THE ROLE OF MULTIFOCAL ATHEROSCLEROSIS IN DEVELOPMENT OF UNFAVORABLE CARDIOVASCULAR OUTCOMES IN PATIENTS AFTER CORONARY BYPASS GRAFTING

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Abstract

Background: The number of disorders caused by atherosclerosis of various arterial tree is constantly increasing worldwide. Multifocal atherosclerosis (MFA) remains to be an important problem limiting effectiveness of coronary bypass grafting.

Aim: To compare one-year rates of unfavorable cardiovascular events in patients, who underwent coronary bypass grafting, depending on the degree of non-coronary stenoses (stenoses of extracranial arteries and lower limb arteries).

Materials and methods: Two hundred and thirty two patients, that underwent coronary bypass graft surgery in 2006 due to clinical manifest coronary atherosclerosis, were included into the study. Oneyear outcome (10–12 months) was assessed with the following endpoints: coronary and non-coronary death, myocardial infarction, stroke, angina pectoris and severe chronic heart failure (III–IV functional classes). One-year combined outcome after coronary bypass grafting was considered unfavorable if these events were registered.

Results: After initial assessment, patients were divided into 2 groups depending on the degree of coronary atherosclerosis; thereafter, each group was subdivided into subgroups depending on presence or absence of MFA. Compared to patients without MFA, those with hemodynamically significant stenosis (≥ 50%) of non-coronary arteries had higher rates of unfavorable one-year outcomes (р = 0.001). They had higher rates of stroke (20% (5) and 5.8% (12) of patients, respectively, р = 0.03) and of recurrent angina (р = 0.001). Patients with hemodynamically non-significant stenoses (≥ 30%) also had significantly higher rates of unfavorable events, compared to patients without stenoses: myocardial infarction, in 12 (11%) and 3 (2%), respectively (p = 0.006), stroke, in 14 (13%) and 3 (2%) (p = 0.001). Eighty four (79%) patients with MFA had clinical manifestations of angina pectoris, whereas among those without MFA, only 23 (18%) of patients (p = 0.0001). Severe chronic heart failure was significantly more frequent in the MFA group, than in patients with isolated coronary atherosclerosis (38 (36%) and 21 (17%) patients, respectively, p = 0.002). In the MFA group, 10 (9%) patients died, while in the group without MFA there was one death (0.8%) (p = 0.003).

Conclusion: Taking into account non-coronary stenoses of ≥ 30%, compared to only hemodynamically significant stenoses of ≥ 50%, produces more significant differences in clinical and historical characteristics of patients.

