Authors
Staroverov Il.N.1,2, Staroverov Iv.N.1, Churakov S.O. 2, Lonchakova O.M. 1,2
1 Yaroslavl regional clinical hospital, Yaroslavl
2 Yaroslavl state medical University, Yaroslavl
Abstract
Aims. To analyze the risk factors for postoperative complications and study long-term outcomes of off-pump CABG surgery in patients with left main disease and acute coronary syndrome.
Materials and methods. We performed a prospective study of surgical treatment of 112 patients with ACS and left main disease. The control group included 82 patients with stable CAD. All patients underwent off-pump CABG surgery. The groups did not differ in age, gender and the Charlson comorbidity index. Risk factors for postoperative complications and intrahospital mortality were analyzed. General and cardiac mortality, freedom from nonfatal myocardial infarction, stroke, and angina pectoris were studied in long-term period.
Results. The incidence of early complications (cardiovascular, pulmonary, and renal) in the main and control groups were 22.3 and 23.2%, respectively, p = 0.89. The risk factors for postoperative complications in ACS were the age of patients >70 years, EuroSCORE II >7 and >5%, stenosis of left main coronary artery >70%, as well as transfusion of blood components in the early postoperative period. Intrahospital mortality in the study group was 3.6%, in the control group 2.4%, p = 0.6. The survival rate according to the Kaplan-Mayer curves in the period up to 8 years were 87 and 84%, respectively, p = 0.67.
Conclusions. Off-pump CABG in ACS allows achieving satisfactory results, both in the early and long-term period. Left main disease more than 70%, elderly age, EuroSCORE II more than 5% were predictors of early postoperative complications.
Keywords: left main disease, acute coronary syndrome, off-pump coronary artery bypass surgery
References
1. Kontsevaya AV, Drapkina OM, Balanova YA, et al. Economic Burden of Cardiovascular Diseases in the Russian Federation in 2016. Rational Pharmacotherapy in Cardiology. 2018; 14(2): 156-166. (In Russ). doi: 10.20996/1819-6446-2018- 14-2-156-166.
2. Sakakura K, Kubo N, Hashimoto, S, et al. Determinants of in-hospital death in left main coronary artery myocardial infarction complicated by cardiogenic shock. Journal of cardiology. 2008; 52(1): 24-29. doi: 10.1016/j.jjcc.2008.03.008.
3. Belevitin AB, Belyakin SA, Shames AB, et al. Сomparative Long-Term Results Of Endovascular And Conservative Treatment Of Acute Coronary Syndrome. Vestnik Rossijskoj Voenno-Medicinskoj Akademii. 2010; 4(32): 8-10. (In Russ).
4. Barbarash OL, Kashtalap VV. Management of patients with non-ST segment elevation acute coronary syndrome. Are all problems solved? Russian Heart Journal. 2016; 15(5): 320—326, (In Russ). doi: 10.18087/rhj.2016.5.2249.
5. Slottosch I, Liakopoulos O, Scherner M, et al. Preoperative intraaortic balloon pump before urgent coronary bypass grafting. Asian Cardiovascular and Thoracic Annals. 2018; 26(5): 353-360. doi: 10.1177/0218492318782066.
6. Harling L, Moscarelli M, Kidher E, et al. The effect of off-pump coronary artery bypass on mortality after acute coronary syndrome: a meta-analysis. International journal of cardiology. 2013; 169(5): 339-348. doi: 10.1016/j.ijcard.2013.09.003.
7. Staroverov IN, Staroverov IvN, Churakov SO, et al. Short-term outcomes off-pump coronary artery bypass surgery in patients with left main coronary artery disease presenting with acute and chronic coronary syndrome. Kardiologia i Serdechno-Sosudistaya Khirurgia. 2020; 13(4): 315-321. (In Russ). doi: 10.17116/kardio202013041315.
8. Beigel R, Matetzky S, Gavrielov‐Yusim N, et al. Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome. Catheterization and Cardiovascular Interventions. 2014; 83(5): 677-683. doi: 10.1002/ccd.25081.
9. Desperak P, Hawranek M, Gąsior P, et al. Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes. Cardiology journal. 2019; 26(2): 157-168. doi: 10.5603/CJ.a2017.0110.
10. Damman P, van’t Hof AW, Ten Berg JM, Jukema JW, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: comments from the Dutch ACS working group. Netherlands Heart Journal. 2017; 25(3): 181-185. doi: 10.1007/s12471-016-0939-y.
11. Ben-Gal Y, Mohr R, Feit F, et al. Surgical versus percutaneous coronary revascularization for multivessel disease in diabetic patients with non-ST-segment-elevation acute coronary syndrome: analysis from the acute catheterization and early intervention triage strategy trial. Circulation: Cardiovascular Interventions. 2015; 8(6): e002032. doi: 10.1161/CIRCINTERVENTIONS.114.002032.
12. Fukui T, Tabata M, Morita S, et al. Early and long-term outcomes of coronary artery bypass grafting in patients with acute coronary syndrome versus stable angina pectoris. The Journal of thoracic and cardiovascular surgery. 2013; 145(6): 1577-1583. doi: 10.1016/j.jtcvs.2012.05.043.
13. Lee CH, Wu CW, Yang TF, et al. Results of Coronary Artery Bypass Grafting in Patients with Acute Coronary Syndrome versus Those with Stable Angina Pectoris: a Single Institution Experience. Wulfenia Journal. 2016; 23(7): 47-63.
14. Musaev KK, Abdullaev FZ, Shikhieva LS, et al. Comparative results of off-pump coronary artery bypass grafting for unstable angina pectoris and acute myocardial infarction. Grudnaya i serdechno-sosudistaya khirurgiya. 2012; (6): 14-21. (In Russ).
15. Shibeko NA, Gelis LG, Medvedeva EA, et al. Risk stratification of postoperative cardiovascular complications in patients with acute coronary syndrom. Eurasian heart journal. 2013; (2): 43-48. (In Russ).
16. Kondrikova NV, Karetnikova VN, Ivanov SV, et al. Factors which affect coronary artery bypass grafting outcomes in subjects with myocardial infarction. Kreativnaya kardiologiya. 2015; (3): 16-25. (In Russ). doi: 10.25881/BPNMSC.2020.22.28.008.
17. Brand YaB, Mazanov MH, Timerbaev AV, et al. Otdalennye rezul'taty koronarnogo shuntirovaniya u pacientov s ostrym koronarnym sindromom. Neotlozhnaya medicinskaya pomoshch'. 2017; 6(3): 251-256. (In Russ). doi: 10.23934/2223-9022-2017-6-3-251-256.
