The aim – to determine factors that may influence on the occurrence of early postoperative complications (EPC) of surgical myocardial revascularization in patients with stable coronary heart disease and to study the effect of perioperative drug therapy.
Material and methods. In a single-center study, data from a prospective study of 155 patients with stable coronary heart disease consecutively selected for isolated coronary artery bypass graft surgery (CABG) were analyzed. In total, 84 EPC were registered in 66 patients during the hospital period; 89 patients had no complications. Groups of patients with and without complications were compared according to demographic parameters, risk factors, concomitant diseases, perioperative therapy, features of the CABG operation.
Results. Most of the early complications (56 %) were the cases of postoperative atrial fibrillation/flutter. In unifactor analysis, the features of patients with complications in the early postoperative period were the presence of severe diabetes (Р=0.025), obesity of I and II degrees (Р=0.070), left ventricle hypertrophy (median (quartiles) 47.9 (41.8–63.1) g/m2.7 vs 43.6 (36.5–55.2) g/m2.7; Р=0.008), the left atrium increase size (median (quartiles) 4.3 (4.2–4.6) cm vs 4.2 (4.0–4.5) cm; Р=0.068); elevated preoperative level of IL-6 (median (quartiles) 4.1 (3.1–9.0) pg/ml vs 3.2 (2.0–5.1) pg/ml; Р=0.044); the absence of statin therapy in perioperative period (Р<0.001) and a long duration of aortic clamping (median (quartiles) 20 (15–25) min vs 17 (13–23) min; Р=0.049). According to the multivariate analysis, the risk of EPC after CABG was 6.25 times higher among patients who did not take statins in the perioperative period, compared to patients who received high-intensity statins for ≥ 7 days. In patients with severe diabetes, the risk of EPC was 1.96 times higher than in patients with mild diabetes.
Conclusions. The presence of severe diabetes and the absence of statin therapy in the perioperative period proved to be independent predictors of the occurrence of EPC. High-intensity statins therapy for ≥ 7 days prior to surgery allowed to reduce the risk of EPC, in particular, post-operative atrial fibrillation/flutter.
The aim – to determine the effect of statins upon parameters of immune inflammation, depending on their initial disturbances in patients with stable coronary artery disease.
Material and methods. 54 patients with stable angina pectoris were examined. Venous blood was taken before and after two months of treatment with atorvastatin (20 mg/day) (n=22) or lovastatin (40 mg/day) (n=12) or simvastatin (40 mg/day) (n=20). Immunological parameters such as TNF-α, IL-6, IL-8, IL-10, high-sensitivity CRP, antibodies to low-density oxidized lipoproteins, number of cells with CD40 receptors, functional-metabolic activity of neutrophils and monocytes, and subpopulations of lymphocytes were determined.
Results. Two-month statin administration in equivalent doses led to a moderate decrease in the synthesis of mononuclear cells of proinflammatory cytokines (TNF-α, IL-8) and decrease of functional activity of monocytes in the general group of patients with stable coronary heart disease. The influence of statins on humoral and cellular factors of immune inflammation directly depended on the initial factor level (R=0,32–0,77; Р=0,04–0,00001).
Сonclusions. Statins affect the adaptive and innate links of immunity in patients with stable ischemic heart disease. The effect of statins on humoral (CRP, ТNF-α, IL-6, IL-8, IL-10) and cellular (monocytes, Th, Ts, Th/Ts) factors of immune inflammation in patients with IHD directly depends on the initial level of the factor. The more the initial level of the indicator is changed relative to the control, the greater the normalizing effect of the same dose of statins.
The aim – to establish predictors of late major adverse outcomes (MAOs) in patients (pts) with stable coronary artery disease (CAD) after coronary artery bypass grafting (CABG) at three years follow-up.
