Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part I

DOI: https://doi.org/10.30702/ujcvs/21.4512/GD048-1017
Keywords: comorbidity, coronary artery bypass grafting, off-pump CABG, diabetes mellitus, connective tissue disease, COVID-19 associated autoimmune processes, chronic kidney disease, gastropathy

Abstract

Every year we see an increase in the number of patients with indications for surgical treatment of coronary artery disease. In addition to the difficulties of the cardiac surgery process, no less important is the therapeutic support of patients, which in addition to cardiac subtleties requires guidance in concomitant nosologies. As the age of patients increases, there is a higher comorbidity which is associated with difficult management of patients, extensive prescription of drugs and higher cost of medical care.

The aim. To analyze the current literature data on comorbidity in patients hospitalized for coronary artery bypass grafting.

Results. According to the literature data, there is a high Charlson comorbidity index, in average 5.7 ± 1.7, in the baseline status of patients with coronary artery disease. High comorbidity index is known for its negative effect on the functioning of grafts in the long-term period after surgical myocardial revascularization. Among patients who underwent surgical revascularization of the myocardium, 22.8–46.9% had diabetes mellitus, 37.5% had obesity, 1.1% had rheumatoid arthritis and 10–12% suffered from chronic kidney disease. There is no statistical data on preoperative status of gastrointestinal tract, but the main complications and predictors of death were identified. Due to the increase in the occurrence of autoimmune diseases on the background of the COVID-19 pandemic, an increase in the number patients with connective tissue diseases in cardiac surgery is predicted, and perioperative management of such patients has its own characteristics and requires further in-depth study.

Conclusions. Searching for comorbidity in cardiac surgery patients with coronary artery disease is an important component of their preoperative preparation and risk stratification. The influence of type 2 diabetes mellitus, obesity, autoimmune diseases, chronic kidney disease on the occurrence of postoperative complications and the result of surgical myocardial revascularization has been proven. SARS-CoV-2 infection in the surgical treatment of coronary artery disease is another challenge of today that requires further observation and research to help address prognosis, complications, and mortality.

