2014


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2014/№1

Multifocal atherosclerosis in patients with ischemic heart disease: Effect on immediate outcomes of coronary bypass

Sumin A. N., Bezdenezhnykh A. V., Ivanov S. V., Barbarash O. L., Barbarash L. S.
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: atherosclerosis, coronary heart disease, coronary bypass surgery

DOI: 10.18087/rhj.2014.1.1889

Background. Predictive value of multifocal atherosclerosis (MFA) in patients with stable clinical manifestations of atherosclerosis is above any doubt. Aim. To study effects of MFA and non-coronary surgical interventions on immediate results of coronary bypass (CB) surgery. Materials and methods. 708 successive patients (564 men and 144 women; median age 59 years) who have undergone CB between March 22, 2011 and March 22, 2012 were evaluated. Three groups of patients were separated, patients with 1 vessel disease (n=350), 2 vessel disease (n=241), and 3 vessel disease (n=117). The groups were compared by data of medical history, results of laboratory and instrumental tests, and prevalence of postoperative complications. Results. Patients with MFA were older than patients with isolated coronary vessel disease (p<0.001). Non-coronary revascularization for hemodynamically significant stenosis was performed in 10 % of patients either prior to or simultaneously with CB. Duration of extracorporeal circulation (ECC) and total duration of surgery were significantly longer in the 2vessel disease group than in other groups (p<0.010 and p<0.001). In the monofactorial logistic regression analysis, the likelihood of complications increased with impairment of renal function (p=0.002), older age (p=0.033) and ECC duration (р<0.001). Age and ECC duration remained significant factors also in the multifactorial analysis (p=0.044 and р<0.001, respectively). The likelihood of fatal outcome was increased with longer ECC (р<0.001) and higher severity of mitral regurgitation (р<0.001) as well as with impairment of cardiac pump function (р<0.012). Conclusion. During CB, 1 vessel disease was found in 34 % of patients and 3 vessel disease – in 16.5 % of patients. In CB, the presence of MFA was associated with longer durations of ECC and the surgery. The presence of MFA does not result in significant increases in the total number CB-related complications and death rate due to timely detection and correction of hemodynamically significant non-coronary artery stenoses.
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Sumin A. N., Bezdenezhnykh A. V., Ivanov S. V. et al. Multifocal atherosclerosis in patients with ischemic heart disease: Effect on immediate outcomes of coronary bypass. Russian Heart Journal. 2014;75 (1):11–17

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