Material and methods. An observational single-center study included 251 consecutive pts with stable CAD (mean age (61±9) years, 218 (86.9 %) males, 33 (13.1 %) females), after isolated CABG. At three years follow-up, MAOs were registered: death – 11 (4.4 %) cases (among them – 9 cardiovascular death cases); myocardial infarction – 4 (1.6 %); unstable angina – 11 (4.4 %); stroke – 5 (2.0 %); heart failure (HF) decompensation – 20 (8.0 %); sustained ventricular tachycardia – 3 (1.6 %); repeated myocardial revascularization – 10 (4.0 %); peripheral artery embolism – 1 (0.4 %). In total, MAOs occurred in 55 (21.9 %) pts.
Results. At univariate analysis, MAOs were related to the following parameters: age; body mass index; HF IIB stage; permanent AF; estimated glomerular filtration rate (eGFR); left atrium antero-posterior dimension, indexed by body surface area (LAD/BSA); left ventricular (LV) end-diastolic volume index; aortic and mitral valve regurgitation; LV ejection fraction (EF); and early major postoperative complications. At multivariate analysis, the independent predictors of MAOs were following: worse LV systolic function at discharge (by LV EF grades (< 40 % vs 40–49 % vs ≥ 50 %): odds ratio (OR) 2.145 (95 % confidence interval (CI) 1.382–3.329); Р=0,001); worse eGFR at baseline (per each 30 ml/(min · 1.73 m2) decrease vs ≥ 90 ml/(min · 1,73 m2): OR1.951 (95 % CI 1.112–3.421); Р=0.020) and larger LAD/BSA (by degrees of enlargement: OR 1.918 (95 % CI 1.119–3.289); Р=0.018).
Conclusions. At three years follow-up, MAOs in pts with stable CAD after CABG were associated with worse baseline filtration kidney function, larger baseline LAD, and worse LV systolic function at discharge. Independent predictive value of baseline eGFR and LAD, and LV EF at discharge should be take into account while planning the postoperative follow-up schedule, as well as individualized prevention of late cardiovascular outcomes.
The aim – to research associations between vascular endothelial growth factor-A (VEGF-A) level and left ventricular remodeling after ST elevation myocardial infarction (MI).
Material and methods. 62 patients with MI, 51 (82.3 %) male and 11 (17.7 %) female at average age 58.63±8.90 years were enrolled into the study. VEGF-A level was determined on the 7th day of MI by enzyme-linked immunoassay. Anxiety level was assessed by Taylor questionnaire during the period of 10–14 days before MI. After 6-month observation 47 patients were assessed.
Results. In patients with MI in comparison with the control group significant rise of serum VEGF-A level was observed, showing positive correlation with creatine kinase level. The level of VEGF-A below median 160 pg/ml in comparison with its level above the median 160 pg/ml was associated with higher frequency of MI in men (Р=0.023), anxiety before MI (Р=0.019), end diastolic diameter (EDD), end systolic diameter (ESD), end diastolic volume (EDV) increase in acute phase, EDD, ESD, EDV, left ventricular myocardial mass, Е/А, lower exercise tolerance after 6-month observation. This processes indicates unfavorable role of low VEGF-A levels and protective – of high VEG-A levels for intracardiac hemodynamic after myocardial infarction. The level of VEGF-A ≤ 201.86 pg/ml with sensitivity 57.9 % and specificity 85.7 % (AUC 0.711; 95 % CI 0.513–0.908; Р=0.036) have prognostic significance for adverse remodeling development.
Conclusions. VEGF-A level – important indicator to estimate the extent of myocardial injury and pathologic remodeling development.
The aim – to evaluate the cardioprotective effect of metabolic therapy in patients with coronary heart disease (ICD) by digital processing of a standard electrocardiogram using original software.