References

  1. Jakovljević M, Ostojić L. Comorbidity and multimorbidityin medicine today: challenges and opportunities for bringing separated branches of medicine closer to each other. Psychiatr Danub. 2013;25 Suppl 1:18-28. PMID: 23806971.
  2. Gogayeva OK. [Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery]. Zaporozhye medical journal. 2021;23(4):485-91. Ukrainian. https://doi.org/10.14739/2310-1210.2021.4.233643
  3. Karabag T, Kalayci B, Sahin B, Coskun E, Somuncu UM, Cakir MO. The Influence of Comorbid Conditions on Graft Stenosis in Patients with Coronary Artery Bypass Graft Operation. Int J Cardiovasc Sci. 2018;31(5):544-7. https://doi.org/10.5935/2359-4802.20180055
  4. D’Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, McDonald D, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality. Ann Thorac Surg. 2016;101(1):24-32. https://doi.org/10.1016/j.athoracsur.2015.11.032
  5. Kindo M, Hoang Minh T, Perrier S, Bentz J, Mommerot A, Billaud P, Mazzucotelli JP. Trends in isolated coronary artery bypass grafting over the last decade. Interact Cardiovasc Thorac Surg. 2017;24(1):71-6. https://doi.org/10.1093/icvts/ivw319
  6. Gogayeva OK, Rudenko AV, Lazoryshynets VV, DzakhoievaLS.[Analysisoftheendocrinestatusofpatients withcoronaryarterydiseaseincardiacsurgery].Ukrainian Journal of Cardiology. 2021;28(1):26-33. Ukrainian. https://doi.org/10.31928/1608-635X-2021.1.2633
  7. McAlister FA, Man J, Bistritz L, Amad H, Tandon P. Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes. Diabetes Care. 2003;26(5):1518-24. https://doi.org/10.2337/diacare.26.5.1518
  8. Fish LH, Weaver TW, Moore AL, Steel LG. Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting. Am J Cardiol. 2003;92(1):74-6. https://doi.org/10.1016/s0002-9149(03)00472-7
  9. Nakano J, Okabayashi H, Hanyu M, Soga Y, Nomoto T, Arai Y, Matsuo T, Kai M, Kawatou M. Risk factors for wound infection after off-pump coronary artery bypass grafting: Should bilateral internal thoracic arteries be harvested in patients with diabetes? J Thorac Cardiovasc Surg. 2008;135(3):540-5. https://doi.org/10.1016/j.jtcvs.2007.11.008
  10. Tran HA, Barnett SD, Hunt SL, Chon A, Ad N. The effect of previous coronary artery stenting on short- and intermediate-term outcome after surgical revascularization in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2009;138(2):316-23. https://doi.org/10.1016/j.jtcvs.2009.03.004
  11. Rudenko AV, Gutovsky VV, Rudenko SA. Osoblyvosti shuntuvannia koronarnykh arterii na pratsiuiuchomu sertsi u khvorykh ishemichnoiu khvoroboiu sertsia iz suputnim tsukrovym diabetom 2 typu [Off-pump coronary artery grafting peculiarities in patients with coronary artery disease with type ii diabetes mellitus]. A Yearbook of Scientific Papers of the Association of cardiovascular surgeons of Ukraine. 2012;20:426-30. Ukrainian.
  12. Liu Y, Han J, Liu T, Yang Z, Jiang H, Wang H. The Effects of Diabetes Mellitus in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. Biomed Res Int. 2016;2016:4967275. https://doi.org/10.1155/2016/4967275
  13. Tennyson C, Lee R, Attia R. Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery? Interact Cardiovasc Thorac Surg. 2013;17(6):1000-8. https://doi.org/10.1093/icvts/ivt351
  14. WHO [Internet]. WHO ;c2017 [cited 2020 Nov 2]. Prevalence of obesity among adults, BMI ≥ 30, age-standardized estimates by Country. Available from: https://apps.who.int/gho/data/view.main.CTRY2450A
  15. ProCon.org [Internet]. Chicago; c2020 [cited 2021 Oct 5]. Global Obesity Levels; [about 1 screen]. Available from: https://obesity.procon.org/global-obesity-levels.
  16. Gogayeva O. [The Influence of Obesity on Perioperative Course in High-Risk Patients with Coronary Artery Disease in Cardiac Surgery]. Ukrainian Journal of Cardiovascular Surgery. 2021;(1(42):20-7. Ukrainian. https://doi.org/10.30702/ujcvs/21.4203/g002020-027/24036
  17. Johnson AP, Parlow JL, Whitehead M, Xu J, Rohland S, Milne B. Body Mass Index, Outcomes, and Mortality Following Cardiac Surgery in Ontario, Canada. J Am Heart Assoc. 2015;4(7):e002140. https://doi.org/10.1161/JAHA.115.002140
