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Gender peculiarities in the estimated risk for cardiac complications of non-coronary vascular surgeries

Sumin A. N., Korok E. V., Bezdenezhnykh A. V., Evdokimov D. O., Ivanov S. V., Barbarash O. L.
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: gender peculiarities, cardiac complications, non-coronary vasculature

DOI: 10.18087/rhj.2013.6.1876

Background. Female gender is included in the EuroSCORE scale as a RF of non-coronary vascular surgery. Cardiac complications are the major cause of death during non-coronary vascular surgery. Existence of gender peculiarities of the coronary vasculature cannot be excluded for this patient category. Aim. Studying the relationship of gender peculiarities with results of coronary angiography, incidence of preventive myocardial revascularization, and immediate outcomes of vascular surgery. Materials and methods. Retrospective analysis was performed on 395 case reports preceding surgeries on carotid vasculature, aorta and leg arteries. The first group consisted of 56 females. The second group included 339 males. Clinical history data and results of major laboratory tests, echoCG, and ultrasound and angiographic examinations of arterial beds were evaluated. Prior to the vascular surgery, all patients underwent coronary angiography and preventive myocardial revasculrization if indicated. Incidences of perioperative complications and death were analyzed. Results. Evaluations showed that women were older (р=0.027), more frequently overweight (р=0.005), and more frequently had AH (р=0.006) and DM (р<0.001). A greater number of men smoked (р<0.001), had a history of MI (р=0.021) and reduced LV EF (р=0.006). Coronary angiography data showed that severity of coronary lesions was comparable in the study groups. Hemodynamically significant stenosis of at least one coronary artery was found in 80.4 % of females and 82.6 % of males. Involvement of three blood vessels was observed more frequently than other types of coronary atherosclerosis distribution in both groups (42.8 and 32.4 %, p=0.127). The groups did not differ in the incidence of preventive myocardial revascularization (33.9 % of females and 44.2 % of males, р=0.148). Coronary bypass was more prevalent in the male group (28.9 % vs. 10.7 %, p=0.004). Carotid surgery prevailed in the female group (р=0.004) whereas peripheral vascular surgery prevailed in the male group (р=0.009). Abdominal aorta surgery had similar prevalence in both groups (p=0.642). Complications were observed in 7.1 % of cases in the female group and in 9.4 % of cases in the male group (p=0.580). Cardiac complications and fatal outcomes were observed in 1.8 % and 0 % of cases for women and 1.8 % and 0.9 % of cases for men. Conclusion. The strategy including routine coronary angiography and preventive myocardial revascularization allowed minimizing the risk of cardiac complications and fatal outcomes in moderate and high risk non-cardiac surgeries independent of patients’ gender.
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Sumin A. N., Korok E. V., Bezdenezhnykh A. V. et al. Gender peculiarities in the estimated risk for cardiac complications of non-coronary vascular surgeries. Russian Heart Journal. 2013;12(6):365-370

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