Российский кардиологический журнал (Mar 2015)

RELATIONSHIP OF MULTIFOCAL ATHEROSCLEROSIS AND RENAL DYSFUNCTION WITH IN-HOSPITAL COMPLICATIONS AFTER CORONARY BYPASS OPERATION IN ISCHEMIC HEART DISEASE

  • K. S. Shafranskaya,
  • M. V. Zykov,
  • V. V. Kashtalap,
  • O. K. Kuzmina,
  • I. S. Bykova,
  • V. N. Karetnikova,
  • A. N. Sumin,
  • S. V. Ivanov S,
  • O. L. Barbarash

DOI
https://doi.org/10.15829/1560-4071-2015-3-72-81
Journal volume & issue
Vol. 0, no. 3
pp. 72 – 81

Abstract

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Aim. To assess the occurence of hemodynamically non-significant multifocal atherosclerosis (from 30% and more), renal dysfunction and their influence on the outcomes of in-hospital period of patients underwent coronary bypass surgery (CABG).Material and methods. The perioperational period of 720 patients analyzed, who were operated in 2011-2012 y. Before CABG all patients were assessed by colored duplex scanning of extracranial arteries and arteries of lower extremities to reveal the signs of multifocal atherosclerosis (MFA), also the creatinine concentration was measured in 1 day before and 7 days after CABG, and GFR was calculated by MDRD equation. The prevalence of worse outcomes was assessed after the operation (myocardial infarction, stroke, acute renal failure, remediastinotomy, death) during in-hospital period.Results. The prevalence of hemodynamically non-significant MFA (30% and more) in patients with CHD after CABG was 48%. Renal dysfunction (RD), by a decrease of GFR <60 ml/min/1,73 m2, developed in 16% of patients underwent CABG. Concomitance of MFA and RD was 21,3%. It was found that in a quarter of patients after CABG there was an adverse outcome that was more prevalent among only those with RD: in 37,9% vs. 22,3% (p=0,03). There were no significant differents found by the prevalence of an adverse outcome in patients only with MFA. Concomitance of MFA and RD was associated with higher chance of adverse outcome in CABG with CHD: in 39,7% cases vs. 23,8% (p=0,006).Conclusion. The high prevalence of MFA and RD (21,3%) was reveled in CHD patients, underwent CABG. Concomitance of MFA and RD is associated with the development of adverse outcome in CABG. It is stated that this exact group of patients is characterized by the highest amount of earlier CABG complications. The main influence on this is of RD, however it is not possible to definitely distinguish the grade of prognostic value of MFA and RD due to common pathophysiological factors of the development of both and quite complicated mechanisms of their influence and worsening.

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