  18. Hernandez AV, Kaw R, Pasupuleti V, Bina P, Ioannidis JP, Bueno H, Boersma E, Gillinov M; Cardiovascular Meta-Analyses Research Group. Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: a systematic review and meta-analysis. Ann Thorac Surg. 2013;96(3):1104-16. https://doi.org/10.1016/j.athoracsur.2013.04.029.
  19. De Santo LS, Esquinas AM. How to delineate obstructive sleep apnea and continuous positive airway pressure link in postoperative atrial fibrillation conundrum? J Crit Care. 2016;31(1):276. https://doi.org/10.1016/j.jcrc.2015.09.027
  20. Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 2021;33(2):155-62. https://doi.org/10.1097/BOR.0000000000000776
  21. Liang C, Zhang W, Li S, Qin G. Coronary heart disease and COVID-19: A meta-analysis. Med Clin (Barc). 2021;156(11):547-54. https://doi.org/10.1016/j.medcli.2020.12.017
  22. Gabriyelyan AV, Cheveliuk OV, Romanova SV, Kudlai IV, Gergi MS, Moshta SS. [Evaluation of the Perioperative Period After Off-Pump Coronary Artery Bypass Grafting in Patients with the History of COVID-19]. Ukrainian Journal of Cardiovascular Surgery. 2021;(3(44)):80-5. Ukrainian. https://doi.org/10.30702/ujcvs/21.4409/g.c.038-80-85
  23. Topal G, Loesch A, Dashwood MR. COVID-19 - Endothelial Axis and Coronary Artery Bypass Graft Patency: a Target for Therapeutic Intervention? Braz J Cardiovasc Surg. 2020;35(5):757-63. https://doi.org/10.21470/1678-9741-2020-0303
  24. Malmberg M, Palomäki A, Sipilä JOT, Rautava P, Gunn J, Kytö V. Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis. Ann Med. 2021;53(1):1512-9. https://doi.org/10.1080/07853890.2021.1969591
  25. Yuan SM. Coronary Artery Bypass Grafting in Patients with Systemic Lupus Erythematosus. J Coll Physicians Surg Pak. 2020;30(9):961-5. https://doi.org/10.29271/jcpsp.2020.09.961
  26. Birdas TJ, Landis JT, Haybron D, Evers D, Papasavas PK, Caushaj PF. Outcomes of coronary artery bypass grafting in patients with connective tissue diseases. Ann Thorac Surg. 2005;79(5):1610-4. https://doi.org/10.1016/j.athoracsur.2004.10.052
  27. Lai CH, Hsieh CY, Barnado A, Huang LC, Chen SC, Tsai LM, Shyr Y, Li CY. Outcomes of acute cardiovascular events in rheumatoid arthritis and systemic lupus erythematosus: a population-based study. Rheumatology (Oxford). 2020;59(6):1355-63. https://doi.org/10.1093/rheumatology/kez456
  28. Lai CH, Lai WW, Chiou MJ, Tsai LM, Wen JS, Li CY. Outcomes of coronary artery bypass grafting in patients with inflammatory rheumatic diseases: an 11-year nationwide cohort study. J Thorac Cardiovasc Surg. 2015;149(3):859-66.e1-2. https://doi.org/10.1016/j.jtcvs.2014.11.038
  29. Ura M, Sakata R, Nakayama Y, Ohtsuka Y, Saito T. Coronary artery bypass grafting in patients with systemic lupus erythematosus. Eur J Cardiothorac Surg. 1999;15(5):697-701. https://doi.org/10.1016/s1010-7940(99)00064-0
  30. Bozbuga N, Erentug V, Kaya E, Akinci E, Yakut C. Coronary artery bypass grafting in patients with systemic lupus erythematosus. J Card Surg. 2004;19(5):471-2. https://doi.org/10.1111/j.0886-0440.2004.05005.x
  31. Ho JS, Sia CH, Chan MY, Lin W, Wong RC. Coronavirus-induced myocarditis: A meta-summary of cases. Heart Lung. 2020;49(6):681-5. https://doi.org/10.1016/j.hrtlng.2020.08.013
  32. Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P. SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. Heart Lung Circ. 2020;29(7):973-87. https://doi.org/10.1016/j.hlc.2020.05.101
  33. Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol. 2009;53(23):2129-40. https://doi.org/10.1016/j.jacc.2009.02.047
  34. Li X, Zhang S, Xiao F. Influence of chronic kidney disease on early clinical outcomes after off-pump coronary artery bypass grafting. J Cardiothorac Surg. 2020;15(1):199. https://doi.org/10.1186/s13019-020-01245-5
  35. Cai Q, Mukku VK, Ahmad M. Coronary artery disease in patients with chronic kidney disease: a clinical update. Curr Cardiol Rev. 2013;9(4):331-9. https://doi.org/10.2174/1573403x10666140214122234
  36. Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A. Acute Kidney Injury: A Relevant Complication After Cardiac Surgery. Ann Thorac Surg. 2011;92(4):1539-47. https://doi.org/10.1016/j.athoracsur.2011.04.123