Material and methods. 46 patients with stable angina pectoris of II functional class were examined. In order to determine the cardioprotective effect of metabolic therapy, the results of digital processing of the standard ECG in patients with coronary heart disease were analyzed using original software. with the evaluation of the effect of drugs (tivortin, tivorel, tiotriazoline, corvitine) with antiarrhythmic anticipation, in comparison with the effects of amiodarone and bisoprolol on the main parameters of HRD and dispersion of the QT interval, the angle of inclination of the ST segment and the results of the analysis differentiated T wave. The possibility of an effective quantitative evaluation of the electrocardiogram with its digital processing (digitalization) with the use of its own Smart-ECG software in patients with stable angina pectoris was proven.
Results. In the complex analysis of effects from the use of drugs, it was found that tivortin/tivorel reduced the risk of adverse events with stable angina pectoris and activated parasympathetic contour, corvitine and tiotriazoline – reduced the dispersion of the QT interval, tiotriazoline, corvitine and tivortin, accelerated transient depression of the ST segment – reducing the risk of coronary heart disease and increasing antiarrhythmic effect. Bisoprolol and amiodarone increase the SDNN score and consequently reduce the risk of adverse events with stable angina pectoris, amiodarone stimulates the activation of the parasympathetic contour and less efficiently affects ST slope than bisoprolol, both drugs slightly optimize the ratio of maximum velocities and thus maintain anti-ischemic status.
Conclusions. Quantitative evaluation of the electrocardiogram with its digital processing (digitization) can be recommended for increasing the effectiveness of the individual approach in the treatment of patients with acute and chronic ischemic heart disease with the objectification of cardioprotection.
The aim – to study the risk factors of an unfavorable prognosis and identify patients groups with high risk of complications after acute coronary syndrome (ACS).
Material and methods. A total of 490 patients (pts) hospitalized with ACS without ST-segment elevation (74.49 % men and 25.51 % women, average age 58.78±0.44 yrs) with acute clinical destabilization that occurred no more than 72 hours before admission to the hospital were examined. The diagnosis of acute myocardial infarction (MI) or unstable angina pectoris was established according to the ESC guidelines. The anamnestic and clinical factors affecting the course of the hospital period were identified. The end points of the study, in addition to the clinical signs, were additionally formed combined endpoint: MI/cardiovascular death/recurrent angina pectoris (MI/CVD/RAP), MI/CVD/acute heart failure (MI/CVD/AHF), MI/CVD/ AHF/RAP.
Results. Most patients had arterial hypertension (AH) (77.35 %) and ischemic heart disease (IHD) (72.04 %) in the anamnesis, including a previous MI – 43.06 %. There were 34.08 % active smokers and 53.88 % – smokers in the past; overweight was detected in 16.53 %, type II diabetes mellitus (DM) – in 16.12 %. Acute HF, MI and death were detected with similar frequency in men and women. RAP developed in women more often than in men (46.4 % vs 29.3 %, respectively, Р<0.001). Ventricular arrhythmias (VA) were registered more often in men (15.1 % vs 6.4 %, Р<0.05). There were no significant differences in the middle and older groups. AHF, RAP, and MI/CVD/RAP, MI/CVD/AHF and MI/CVD/AHF/RAP have developed or progressed more often in men with DM than in women. In men, the presence of DM in 2 times increases AHF developing risk (Р<0.05) during the hospital period, 4 times the risk of progression AHF (Р<0.01), 2 times the risk of RAP, MI/CVD/RAP, MI/CVD/AHF/RAP (Р<0.05, in all cases) and almost 5 times the risk of MI/CVD/AHF (Р<0.01). Significant differences during the hospital period are observed in pts younger than 55 yrs and older than 65 yrs. There were no differences in middle age pts. The IHD history significantly increased the AHF progression, RAP development and the frequency of combined endpoint: MI/CVD/RAP, MI/CVD/AHF, MI/CVD/AHF/RAP. The previous MI did not affect the development of the hospital period complications of ACS without ST elevation. Chronic heart failure (CHF) in the history significantly increased the risk of AHF development during the hospital period of ACS, as well as the risk of AHF developing on the 1st day of the disease, the development of RAP and combined CT: MI/CVD/RAP, MI/CVD/AHF/RAP. The presence of AH significantly increased RAP development risk by 26 %.
