Comparative Analysis of the Perioperative Period in High-Risk Cardiac Surgery Patients with Stable and Unstable Angina Pectoris

  • Olena K. Gogayeva National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-7338-475X
  • Anatoliy V. Rudenko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-1099-1613
  • Larysa A. Klymenko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  • Vasyl V. Lazoryshynets National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-1748-561X
Keywords: coronary artery disease, polymorbidity, subocclusion, intra-aortic balloon counterpulsation, surgical myocardial revascularization, off-pump, artificial circulation

Abstract

 

The aim. To analyze the features of the perioperative period in cardiac surgery patients with stable and unstable angina.

Materials and methods. Retrospective analysis of random 194 cardiac surgery patients with coronary artery disease (CAD) and EuroSCORE II > 5%, who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical, laboratory and functional tests, coronary angiography and coronary artery bypass grafting (CABG).

Results. When assessing the initial clinical picture of randomized patients, 110 (56.7%) were diagnosed with stable angina, and 84 (43.2%) with unstable. On admission, acute myocardial infarction (AMI) was diagnosed in 12 (14.3%) patients (p < 0.0001), and among patients with stable angina 91 (82.7%) had a history of AMI (p = 0.0158). All the patients had polymorbidity: the Charlson comorbidity index was 5.7 ± 1.8 in patients with unstable angina and 5.9 ± 1.9 in stable CAD (p = 0.4583). Patients with unstable angina were more likely to have subocclusive-occlusive lesions of the left main coronary artery (p = 0.0083), left anterior descending artery (p = 0.0392) and left circumflex artery (p = 0.0387). All the patients were discussed by the cardiac team prior to surgery which was performed by experienced cardiac surgeons with 24 ± 12.5 years of experience. Emergency surgery was performed in 43 (51.1%) patients with unstable angina and 12 (10.9%) with stable angina (p <0.0001), off-pump CABG was performed in 82 (97.6%) and 105 (95.4%) patients, respectively (p = 0.4231). The postoperative period in patients with unstable angina was almost no different from that in patients with stable CAD. The patients with unstable angina were discharged on average on day 8.7 ± 4.04, and those with stable CAD were discharged on day 8.2 ± 3.2 (p = 0.3373).

Conclusions. The outcome of the operation depends on the quality of the heart team work and requires a highly qualified cardiac surgeon with sufficient experience. Performing CABG on a working heart minimizes the occurrence of perioperative complications in patients with both unstable and stable CAD.

References

1. Reynolds HR, Shaw LJ, Min JK, Page CB, Berman DS, Chaitman BR, et al. Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity.Circulation. 2021;144(13):1024-38. https://doi.org/10.1161/CIRCULATIONAHA.120.049755

2. TCTMD [Internet]. Debating ISCHEMIA: Do the Results Apply to CABG, Too? TCTMD; 2021 Nov 4 [cited 2022 Feb 27]. Available from: https://www.tctmd.com/news/debating-ischemia-do-results-apply-cabg-too

3. Rogers CA, Pike K, Campbell H, Reeves BC, Angelini GD, Gray A, et al. Coronary artery bypass grafting in high-RISk patients randomised to off- or on-Pump surgery: a randomised controlled trial (the CRISP trial). Health Technol Assess. 2014;18(44):v-xx, 1-157. https://doi.org/10.3310/hta18440

4. Gersh BJ, Frye RL. Methods of coronary revascularization – things may not be as they seem. N Engl J Med. 2005;352(21):2235-7. https://doi.org/10.1056/NEJMe058053

5. Hannan EL, Racz M, Holmes DR, King SB 3rd, Walford G, Ambrose JA, et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation. 2006;113(20):2406-12. https://doi.org/10.1161/CIRCULATIONAHA.106.612267

6. Badhwar V, Rankin JS, Thourani VH, D’Agostino RS, Habib RH, Shahian DM, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Research: Outcomes Analysis, Quality Improvement, and Patient Safety. Ann Thorac Surg. 2018;106(1):8-13. https://doi.org/10.1016/j.athoracsur.2018.04.052

7. D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. Ann Thorac Surg. 2018;105(1):15-23. https://doi.org/10.1016/j.athoracsur.2017.10.035

8. Gogayeva O. [Coronary Bypass Grafting for High-Risk Patients (Literature review)]. Ukrainian Journal of Cardiovascular Surgery. 2020;(1(38)):7-12. Ukrainian. https://doi.org/10.30702/ujcvs/20.3803/002007-012

9. Lazar HL. Should off-pump coronary artery bypass grafting be abandoned? Circulation. 2013;128(4):406-13. https://doi.org/10.1161/CIRCULATIONAHA.113.003388

10. Polomsky M, Puskas JD. Off-pump coronary artery bypass grafting – The current state. Circ J. 2012;76(4):784-90. https://doi.org/10.1253/circj.cj-12-0111

11. Gogayeva OK, Rudenko AV, Lazoryshynets VV. [Risk stratification in patients with coronary heart disease before cardiac surgery]. Klin Khir. 2021;88(1-2):28-32. Ukrainian. https://doi.org/10.26779/2522-1396.2021.1-2.28

12. Jin R, Hiratzka LF, Grunkemeier GL, Krause A, Page US 3rd. Aborted off-pump coronary artery bypass patients have much worse outcomes than on-pump or successful off-pump patients. Circulation. 2005;112(9 Suppl):I332-7. https://doi.org/10.1161/CIRCULATIONAHA.104.526228

13. Mukherjee D, Rao C, Ibrahim M, Ahmed K, Ashrafian H, Protopapas A, et al. Meta-analysis of organ damage after conversion from off-pump coronary artery bypass procedures. Ann Thorac Surg. 2011;92(2):755-61. https://doi.org/10.1016/j.athoracsur.2011.05.037

14. Miyahara K, Matsuura A, Takemura H, Saito S, Sawaki S, Yoshioka T, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. J Thorac Cardiovasc Surg. 2008;135(3):521-6. https://doi.org/10.1016/j.jtcvs.2007.10.006

15. Gogayeva OK. [Сoronary Artery Bypass Grafting for High-Risk Patients: Features of the Perioperative Period]. Kardiologiya v Belarusi. 2021;13(2):261-7. Russian.
Published
2022-06-24
How to Cite
Gogayeva, O. K., Rudenko, A. V., Klymenko, L. A., & Lazoryshynets, V. V. (2022). Comparative Analysis of the Perioperative Period in High-Risk Cardiac Surgery Patients with Stable and Unstable Angina Pectoris. Ukrainian Journal of Cardiovascular Surgery, 30(2), 17-21. https://doi.org/10.30702/jcvs/22.30(02)/GR027-1721

Most read articles by the same author(s)

<< < 1 2 3 4