The aim: To determine the role of adherence to the guidelines on basic pharmacotherapy in prevention of late major adverse clinical events (MAEs) in patients with stable CAD for three years following isolated CABG. Materials and methods: A prospective single-centre study included 251 consecutive patients with stable CAD (mean age (61±9) years, 218 (86.9%) males), after isolated CABG. In three years MAЕs occurred in 55 (21.9%) patients. The data on pharmacotherapy at follow-up were obtained in 250 patients: 196 (78.4%) patients without MAEs (at scheduled visit) and 54 (21.6%) patients with MAEs (based on in-hospital or archive data). Results: Basic CAD pharmacotherapy after CABG was comparable in MAEs vs. no-MAEs groups, with the vast majority of patients receiving guideline-recommended therapy with angiotensin-converting enzyme inhibitors (ACEII) or angiotensin-II receptors blockers (ARBs), statins and antiplatelet drugs. At three years follow-up, MAEs group, as opposed to no-MAEs group, was characterized by the lower usage of ACEII/ARBs (68.5% vs. 87.2%, respectively; p=0,001) and statins (59.3% vs. 86.7%, respectively; p<0,001), as well as basic triple therapy (ACEII or ARBs/statins/antiplatelet drugs: 35.2% vs. 70.4%, respectively [p<0,001]). Conclusions: At three – year follow-up MAEs in patients with stable CAD after CABG were associated with more frequent discontinuation of previously prescribed basic pharmacotherapy, namely ACEII/ARBs and statins, as well as triple therapy (ACEII/ARBs, statins and antiplatelet drugs).
Резюме. Целью данной работы авторы ставили анализ собственного опыта хирургического лечения ишемической болезни сердца (ИБС) в сочетании с атеросклеротическим поражением восходящей аорты. Приведенные результаты хирургических вмешательств при ИБС показывают наиболее информативные методы диагностики тяжести поражения восходящей аорты атеросклерозом и оптимальные подходы к хирургическому лечению данной патологии.Ключевые слова: аортокоронарное шунтирование, эхокардиография, эпиаортальное сканирование.
Objective. Аnalysis of levels of the myocardium damage markers and state of the oxygen budget in patients, suffering the mitral valve insufficiency, in surgical correction, using crystalloid cardioplegia, was performed. Маterials and methods. There were examined 40 patients, suffering the mitral valve insufficiency and ageing (56.2 ± 4.5) yrs old, admitted to the Institute of the Heart MH of Ukraine for surgical correction of the failure. The therapy and operative intervention, the mitral valve prosthesis, were conducted in the patients in accordance to actual local protocol of intraoperative cardioprotection, using the crystalloid cardioplegia (Bretschtider’s solution). The markers levels, concerning the myocardium affection (troponin I, sodiumuretic peptide, alaninaminotranspherase, aspartataminotransphefase, creatinphosphokinase, МВ fraction of creatinephosphokinase), indices of the oxygen budget (hemoglobin, hematocrit, hemoglobin saturation by oxygen in arterial and venous blood, partial pressure of oxygen in arterial and venous blood, lactate) were performed in the patients while exit from perfusion, before admittance to the Department of Intensive Therapy and discharge from it. There were calculated: the ratio of creatinephosphokinase-MB towards creatinephosphokinase, аrterio-venous difference of hemoglobin saturation by the oxygen, content of oxygen in arterial and venous blood, transport, consumption of oxygen and coefficient of the oxygen extraction by the tissues. Results. The levels of markers investigated, concerning affection of myocardium in the patients, did not exceeded the norm range, while statistically significant dynamics was registered only for concentration of sodiumuretic peptide and ratio of creatinephosphokinase-MB towards creatinephosphokinase. The indices of hemic chain of the oxygen transport trustworthily lowered while exit from perfusion only. Тhe oxygen transport and consumption after the failure correction have reduced trustworthily, while coefficient of the oxygen extraction by the tissues did not change essentially. Arterio-venous difference for the oxygen content have reduced trustworthily, but on this background the lactate level have raised significantly. Conclusion. The levels of markers studied, concerning the myocardium damage, did not differ during the investigation course essentially, what witnesses satisfactory state of myocardium.
2 Національна медична академія післядипломної освіти імені П.Л. Шупика, Київ Режим перфузії як фактор виникнення когнітивної дисфункції у хворих, що перенесли аортокоронарне шунтування в умовах штучного кровообігу Мета роботи-оцінити вплив перфузійного тиску на виникнення післяопераційної когнітивної дисфункції у хворих, яким виконували аортокоронарне шунтування в умовах штучного кровообігу (ШК). Матеріали і методи. У ретроспективному обсерваційному одноцентровому дослідженні проаналізовано дані, отримані при клінічному та інструментальному обстеженні 71 пацієнта, відібраного для проведення оперативного втручання з приводу ішемічної хвороби серця-аортокоронарного шунтування в умовах ШК (57 (80,2 %) чоловіків і 14 (19,8 %) жінок, віком у середньому (58,7 ± 7,7) року). Хворих розділили на дві групи залежно від режиму перфузії, а саме за величиною артеріального тиску, який підтримувався під час ШК: 1-ша група-40-60 мм рт. ст., 2-га-більше 60 мм рт. ст. Нейрокогнітивні та психометричні тести в обох групах проводили до оперативного втручання, на 7-му добу і через 3 місяці після операції. Батарея тестів складалася зі шкали оцінки психічного статусу (Mini-Mental State Examination, MMSE), тесту вкладання паличок у отвори відповідно до форми (Grooved Pegboard) і тесту на встановлення цифр та літер (Trial Making Test Part A).
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