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Interrelation of arterial stiffness and immediate outcomes of coronary bypass in patients with IHD

Sumin A. N., Shcheglova A. V., Fedorova N. B., Zhuchkova E. A., 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: vascular stiffness, CAD, coronary bypass surgery, cardio-ankle vascular index

DOI: 10.18087/rhj.2014.5.1930

Background. Increased arterial stiffness is one of markers for higher risk of CVD. In already developed abnormality, this index can serve as a marker for disease severity and prediction. Aim. To study the interrelation between arterial stiffness parameters and coronary bypass (CB) outcomes in IHD patients. Material and methods. 356 patients who had undergone CB were divided into 2 groups based on the value of cardio-ankle vascular index (CAVI); group I, CAVI ≥9.0 (n=231) and group II, CAVI <9.0 (n=125). After the CB surgery, the following complications were assessed: fatal outcome, MI, acute cerebrovascular disease (ACVD), transient ischemic attack (TIA), heart rhythm disorders, multiple organ dysfunction syndrome, and development of any of these complications (composite endpoint). An additional analysis was performed to study the effect of various pre- and perioperative factors on incidence of the above-listed events. Results. Presence of abnormal CAVI adversely affected immediate outcomes of CB. Such patients had more perioperative complications, including ACVD and fatal outcomes (р=0.05 and р=0.02, respectively). A probability of perioperative complications in relation to different factors was evaluated using a logistic regression. In monofactorial analysis, the probability of complications increased with increasing CAVI (p=0.003), age (р<0.001), presence of a ≥50 % non-coronary artery stenosis (р=0.00004), longer duration of extracorporeal circulation (ECC) (р<0.001), placing at least three coronary bypasses (p=0.0036), and CB combined with carotid endarterectomy (p=0.04). Reduced risk of CB complications was associated with surgeries involving placement of a single coronary bypass (p=0.04). The multifactorial analysis showed that the risk of CB perioperative complications independently correlated with such factors as duration of ECC and age of patients (OR, 1.02; 95 % CI, 1.01–1.02; р<0.001 and OR, 1.1; 95 % CI, 1.07–1.1, р<0.001, respectively). Conclusion. 35 % of IHD patients had abnormal CAVI (>9.0) before the CB surgery. The presence of abnormal CAVI was associated with higher incidence of CB perioperative complications, specifically, fatal outcome and stroke. In the multifactorial analysis, increased arterial stiffness had no independent influence on immediate outcomes of CB, as distinct from such factors as patient’s age and ECC duration.
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Sumin A. N., Shcheglova A. V., Fedorova N. B. et al. Interrelation of arterial stiffness and immediate outcomes of coronary bypass in patients with IHD. Russian Heart Journal. 2014;79 (5):263–270

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