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Khirurgii

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Year 2023 Vol. 31 No 1

SCIENTIFIC PUBLICATIONS

A.A. SEMAGIN 2, O.P. LUKIN 1, 2, A.A. FOKIN 1

ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS UNDERGOING EMERGENCY PERCUTANEOUS CORONARY INTERVENTION AFTER CORONARY ARTERY BYPASS GRAFTING

Federal State Budgetary Educational Institution of Higher Professional Education
«South Ural State Medical University» of the Ministry of Health of the Russian Federation 1,
Federal State Budgetary Institution «Federal Center for Cardiovascular Surgery»
of the Ministry of Health of the Russian Federation 2, Chelyabinsk,
Russian Federation

Objective. To study the rate of long-term mortality and major adverse cardiovascular events within 10 years in patients undergoing emergency endovascular myocardial revascularization in the early postoperative period after planned coronary artery bypass surgery.
Methods. From 2011 to 2020 8801 patients underwent isolated coronary artery bypass grafting in the Federal State Budgetary Institution «FTSSSH» of the Ministry of Health of the Russian Federation in the city of Chelyabinsk. Due to signs of acute myocardial ischemia, 196 (2.23%) patients underwent emergency coronary angiography. Inclusion criteria in the study were as follows: patients (n=60; 0.68%) with a stable form of cardiac ischemia, who underwent emergency stenting due to acute grafts dysfunction after elective coronary artery bypass grafting based on coronary angiography. Exclusion criteria: patients who underwent urgent coronary artery bypass grafting, patients from the endovascular treatment group (n=6/10%) who deceased in the clinic within 30 days, patients with whom contact was lost after their discharge from the hospital (n=14/23,3%). Mortality has long been used as a primary end point for randomized controlled trials in critical care; cardiovascular events was considered as the secondary endpoint. To conduct a comparative analysis by random number generation, group II (n=60) consisting of patients with an uncomplicated postoperative period was formed. The exclusion criteria were just the same (deceased in the clinic n=1/1.6% and loss of communication after discharge from the hospital n=6/10%). After application of exclusion/inclusion criteria, group I included 40 patients and group II 53 patients. To ascertain patient reports of problems after discharge the telephone interviews have been conducted.
Results. When comparing the long-term total mortality rate in patients of group I (106.3±5.9 months) and group II (87.5±3.8 months), no statistically significant differences were found (p=0.737) in the incidence of major adverse cardiovascular events in Group I and Group II. There were also no statistically significant differences in vascular events in group I and group II, 111.5±4.8 months and 87.8±4.2 months, respectively (p=0.582). When conducting a multivariate Cox regression analysis in group I, this study shows that increasing age in 1 year significantly contribute to a fatal outcome in 1,361 fold (p=0,015), a decrease in LV EF by 1% - by 1/0.854 fold (p=0.012), with an increase in time from the first result of the analysis of Troponin I to stenting procedure for 1 hour by 1.029 folds (p=0.023).
Conclusion. When comparing long-term mortality rate and adverse cardiovascular events in the group of patients undergoing emergency stenting with the control group, no statistically significant difference was found. Factors that increase the risk of lethality in the long-term period in the stenting group were: the patient’s age, left ventricular ejection fraction in the preoperative period, the time elapsed from the results of the first Troponin I test to stenting procedure.

Keywords: coronary artery bypass, myocardial infarction, postoperative complications
p. 16-25 of the original issue
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Address for correspondence:
454003, Russian Federation,
Chelyabinsk, avenue Hero of Russia Rodionova E.N., 2,
Federal State Institution «Federal Centre for Cardiovascular Surgery,
the Ministry of Health of the Russian Federation,
tel.: +79823135426,
e-mail: AASemagin@gmail.com,
Semagin Aleksei A.
Information about the authors:
Semagin Aleksey A., PhD, Cardio-Vascular Surgeon; Federal State Budgetary Institution «Federal Center for Cardiovascular Surgery» of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0002-1011-2300
Lukin Oleg P., MD, Chief Physician, Professor of the Department of Hospital Surgery; Federal State Budgetary Institution «Federal Center for Cardiovascular Surgery» of the Ministry of Health of the Russian Federation, Federal State Budgetary Educational Institution of Higher Professional Education «South Ural State Medical University» of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0003-3162-1523
Fokin Aleksey A., MD, Professor, Head of the Department of Surgery of the Institute of Additional Professional Education; Federal State Budgetary Educational Institution of Higher Professional Education «South Ural State Medical University» of the Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation.
https://orcid.org/0000-0001-7806-2357
Contacts | ©Vitebsk State Medical University, 2007-2023