About the authors

L. S. Barbarash

Research Institute for Complex Issues of Cardiovascular Diseases

Email: fake@neicon.ru

MD, PhD, Professor, Chief Research Fellow, Member of Russian Academy of Sciences

Russian Federation

K. S. Shafranskaya

Research Institute for Complex Issues of Cardiovascular Diseases

Author for correspondence.
Email: kssh_83@mail.ru

PhD, Research Fellow, Laboratory of Polyvascular Atherosclerosis Pathophysiology

Russian Federation

V. V. Kashtalap

Research Institute for Complex Issues of Cardiovascular Diseases

Email: fake@neicon.ru

PhD, Chief of the Laboratory of Polyvascular Atherosclerosis Pathophysiology

Russian Federation

O. L. Barbarash

Research Institute for Complex Issues of Cardiovascular Diseases

Email: fake@neicon.ru

MD, PhD, Professor, Director

Russian Federation

References

  1. Оганов РГ, Лепахин ВК, Фитилев СБ, Левин АМ, Титарова ЮЮ, Сычев ЕН. Особенности диагностики и терапии стабильной стенокардии в Российской Федерации (Международное исследование АТР – Angina Treatment Pattern). Кардиология. 2003;(5):9–15. Oganov RG, Lepakhin VK, Fitilev SB, Levin AM, Titarova YuYu, Sychev EN. Osobennosti diagnostiki i terapii stabil'noy stenokardii v Rossiyskoy Federatsii (Mezhdunarodnoe issledovanie АТР – Angina Treatment Pattern) [Particulars
  2. of diagnostics and treatment of stable angina pectoris in the Russian Federation (Multinational trial АТР – Angina Treatment Pattern)]. Kardiologiya [Cardiology]. 2003;(5):9–15 (in Russian).
  3. Бокерия ЛА, Бухарин ВА, Работников ВС, Алшибая МД. Хирургическое лечение больных ишемической болезнью сердца с поражением брахиоцефальных артерий. М.: НЦССХ им. А.Н. Бакулева РАМН; 2006. 176 с. Bokeriya LA, Bukharin VA, Rabotnikov VS, Alshibaya MD. Khirurgicheskoe lechenie bol'nykh ishemicheskoy bolezn'yu serdtsa s porazheniem brakhiotsefal'nykh arteriy [Surgical treatment of ischemic heart disease patients with involvement of brachycephalic arteries]. Moscow: NTsSSKh im. A.N. Bakuleva RAMN [Bakulev Scientific Center for Cardiovascular Surgery]; 2006. 176 p. (in Russian).
  4. Акберов РФ, Шарафеев АЗ, Михайлов МК, Зыятдинов КШ, Коробов ВВ, Абашев АР, Сафиуллина ЛР. Прогрессирующий мультифокальный атеросклероз: этиология, клинико-лучевая диагностика, современные аспекты лечения. Казань: Иделресс; 2008. 214 с. Akberov RF, Sharafeev AZ, Mikhaylov MK, Zyyatdinov KSh, Korobov VV, Abashev AR, Safiullina LR. Progressiruyushchiy mul'tifokal'nyy ateroskleroz: etiologiya, kliniko-luchevaya diagnostika, sovremennye aspekty lecheniya [Progressive multifocal atherosclerosis: etiology, clinical and radiological diagnostics, modern treatment strategies]. Kazan: Idel-Press; 2008. 214 p. (in Russian).
  5. Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, De Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL; Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG). Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the
  6. European Society of Cardiology. Eur Heart J. 2006;27(11):1341–81.
  7. Бокерия ЛА, Кация ГВ, Сигаев ИЮ, Беришвили ИИ, Бузиашвили ЮИ, Амбатьелло СГ, Мерзляков ВЮ, Алекян БГ, Пискун АВ. Результаты полной артериальной реваскуляризации миокарда у больных ишемической болезнью сердца с мультифокальным атеросклерозом. Анналы хирургии. 2002;(6):19–22. Bokeriya LA, Katsiya GV, Sigaev IYu, Berishvili II, Buziashvili YuI, Ambat'ello SG, Merzlyakov VYu, Alekyan BG, Piskun AV. Rezul'taty polnoy arterial'noy revaskulyarizatsii miokarda
  8. u bol'nykh ishemicheskoy bolezn'yu serdtsa s mul'tifokal'nym aterosklerozom [Results of complete arterial revascularization of myocardium in ischemic heart disease patients with multifocal atherosclerosis]. Annaly khirurgii [Annals of Surgery]. 2002;(6):19–22 (in Russian).
