Non-protected carotid artery stent without angioplasty in high-risk patients with carotid and coronary artery disease undergoing cardiac surgery

2010 ◽  
Vol 19 (3) ◽  
pp. 184-188 ◽  
Author(s):  
Martin Rabellino ◽  
Luis Garcia-Nielsen ◽  
Sebastian Baldi ◽  
Tobias Zander ◽  
Carmen Casasola ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
High Risk ◽  
Carotid Artery ◽  
High Risk Patients ◽  
Carotid Artery Stent ◽  
Risk Patients ◽  
Artery Disease

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 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 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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