RELATIONSHIP OF MULTIFOCAL ATHEROSCLEROSIS AND RENAL DYSFUNCTION WITH IN-HOSPITAL COMPLICATIONS AFTER CORONARY BYPASS OPERATION IN ISCHEMIC HEART DISEASE

Aim. To assess the occurence of hemodynamically non-significant multifocal atherosclerosis (from 30% and more), renal dysfunction and their influence on the outcomes of in-hospital period of patients underwent coronary bypass surgery (CABG).

Material and methods. The perioperational period of 720 patients analyzed, who were operated in 2011-2012 y. Before CABG all patients were assessed by colored duplex scanning of extracranial arteries and arteries of lower extremities to reveal the signs of multifocal atherosclerosis (MFA), also the creatinine concentration was measured in 1 day before and 7 days after CABG, and GFR was calculated by MDRD equation. The prevalence of worse outcomes was assessed after the operation (myocardial infarction, stroke, acute renal failure, remediastinotomy, death) during in-hospital period.

Results. The prevalence of hemodynamically non-significant MFA (30% and more) in patients with CHD after CABG was 48%. Renal dysfunction (RD), by a decrease of GFR <60 ml/min/1,73 m2, developed in 16% of patients underwent CABG. Concomitance of MFA and RD was 21,3%. It was found that in a quarter of patients after CABG there was an adverse outcome that was more prevalent among only those with RD: in 37,9% vs. 22,3% (p=0,03). There were no significant differents found by the prevalence of an adverse outcome in patients only with MFA. Concomitance of MFA and RD was associated with higher chance of adverse outcome in CABG with CHD: in 39,7% cases vs. 23,8% (p=0,006).

Conclusion. The high prevalence of MFA and RD (21,3%) was reveled in CHD patients, underwent CABG. Concomitance of MFA and RD is associated with the development of adverse outcome in CABG. It is stated that this exact group of patients is characterized by the highest amount of earlier CABG complications. The main influence on this is of RD, however it is not possible to definitely distinguish the grade of prognostic value of MFA and RD due to common pathophysiological factors of the development of both and quite complicated mechanisms of their influence and worsening.

1. Plyusch MG, Yarustovskiy MB, Abramyan MV, et al. Neutrophil gelatinase-associated lipocalin — an early marker of acute kidney injury in patients undergone open heart an vessels surgery. Bulletin of Bakulev CCVS RAMS, 2012; 3: 53-9. Russian (Плющ М. Г ., Ярустовский М. Б ., Абрамян М. В. и др. Нейтрофильный желатиназо-ассоциированный липокалин — ранний маркер острого повреждения почек у пациентов после открытых операций на сердце и сосудах. Бюллютень НЦССХ им. А. Н. Бакулева РАМН, 2012; 3: 53-9).

2. Ko B, Garcia S, Mithani S, et al. Risk of acute kidney injury in patients who undergo coronary angiography and cardiac surgery in close succession. Eur Heart J (2012) 33 (16): 2065-70.

3. Berezin AE. Cardiorenal syndrome. News of medicine and pharmacy. Cardiology 2011; 359: 24-32. Russian (Березин А. Е. К ардиоренальный синдром // Новости медицины и фармации. Кардиология 2011; 359: 24-32).

4. National guidelines. Chronic renal disease: main provision, definition, diagnostics, screening, prevention and treatment approaches. http://journal.nephrolog.ru/ckd/. Russian (Национальные рекомендации “Хроническая болезнь почек: основные положения, определение, диагностика, скрининг, подходы к профилактике и лечению” http://journal.nephrolog.ru/ckd/).

5. Shafranskaya KS, Barbarash OL, Ivanov SV, et al. The incidence rate of adverse cardiovascular events in patients with polyvascular disease of different severity undergone coronary artery bypass grafting. Medicine in Kuzbass 2011; 3(10): 40-6. Russian (Шафранская К .С, Барбараш О. Л., Иванов С . В., и др. Частота развития неблагоприятных сердечно-сосудистых событий у пациентов с мультифокальным атеросклерозом различной степени выраженности, подвергшихся коронарному шунтированию. Медицина в К узбассе 2011; 3(10): 40-6).

6. Ohman EM, Bhatt DL, Steg PG, et al. The reduction of atherothrombosis for continued health (REACH) registry: an international, prospectional investigation in subject at risk for atherothrombotic events-study design. Am. Heart J. 2006; 4(151): 1-10.

7. Shafranskaya KS, Barbarash OL, Barbarash LS, et al. Possibility to use EUROSCORE modified scale for assessment of annual coronary artery bypass grafting prognosis in patients polyvascular disease. Circulation pathology and cardiosurgery. 2010; 2: 52-6. Russian (Шафранская К . С ., Барбараш О. Л., Барбараш Л. С . и др. Возможность использования модифицированной шкалы EUROSCORE для оценки годового прогноза коронарного шунтирования у пациентов с мультифокальным атеросклерозом. Патология кровообращения и кардиохирургия. 2010; 2: 52-6).

8. Belyalov FI. Diagnostics and treatment of ischemic heart disease in chronic renal disease. 2010. http://therapy.irkutsk.ru Russian (Белялов Ф . И . Д иагностика и лечение ишемической болезни сердца при хронической болезни почек. 2010. http://therapy. irkutsk.ru).

9. Baldassarre D, De Jong A, Amato M, et al. Carotid intima-media thickness and markers of inflammation, endothelial damage and hemostasis. Ann Med 2008; 40: 21-44.

10. Liew JP, Bartholomew JR, Demirjian S, et al. Combined effect of chronic kidney disease and peripheral arterial disease on all-cause mortality in a high-risk population. Clinical Journal of The American Society of Nephrology. 2008; 3(4): 1084-9.

11. Barbarash OL, Zykov MV, Bykova IS, et al. Role of renal dysfunction and polyvascular disease in prognosis assessment in patients with ST-elevated myocardial infarction. Cardiology 2013; 9(53): 26-32. Russian (Барбараш О. Л., Зыков М. В., Быкова И . С . и др. Роль дисфункции почек и мультифокального атеросклероза в оценке прогноза у больных инфарктом миокарда с подъемом сегмента ST. Кардиология 2013; 9(53): 26-32).

12. Akberov RF, Sharafeev AZ, Mikhailov MK, et al. Progressive polyvascular disease: etiology, clinical and radiodiagnosis, modern aspects of treatment. Kazan: Idel-Press, 2008. 214. Russian (Акберов Р. Ф ., Шарафеев А. З., Михайлов М. К . и др. Прогрессирующий мультифокальный атеросклероз: этиология, клинико-лучевая диагностика, современные аспекты лечения. Казань: Идел-Пресс, 2008. 214).

13. Van Kuijk JP, Flu WJ, Chonchol M, et al. The prevalence and prognostic implications of polyvascular atherosclerotic disease in patients with chronic kidney disease. Nephrol Dial Transplant 2010; 25: 1882-8.

14. Zakeri R, Freemantle N, Barnett V, et al. Relation Between Mild Renal Dysfunction andOutcomes After Coronary Artery Bypass Grafting. Circulation 2005; 112: 270-5.

15. Thakar CV, Worley S, Arrigain S, et al. Influence of renal dysfunction on mortality after cardiac surgery: Modifying effect of preoperative renal function. Kidney Int. 2005; 67: 1112-9.