COMPARISON OF TWO STRATEGIES TO MINIMIZE THE RISK OF CARDIAC COMPLICATIONS FOLLOWING VASCULAR SURGERIES: LONG-TERM RESULTS

Purpose. To compare preoperative risk assessment strategies prior to vascular surgeries and evaluate their impact on long-term survival.

Materials and methods. Clinical records of the two patient groups, who underwent preoperative assessment prior to surgeries on abdominal aorta and lower extremity arteries, were retrospectively reviewed. 202 patients, who received surgical treatment in Kemerovo Cardiology Center were included in Group 1 (59,9 ± 7,4 years) and 121 patients operated in City Clinical Hospital № 29, Novokuznetsk, were enrolled in Group 2 (56,8 ± 7,7 years). The majority of patients in Group I underwent coronary angiography prior to surgery, and preventive myocardial revascularization was done in case general indications were found. Long-term outcomes were evaluated for an average of 4,5 years.

Results. Preventive myocardial revascularization was performed in 57 Group I patients (28 %) and coronary angiography in 162 (80 %) Group I patients. Follow-up mortality rates were 3,5 % for Group 1 and 32,2 % for Group II (p < 0,001). Univariate analysis was performed to identify factors increasing mortality rates in both groups: no prior preventive revascularization and age. Factors reducing mortality rates were β-blockers, ACE inhibitors and aspirin. Multivariate analysis was performed to identify independent risk factors increasing mortality rates: no prior preventive myocardial revascularization (RR 5,97; 95 % CI 0,79–44,77; p = 0,08) and patients’ age (RR 1,13; 95 % CI 1,07–1,19; p = 0,001).

Conclusions. Preventive myocardial revascularization improved the long-term survival in those patients who underwent high risk vascular surgeries. Preoperative assessment and cardiac complications risk reduction strategy as well as patients’ age produced an independent effect on long-term mortality after surgery.

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