  37. Reiss AB, Miyawaki N, Moon J, Kasselman LJ, Voloshyna I, D’Avino R Jr, De Leon J. CKD, arterial calcification, atherosclerosis and bone health: inter-relationships and controversies. Atherosclerosis. 2018;278:49-59. https://doi.org/10.1016/j.atherosclerosis.2018.08.046
  38. Kannan A, Poongkunran C, Medina R, Ramanujam V, Poongkunran M, Balamuthusamy S. Coronary revascularization in chronic and end-stage renal disease: a systematic review and meta-analysis. Am J Ther. 2016;23(1):e16-28. https://doi.org/10.1097/MJT.0000000000000089
  39. Wang Y, Zhu S, Gao P, Zhang Q. Comparison of coronary artery bypass grafting and drug-eluting stents in patients with chronic kidney disease and multivessel disease: a meta-analysis. Eur J Intern Med. 2017;43:28-35. https://doi.org/10.1016/j.ejim.2017.04.002
  40. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366(16):1489-97. https://doi.org/10.1056/NEJMoa1200388
  41. Garg AX, Kurz A, Sessler DI, Cuerden M, Robinson A, Mrkobrada M, et al. Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial. JAMA. 2014;312(21):2254-64. https://doi.org/10.1001/jama.2014.15284
  42. Gogayeva O, Rudenko A, Lazoryshynets V. [Comparison of On-Pump and Off-Pump Coronary Artery Bypass Grafting. Our experience of participation in the international study]. Ukrainian Journal of Cardiovascular Surgery. 2020;(4(41):9-14. Ukrainian. https://doi.org/10.30702/ujcvs/20.4112/048009-014/1.53
  43. Gogayeva O, Lazoryshynets V, Rudenko A, Dzakhoieva L, Yuvchyk O. [Perioperative evaluation of kidney function for patients with complicated forms of coronary artery disease]. Ukr J Nephr Dial. 2020;4(68):52-8. Ukrainian. https://doi.org/10.31450/ukrjnd.4(68).2020.08
  44. Karangelis D, Oikonomou K, Koufakis T, Tagarakis GI. Gastrointestinal Complications Following Heart Surgery: An Updated Review. Eur J Cardiovasc Med. 2011;I(Issue III):34-7. https://doi.org/10.5083/ejcm.20424884.32
  45. Vassiliou I, Papadakis E, Arkadopoulos N, Theodoraki K, Marinis A, Theodosopoulos T, Palatianos G, Smyrniotis V. Gastrointestinal emergencies in cardiac surgery. A retrospective analysis of 3,724 consecutive patients from a single center. Cardiology. 2008;111(2):94-101. https://doi.org/10.1159/000119696
  46. Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw AL, Berger DL. Gastrointestinal complications in patients undergoing heart operation: An analysis of 8709 consecutive cardiac surgical patients. Ann Surg. 2005;241(6):895-901; discussion 901-4. https://doi.org/10.1097/01.sla.0000164173.05762.32
  47. Jayaprakash A, McGrath C, McCullagh E, Smith F, Angelini G, Probert C. Upper gastrointestinal haemorrhage following cardiac surgery: a comparative study with vascular surgery patients from a single centre. Eur J Gastroenterol Hepatol. 2004;16(2):191-4. https://doi.org/10.1097/00042737-200402000-00011
  48. Simic O, Strathausen S, Geidel S, Hess W, Mörl F, Ostermeyer J. Abdominelle Komplikationen nach kardiochirurgischen Eingriffen [Abdominal complications after heart surgery interventions]. Zentralbl Chir. 1997;122(10):893-7. German. PMID: 9446453.
  49. Poirier B, Baillot R, Bauset R, Dagenais F, Mathieu P, Simard S, Dionne B, Caouette M, Hould FS, Doyle D, Poirier P. [Abdominal complications associated with cardiac surgery. Review of a contemporary surgical experience and of a series done without extracorporeal circulation]. Can J Surg. 2003;46(3):176-82. French. PMID: 12812238.
  50. Passage J, Joshi P, Mullany DV. Acute cholecystitis complicating cardiac surgery: case series involving more than 16,000 patients. Ann Thorac Surg. 2007;83(3):1096-101. https://doi.org/10.1016/j.athoracsur.2006.09.048
Published
2021-12-22
How to Cite
1.
Gogayeva OK, Drobnich MA, Lytvyn NO, Nastenko OO, Salo RI. Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part I. ujcvs [Internet]. 2021Dec.22 [cited 2024Dec.21];(4 (45):10-7. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/443
Issue
Ukrainian Journal of Cardiovascular Surgery No 4 (45) 2021
Section
ISCHEMIC HEART DISEASE

Most read articles by the same author(s)

1 2 > >>