Risk factors of adverse outcomes of various interventions when treating patients with concomitant lesions of the coronary bed and carotid arteries in 30-day follow-up

Abstract

<p><strong>Aim.</strong> The study looks at clinical and instrumental factors associated with adverse outcomes in the hospital and long-term follow-up when using various surgical strategies for treatment of patients with multifocal atherosclerosis.<br /><strong>Methods.</strong> From 2011 to 2015, three hundred ninety-one patients with combined hemodynamically significant atherosclerotic lesion of the coronary bed and internal carotid arteries were included in this study in a continuous sampling mode. A detailed analysis of the prognostic significance of a wide range of clinical-instrumental, anatomical-angiographic and perioperative factors was performed.<br /><strong>Results.</strong> Against the background of patients’ initially severe comorbid condition, the most significant hospital risk factors were III–IV functional class angina and stroke in the anamnesis. It is important to note a high risk of complications, with bleeding reaching three points or higher on the Bleeding Academic Research Consortium (BARC) scale during simultaneous coronary artery bypass graft surgery and carotid endarterectomy. At the same time, EuroSCORE II value not higher than 2% and the duration of artificial circulation 74 minutes or less turned out to be protective factors. <br /><strong>Conclusion.</strong> The study is not randomized and requires further research on the algorithms for choosing the optimal option of revascularization in this group of patients. The results obtained can form the basis for further research aimed at developing optimal surgical protocols for patients with multifocal atherosclerosis.</p><p>Received 2 August 2017. Revised 16 October 2017. Accepted 25 October 2017.</p><p><strong>Funding:</strong> The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: R.S. Tarasov<br />Data collection and analysis: A.A. Golovin, N.N. Burkov, M.G. Zinets<br />Drafting the article: A.N. Kazantsev<br />Critical revision of the article: S.V. Ivanov, A.I. Anoufriev<br />Final approval of the version to be published: R.S. Tarasov, A.N. Kazantsev, S.V. Ivanov, A.A. Golovin, N.N. Burkov, A.I. Anoufriev, M.G. Zinets, L.S. Barbarash</p>

Influence of risk factors on progression of atherosclerosis of brachiocephalic artery with un-derlying treatment with statins

“…асимптомного, внутренней сонной артерии (ВСА), по данным исследования ACST, является каротидная эндартерэктомия (КЭАЭ), которая снижает частоту развития НМК и уровень смертности [2,3]. Медикаментозное лечение проводится с целью коррекции ФР, уменьшения риска развития рестеноза ВСА, частоты конечных точек (инфаркта миокарда (ИМ), НМК и, в итоге, снижения летальности в периоперационном периоде [4,5]. В исследовании SPARCL (Stroke Prevention by Aggressive Reduсtionin Cholesterol Levels) была продемонстрирована эффективность назначения статинов с целью вторичной профилактики НМК, за счет коррекции одного из важнейших ФР -гиперлипидемии [6].…”