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 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.

No effect of lipid lowering on platelet activity in patients with coronary artery disease and type 2 diabetes or impaired glucose tolerance

2009 ◽  
Vol 101 (01) ◽  
pp. 157-164 ◽  
Author(s):  
Magnus Settergren ◽  
Felix Böhm ◽  
John Pernow ◽  
Paul Hjemdahl ◽  
Rickard Malmström
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Lipid Lowering ◽  
Platelet Activity ◽  
Artery Disease ◽  
Stable Cad

SummaryIn addition to lowering cholesterol, statins may reduce platelet activity and exert beneficial non-lipid (pleiotropic) effects. We evaluated the effects of two different simvastatin based treatment regimens on platelet reactivity in patients with dysglycemia and coronary artery disease (CAD). Thirty-two patients with type 2 diabetes or impaired glucose tolerance and stable CAD received six weeks of double-blind treatment with simvastatin 80 mg daily (S80; n=16) or ezetimibe 10 mg and simvastatin 10 mg daily (E10/S10; n=16). Total and low-density lipoprotein (LDL) cholesterol, and high sensitivity C-reactive protein (CRP) decreased similarly in the two groups. LDL (mM) decreased from 3.2 ± 0.6 to 1.7 ± 0.7 with E10/S10 and from 3.0 ± 1.0 to 1.4 ± 0.5 with S80 treatment. Platelet function was evaluated by whole blood flow cytometry and turbidimetric aggregometry with agonist stimulation ex vivo before and after treatment. Neither treatment affected basal or adenosine diphosphate (ADP)- or thrombin-induced platelet P-selectin expression, or fibrinogen binding, or platelet-leukocyte aggregation. Similarly, neither treatment affected ADP-induced platelet aggregation. In conclusion, lipid lowering treatment with high dose simvastatin or low dose simvastatin plus ezetimibe did not exert any substantial inhibitory effects on the basal or agonist-stimulated activity of circulating platelets in patients with stable CAD and type 2 diabetes or impaired glucose tolerance.

scholarly journals Use of extracorporeal membrane oxygenation as a bridge to transcatheter aortic valve replacement in a patient with aortic stenosis and severe coronary artery disease: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Majid Ahsan ◽  
Rolf Alexander Jánosi ◽  
Tienush Rassaf ◽  
Alexander Lind
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Artery Disease

Abstract Background Patients with severe aortic stenosis (AS) often present with multiple comorbidities and suffer from critical coronary artery disease (CAD). Transcatheter aortic valve replacement (TAVR) has become the therapy of choice for moderate to high-risk patients. Venoarterial extracorporeal membrane oxygenation (v-a-ECMO) offers the possibility of temporary cardiac support to manage life-threatening critical situations. Case summary Here, we describe the management of a patient with severe AS and CAD with impaired left ventricular ejection fraction (LVEF). We used v-a-ECMO as an emergency strategy in cardiogenic shock during a high-risk coronary intervention to stabilize the patient, and as a further bridge to TAVR. Discussion Very high-risk patients with severe AS are unlikely to tolerate the added risk of surgical aortic valve replacement. Using ECMO may help them to benefit from TAVR as the only treatment option available.

Transaortic Transcatheter Aortic Valve Implantation and Concomitant off Pump Revascularization

2016 ◽  
Vol 11 (5) ◽  
pp. 363-366 ◽  
Author(s):  
Hardy Baumbach ◽  
Samir Ahad ◽  
Stephan Hill ◽  
Tim Schäufele ◽  
Sara Adili ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Revascularization ◽  
Off Pump ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Artery Disease ◽  
Valve Implantation

An increasing number of patients with severe aortic stenosis and concomitant critical coronary artery disease were referred to our hospital. Some of those patients were classified as high-risk patients qualifying for a transcatheter therapy with the additional need for coronary revascularization. As a consequence of their comorbidities, the established transapical as well as transfemoral approach were either not possible or not favored owing to the indispensable need for coronary revascularization. We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting. All patients were discharged free from stroke, myocardial infarction, or access site complications either to rehabilitation facility or to the referring hospital with none or trace aortic regurgitation and patent grafts. These cases confirm the feasibility of those combined operations and should be considered as realistic alternative for surgical treatment in high-risk patients who are clearly identified to benefit from transcatheter approach to treat aortic stenosis and who have severe concomitant coronary artery disease.

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

Utility of Platelet Indices in Assessing the Risk of Coronary Artery Disease in Patients of Diabetes Mellitus

2020 ◽  
Author(s):  
Ayesh Khatoon ◽  
Shakti Kumar Yadav ◽  
Sompal Singh ◽  
Harsh Vardhan Singh ◽  
Namrata Sarin
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Platelet Volume ◽  
Distribution Width ◽  
Type 2 Dm ◽  
Significant Difference ◽  
Artery Disease

Abstract Background: Platelet volume indices (PVI) such as mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR), are the indicators of increased platelet activity which may play a role in development of vascular complications in diabetic patients. This study was performed to evaluate and compare the platelet volume indices such as MPV, PDW, P-LCR in patients of type 2 diabetes mellitus (DM) with and without manifested coronary artery disease in order to identify their usefulness in determining the risk for development of coronary complications.Methods: Analytical cross - sectional study included 150 patients of which 100 patients were diagnosed as type 2 DM and 50 apparently healthy controls. The study cases were divided into two groups based on presence or absence of coronary artery disease. Group A included 50 cases of type 2 DM without manifested coronary artery disease and group B included 50 cases of type 2 DM with manifested coronary artery disease. PVI was obtained using automated cell counter.Results: MPV, PDW, P-LCR were significantly higher in diabetics as compared to controls subjects (P < 0.001 for all). However, no statistically significant difference was found between diabetics with and without manifested coronary artery disease.Conclusions: The study showed higher PVI in diabetic subjects when compared to control subjects, but no difference between patients with and without manifested coronary artery disease suggesting that various other factors might be associated with the pathogenesis of CAD in patients of DM.

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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