Conclusions. Factors of poor prognosis of the hospital period in patients with ACS without ST segment elevation include DM in men, IHD, CHF and AH in the history. The risk of RAP, MI/CVD/RAP, MI/CVD/AHF/RAP are significantly higher in women than in men, while VA reliable more frequently develop in men. The most important gender differences regarding development of hospital complications are observed in patients younger than 55 yrs.
The aim – to study clinical and functional characteristics of patients with ST-segment elevation myocardial infarction (STEMI), the terms of urgent percutaneous coronary intervention (PCI), the coronary artery lesions, gender and age, the parameters of intracardiac hemodynamics depending on the time to PCI; to assess the end-points at 1 year follow-up.
Material and methods. Between Feb till May 2015 we conducted a single-center prospective study and enrolled 108 patients with STEMI that underwent PCI (coronary angiography with stenting). We analyzed the terms of PCI after acute coronary syndrome symptoms onset, demographic, anamnestic, clinical, echocardiographic, angiographic data, as well as characteristics of interventions. We studied end-points, such as death, recurrent non-fatal MI, unstable angina, at 12 months follow-up after STEMI. Data on clinical outcomes were available in 100 of 108 patients (92.6 %).
Results. According to the study results, half of STEMI patients underwent PCI within 3.5 hours; only 20.4 % patients – within the optimal time window (up to 2 hours); 60 % of patients – from 2 to 6 hours. Only 47 % of patients underwent complete revascularization. However, stenotic lesions ≥ 70 % were identified in 40 % of patients. Severe coronary lesions, suitable for CABG, were detected in 14 % of cases. Large LV aneurysm with intramural thrombus formation was diagnosed in 4 % of patients. Females, compared to males, were older, with the more prevalent concomitant hypertension and diabetes mellitus. Only 33 % of patients were judged as low-risk patients, according to the PAMI-II criteria. At 1 year follow-up, 3 % patients died from recurrent MI. These patients had single- or two-vessel disease, with stenting of the culprit artery. Among patients suitable for CABG, surgical revascularization was performed only in 1/3 cases.
Conclusions. The registry data allow to assess the profile of STEMI patients undergoing PCI, as well as short-term (at discharge) and long-term (at 1 year follow-up) outcomes.
The aim – to compare the clinical, anamnestic characteristics and course of in-hospital period in patients of different age groups with ST-elevation acute coronary syndrome.
Material and methods. Were analyzed the data of 835 patients with ST-elevation acute coronary syndrome admitted to the emergency departments from January 2000 to December 2015. Patients were divided into two groups: I group – < 45 years of age (n=189), II group ≥ 45 years (n=646).
Results. The average age of patients in the I group was (37.8±6.5) years, in the II group – 59.3±8.1 years (Р<0.0001). Among the patients in group I there were more men (Р<0.0001). The mean body mass index (BMI) in young patients was 28.7±4.6 kg/m2 compared to 27.8±4.2 kg/m2 in group II (Р<0.021). The frequency of diabetes mellitus in patients of the I group was 4.2 %, arterial hypertension – 41.8 %. Young patients were much less likely to have a history of myocardial infarction or stroke and concomitant heart failure. The anterior localization of myocardial infarction in group I patients was registered in 59.8 % cases vs 51.9 % in the II group, Р=0.045; there were no significant differences regarding frequency of posterior and lateral infarctions. The average time from the development of symptoms to hospitalization in the I group was 9.7±7.6 hours, and in group II – 4.5±5.3 hours (Р<0.001).
Conclusions. Patients under 45 years of age with ST-elevation acute coronary syndrome are heterogeneous. The most important risk factors for the development of AMI in these patients are smoking, overweight and heredity. Hypertension and diabetes mellitus in young patients were much less frequent than in the older age group. In-hospital course of AMI in young patients was more favorable with fewer complications.