  9. Сигаев АА, Швальб ПГ. Инфаркт миокарда как провоцирующий фактор тромботических осложнений в ангиохирургии. Кардиология. 1994;(3):37–8. Sigaev AA, Shval'b PG. Infarkt miokarda kak provotsiruyushchiy faktor tromboticheskikh oslozhneniy v angiokhirurgii [Myocardial infarction as a provoking factor for thrombotic complications in vascular surgery]. Kardiologiya [Cardiology]. 1994;(3):37–8 (in Russian).
  10. Симоненко ВБ, Широков ЕА. Превентивная кардионеврология. СПб.: Фолиант; 2008. 224 с. Simonenko VB, Shirokov EA. Preventivnaya kardionevrologiya [Preventive cardioneurology]. Saint Petersburg: Foliant; 2008. 224 p. (in Russian).
  11. Сумароков АБ. Ишемическая болезнь сердца и начальный атеросклероз экстракраниальных сосудов. Кардиология. 1996;(12):79–89. Sumarokov AB. Ishemicheskaya bolezn' serdtsa i nachal'nyy ateroskleroz ekstrakranial'nykh sosudov [Ischemic heart disease and initial atherosclerosis of extracranial vasculature]. Kardiologiya [Cardiology]. 1996;(12):79–89 (in Russian).
  12. Дуданов ИП, Покровский АВ, ред. Актуальные проблемы ангионеврологии (мультифокальный атеросклероз, церебральная ишемия, инсульт): научно-практический се- минар; лекции. Петрозаводск; 2002. 228 с. Dudanov IP, Pokrovskiy AV, editors. Aktual'nye problemy angionevrologii (mul'tifokal'nyy ateroskleroz, tserebral'naya ishemiya, insul't): nauchno-prakticheskiy seminar; lektsii [Pressing problems of angioneurology (multifocal atherosclerosis, cerebral ischemia, stroke): workshop on research and practice, lectures]. Petrozavodsk; 2002. 228 p. (in Russian).
  13. Бокерия ЛА, Спиридонов АА, Бузиашвили ЮИ, Алекян БГ, Макаренко ВН, Аракелян ВС, Пирцхалаишвили ЗК, Серов РА, Чигогидзе НА, Беспаев АТ. Кардиальные осложнения у больных с атеросклеротическим сочетанным поражением брахиоцефальных артерий и брюшной аорты. Анналы хирургии. 2004;(4):8–14. Bokeriya LA, Spiridonov AA, Buziashvili YuI, Alekyan BG, Makarenko VN, Arakelyan VS, Pirtskhalaishvili ZK, Serov RA, Chigogidze NA, Bespaev AT. Kardial'nye oslozhneniya u bol'nykh s ateroskleroticheskim sochetannym porazheniem brakhiotsefal'nykh arteriy i bryushnoy aorty [Cardiac complications in patients with combined atherosclerosis of brachycephalic arteries and abdominal aorta]. Annaly khirurgii [Annals of Surgery]. 2004;(4):8–14 (in Russian).
  14. Algra A, Gates PC, Fox AJ, Hachinski V, Barnett HJ; North American Symptomatic Carotid Endarterectomy Trial Group. Side of
  15. brain infarction and long-term risk of sudden death in patients with symptomatic carotid disease. Stroke. 2003;34(12):2871–5.
  16. Боженко СА. Реваскуляризация миокарда на работающем сердце. Вестник хирургии им. И.И. Грекова. 2000;(1):111–6. Bozhenko SA. Revaskulyarizatsiya miokarda na rabotayushchem serdtse [Myocardial revascularization in the working heart]. Vestnik khirurgii im. I.I. Grekova [Surgery Reporter named after I.I. Grekov]. 2000;(1):111–6 (in Russian).
  17. Авалиани ВМ. Особенности аортокоронарного шунтирования у больных системным атеросклерозом. Архангельск: ГМУ; 2007. 223 с. Avaliani VM. Osobennosti aortokoronarnogo shuntirovaniya u bol'nykh sistemnym aterosklerozom [Particulars of coronary bypass grafting in patients with systemic atherosclerosis]. Arkhangelsk: SGMU; 2007. 223 p. (in Russian).
  18. Дуданов ИП, Петровский ВИ, Субботина НС. Мультифокальный атеросклероз: клинико-патогенетические аспекты ишемических органных поражений. Петрозаводск: ПетрГУ; 2004. 240 с. Dudanov IP, Petrovskiy VI, Subbotina NS.
  19. Mul'tifokal'nyy ateroskleroz: kliniko-patogeneticheskie aspekty ishemicheskikh organnykh porazheniy [Multifocal atherosclerosis: clinical and pathophysiological aspects of ischemic organ lesions]. Petrozavodsk: PetrGU; 2004. 240 p. (in Russian).

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Copyright (c) 2015 Barbarash L.S., Shafranskaya K.S., Kashtalap V.V., Barbarash O.L.

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