Role of dihydropyridine calcium channel blockers in coronary bypass surgery using the radial artery graft
https://doi.org/10.15829/1560-4071-2022-4744
Abstract
Aim. To assess the effect of a pharmacological protocol for the prevention of radial artery spasm, which is based on the systemic and local use of dihydropyridine calcium channel blockers, on the long-term outcomes of autoarterial coronary artery bypass grafting.
Material and methods. According to the protocol, oral nifedipine at a dose of 5 mg/day is prescribed 3 days before surgery. Then, after the radial artery is isolated, the vessel is preserved in a solution of nifedipine (adalat) until it is used. After releasing the clamp from the aorta, a nifedipine (adalat) is infused intravenously at a dose of 0,63 mg/h. In the postoperative period, the infusion of nifedipine continues for 6 hours. In the future, patients are recommended to take dihydropyridine calcium channel blockers at a dose of 5 mg/day after discharge from the hospital.
Results. The use of the pharmacological protocol (n=225) is associated with a lower number of major cardiovascular events (mortality, myocardial infarction, stroke) compared with the control group (n=230) (9,3% and 15,7%, p=0,031) during the 5-year follow-up. This result was achieved mainly by reducing the incidence of myocardial infarction (6,2% and 12,6%, p=0,018). Also, the use of the pharmacological protocol led to a decrease in repeated revascularizations (4,4% and 16,1%, p=0,0001) compared with the control group.
Conclusion. The use of a pharmacological protocol for the prevention of radial artery spasm based on the systemic use of dihydropyridine calcium channel blockers improves the long-term outcomes of autoarterial coronary artery bypass grafting.
About the Authors
V. V. Zatolokin
Cardiology Research Institute, Tomsk National Research Medical Center
Russian Federation
Competing Interests:
Russian Federation
Tomsk
Competing Interests:
none
Yu. Yu. Vechersky
Cardiology Research Institute, Tomsk National Research Medical Center
Russian Federation
Competing Interests:
Russian Federation
Tomsk
Competing Interests:
none
D. V. Manvelyan
Cardiology Research Institute, Tomsk National Research Medical Center
Russian Federation
Competing Interests:
Russian Federation
Tomsk
Competing Interests:
none
B. N. Kozlov
Cardiology Research Institute, Tomsk National Research Medical Center
Russian Federation
Competing Interests:
Russian Federation
Tomsk
Competing Interests:
none
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For citations:
Zatolokin V.V., Vechersky Yu.Yu., Manvelyan D.V., Kozlov B.N. Role of dihydropyridine calcium channel blockers in coronary bypass surgery using the radial artery graft. Russian Journal of Cardiology. 2022;27(8):4744. (In Russ.) https://doi.org/10.15829/1560-4071-2022-4744
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