Material and methods. The study involved 91 male patients aged 33-68 (average age (52.3±1.5) years with Q-wave MI. In the first hours after MI onset, all patients had urgent coronary angiography, a stent was inserted into the culprit coronary artery and drug therapy was administered in accordance to the current protocols and guidelines. Depending on the amount of physical rehabilitation, the patients were divided into two groups: group 1 included 47 patients who underwent physical cycling course training (three times a week, a total of 30 sessions), group 2 consisted of 44 patients whose rehabilitation consisted in distance walking and remedial exercises. The examinations were carried out at discharge from the inpatient department (12–15 days). Both clinical, instrumental and biochemical tests were performed after 4, 6 and 12 months following MI.
Results. At the initial stage, the patients of either group didn’t demonstrate differences in clinical indicators or medical history data. At the first survey, the threshold power level and the cost of the work performed according to the indicator of the ratio of dual product to the level of performed work (DP/A) didn’t differ significantly. After 30 training sessions, the threshold power increased significantly (125.0 (125.0–140.0) W in group 1 at the value of DP/A 0.92 (0.76–1.17) units). In group 2, the threshold power increased to 100.0 (75.0–100.0) W, but at the level of DP/A (1.73±0.18) units. One year after MI the level of threshold power increased to 140,0 (125.0–150.0) W at low cost (1.17 (0.98–1.32) units) in group 1, while in group 2 the level of threshold power decreased and approached the data of the first survey (75,0 (75.0–100.0) W) with a significant increase of the cost of work (2.41 (1.73–3.36) units). Such dynamics of the indicators of exercise tolerance was accompanied by changes of hemodynamic indices.
Conclusions. Exercise training program increased physical tolerance with better parameters of bicycle ergometry after its interruption and preserving of the effect during one year after MI. This was accompanied by optimization of the remodeling and restoration of wall kinesis. The exercise training program contributed to improving the physical fitness in patients with late opening of the infarction-related coronary artery disease and incomplete revascularization. The effect of exercise training was short-lived and limited in multifocal lesions.
Material and methods. A retrospective observational single-center study included 576 consecutive pts with stable CAD (mean age 61±9 years, 491 (85.2 %) males, 85 (14.8 %) females), undergoing isolated CABG. We analyzed demographic, clinical, laboratory, echocardiographic, coronary angiographic, intra- and postoperative data, and assessed health-related quality of life. In total, EPOC were registered in 112 (19.4 %) cases. Acute kidney injury (n=55) and acute heart failure (n=49) were the most frequent major EPOC (9.5 % and 8.5 %, respectively). Two patients (0.4 %) died early after CABG.
Results. At univariate analysis, EPOC were related to the following baseline parameters: age; body mass index (BMI); heart failure NYHA class; permanent AF; severe diabetes mellitus (DM); poor kidney function (by estimated glomerular filtration rate (eGFR)); left atrium and left ventricular (LV) end-diastolic volume index; LV systolic dysfunction; LV hypertrophy; aortic and mitral valve regurgitation; three-vessel CAD. At multivariate analysis, the independent predictors of EPOC were as follows: BMI (per 5 kg/m2 increase vs < 25.0 kg/m2 as reference (r): OR 1.38 (95 % CI 1.06–1.79); Р=0.017); DM severity (per each severity category increase vs no DM (r): OR 1.75 (95 % CI 1.47–2.10); Р<0.001); eGFR (per each 30 ml/min/1.73 m2 decrease vs ≥ 90 ml/min/1.73 m2 (r): OR 2.29 (95 % CI 1.58–3.31); Р<0.001); and LV ejection fraction (EF) (< 40 % vs. 40–49 % vs. ≥ 50 % (r): OR 1.92 (95 % CI 1.49–2.49); Р<0.001).
Conclusions. Multiple characteristics related to EPOC reflected comorbidity burden in the study cohort. Independent predictive value of baseline BMI, DM severity, eGFR and LV EF should be taken into account for risk stratification before CABG.