance of antiplatelet therapy. Ticagrelor reduces ischemic events compared with clopidogrel, with the greatest risk reduction in patients with both DM and CKD. However, how CKD status affects the pharmacodynamic (PD) and pharmacokinetic (PK) profiles of different ticagrelor dosing regimens in DM patients is unknown. Methods: This was a prospective, randomized, cross-over study testing the PD/PK profiles of ticagrelor 90mg bid and 60mg bid among DM patients with and without CKD. All patients had coronary artery disease and were on dual antiplatelet therapy with aspirin (81mg qd) and clopidogrel (75mg qd). PD and PK assessments were performed at 3 visits: baseline, after 7-10 days of ticagrelor therapy (pre-crossover; peak and trough), and after 7-10 days of alternative ticagrelor regimen (post-crossover; peak and trough). Results: A total of 92 patients were randomized (CKD-, n=48; CKD+, n=44). Platelet reactivity as assessed by multiple assays (VASP-PRI; VerifyNow P2Y12; LTA) was increased with 60mg compared with 90 mg, which was statistically significant in CKD- but not in CKD+ patients for most PD measures (Figure). Although trough levels of platelet reactivity were numerically lower in CKD+ patients compared with CKD-, there was no significant difference in the pre-defined primary endpoint (trough levels of VASP-PRI following ticagrelor 90 mg dosing) between DM subjects with and without CKD (31±20 vs 25±14; mean difference= 6.4; 95% CI: -1.1 to 14.3; p=0.105; primary endpoint; Figure). PK assessments tracked PD profiles. Conclusions: In patients with DM, platelet inhibition by ticagrelor is similar irrespective of CKD status. However, the PD effects of the 60mg ticagrelor regimen is reduced compared with the 90mg regimen in patients without CKD.

scholarly journals Treatment of complex coronary artery disease in patients with diabetes mellitus and chronic kidney disease: 10-year results comparing outcomes of CABG and PCI in the SYNTAXES trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Gao ◽  
R.T Wang ◽  
K Takahashi ◽  
H Kawashima ◽  
R.J Van Geuns ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Funding Source ◽  
Private Company ◽  
All Cause Mortality ◽  
Artery Disease

Abstract Background The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of the SYNTAX trial, which was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease. The SYNTAXES study is the first randomized trial that reported the complete 10-year data on all-cause death in patients with complex coronary artery disease. Purpose Patients with coronary artery disease (CAD) and concomitant diabetes mellitus (DM) or chronic kidney disease (CKD) are more susceptible to major adverse cardiovascular and cerebrovascular events. However, to date, the long-term prognosis and which revascularization strategy was associated with better clinical outcomes for patients with complex coronary artery disease and concomitant with DM and CKD have not been documented. Methods In this sub-analysis of the SYNTAXES trial, a total of 1,638 patients were classified into four subgroups according to the DM and CKD status: DM−/CKD− (n=999, 60.1%), DM+/CKD− (n=323, 19.7%), DM−/CKD+ (n=231, 14.1%), and DM+/CKD+ (n=85, 5.2%). The treatment effects of PCI and CABG were analyzed in each subgroup. The primary endpoint was all-cause death at 10 years. Results Compared with the DM−/CKD− patients, patients with DM+/CKD+ were older, more often had a history of stroke, hypertension, heart failure, and were more frequently presented with total occlusion, bifurcation lesion and three-vessel disease. At 10 years, patients with DM+/CKD+ had a 3.94-fold higher incidence of all-cause mortality compared with DM−/CKD− individuals (54.1% versus 18.9%, 95% CI [2.85–5.44]). Patients with DM−/CKD+ (38.1%, HR 2.36; 95% CI [1.83–5.44]) or DM+/CKD− (28.2%, HR 1.61; 95% CI [1.26–2.07]) had intermediate risk profile. For DM+/CKD+ patients, compared with PCI, those who underwent CABG were associated with lower incidence of all-cause mortality (64.3% versus 44.2%, adjusted HR 0.52; 95% CI [0.27–0.99], p=0.047, pinteraction=0.443). The number of needed-to-treat to reduce mortality for CABG was 12. Conclusion In the SYNTAX population, patients with DM and CKD are at markedly increased risk of long-term mortality rate compared with patients one or neither of these risk factors. For patients with both comorbidities, CABG was associated with better clinical outcome compared with PCI. These findings should be interpreted as hypothesis-generating. Figure 1. Kaplan-Meier curves showing the clinical events according to treatment and DM/CKD status. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Boston Scientific Corporation

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