Gender differences in immediate outcomes of patients with acute non-ST-elevation myocardial infarction undergoing off-pump coronary artery bypass grafting
https://doi.org/10.17802/2306-1278-2020-9-1-25-33
Abstract
Aim.To determine gender differences in immediate outcomes of patients with acute non-ST-elevation myocardial infarction undergoing off-pump coronary artery bypass grafting (CABG).
Methods.CABG was indicated to patients with persistent myocardial ischemia (postinfarction angina) who did not meet criteria for percutaneous coronary intervention. Hybrid procedures and CABG aimed at repairing mechanical complications of AMI were not considered. Men (n = 66, 65.3%) were assigned to Group 1, whereas women (n = 35, 34.7%) were assigned to Group 2. Women were older and obese (grades 2-3), had higher GRACE scores, levels of cardiospecific troponin and higher rate of type 2 diabetes (p<0.05). Men and women commonly had three-vessel CAD (3.0; 4.0). The mean SYNTAX score for men and women was 29.0 (24.0; 33.0) and 27.0 (24.0; 28.0), p>0.05.
Results.The median preoperative period was 4.0 days (3.8; 5.0) in male patients and 5.0 (4.0; 6.0) days in female patients (p>0.05). The groups did not have any significant differences in technical aspects of CABG (p>0.05). Mortality was 3.0% in men and 2.9% in women (p>0.05). No deaths were recorded from the onset of AMI till the first 72 hours after CABG. Three patients who under CABG died after 72 hours from the onset of MI (p>0.05). The total number of complications was 13 (19.7%) in men and 5 (14.3%) in women (p>0.05). There were no cases of conversion to cardiopulmonary bypass.
Conclusion.The immediate outcomes of delayed of-pump CABG in both, men and women with acute non-ST-segment myocardial infarction, were comparable in mortality and complications (p>0.05). The immediate outcomes of CABG performed within 72 hours in both, men and women, were comparable in mortality as compared to surgeries performed after 72 hours from the MI onset. Obtained data demonstrated safety of early open-heart surgeries for acute non-ST-elevation myocardial infarction.
About the Authors
A. A. Fokin
Railway Clinical hospital on station Cheljabinsk "Russian Railway"; State Educational Institution of Higher Education "Chelyabinsk State Medical Academy of Federal Agency of Health Care and Social Development"
Russian Federation
Russian Federation
Fokin Alexey A.- PhD, Professor, Head of the Inter-Road Center for Cardiovascular Surgery; Head of the Department of Surgery at the Institute of Continuing Professional Education.
23, Dovatora St., Chelyabinsk, Russian Federation, 454048
64, Vorovskogo St., Chelyabinsk, Russian Federation, 454092
K. A. Kireev
Railway Clinical hospital on station Cheljabinsk "Russian Railway"; State Educational Institution of Higher Education "Chelyabinsk State Medical Academy of Federal Agency of Health Care and Social Development"
Russian Federation
Russian Federation
Kireev Konstantin A.- PhD, Head of Interventional Cardiology Center, Railway Clinical Hospital on Station Cheljabinsk "Russian Railway"; Associate Professor at the Department of Surgery, State Educational Institution of Higher Education "Chelyabinsk State Medical Academy of Federal Agency of Health Care and Social Development".
23, Dovatora St., Chelyabinsk, Russian Federation, 454048
64, Vorovskogo St., Chelyabinsk, Russian Federation, 454092
S. V. Netisanov
State Educational Institution of Higher Education "Chelyabinsk State Medical Academy of Federal Agency of Health Care and Social Development"
Russian Federation
Russian Federation
Netisanov Sergey V.-Head of the Cardiac Surgery Department, Railway Clinical Hospital on Station Cheljabinsk "Russian Railway".
23, Dovatora St., Chelyabinsk, Russian Federation, 454048
References
1. Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty versus thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet. 2003; 361:13-20.
2. Dubachinsky L.Ya., Kireev K.A., Fokin A.A. Specialized medical care for acute myocardial infarction in a regional vascular center. Chelyabinsk; 2017. (In Russan)
3. Kireev K.A. Three years of experience in providing specialized medical care in acute coronary syndrome: first results, problems, prospects. Scientific reports of Belgorod State University. 2015; 10: 126-130. (In Russian)
4. Bokeriya L.A., Klyuchnikov I.V. Tactics of surgical revascularization after primary reperfusion in acute myocardial infarction. Thoracic and Cardiovascular Surgery, 2014; 1: 4-10. (In Russian)
5. Ranasinghe I., Alprandi-Costa B., Chow V., Elliott J.M., Waites J., Counsell J.T. et al. Risk stratification in the setting of non-ST elevation acute coronary syndromes 1999 – 2007. American Journal of Cardiology. 2011;108: 617-624. doi: 10.1016/j.amjcard.2011.04.005
6. Guidelines on myocardial revascularization 2018 ESC/ EACTS. European Heart Journal. 2019; 40: 87-165.
7. Chang M., Lee C.W., Ahn J-M., Cavalcante R., Sotomi Y. et al. Comparison of outcome of coronary artery bypass grafting versus drug-eluting stent implantation for non-ST-elevation acute coronary syndrome. American Journal of Cardiology. 2017; 120: 380-386. doi: 10.1016/j.amjcard.2017.04.038
8. Serchelik A., Fetcer D.V., Turkmen S., Ujgur F. NiyazovaKarben Z.A., Ozgul' S. et al. Comparative assessment of risk factors and hospital outcomes in male and female patients undergoing coronary artery bypass grafting. Cardiology. 2012; 11: 12-16. (In Russian)
9. Sumin A.N., Korok E.V., Gajfulin R.A., Ivanov S.V., Barbarash O.L. Bulletin SO RAMN. 2014; 4: 73-80. (In Russin)
10. Bokeriya L.A., Rabotnikov V.S., Kovalenko O.A., Alshibaya M.D. Hirurgicheskoe lechenie ishemicheskoj bolezni serdca u zhenshchin.Moscow; 2006. (In Russian)
11. Semukhina E.N. , Semukhin M.V., Gapon L.I., Zyryanov I.P. Gender-related differences and treatment for non-ST segment elevation acute coronary syndrome in a young woman. Complex Issues of Cardiovascular Diseases. 2019; 8 (1): 134139. (In Russian). https://doi.org/10.17802/2306-1278-2019-81-134-139
12. Karamova I.M., Nikolaeva I.E., Nagaev I.A., Buzaev I.V., Kazieva Z.A., YAmanaeva I.E. Features of the course of acute coronary syndrome with ST segment elevation in women. Medical Bulletin of Bankortostan. 2011; 6: 50-53. (In Russian)
13. Bokeriya L.A., S.A. Vishchipanov S.A., Kovalenko O.A., A.S. Vishchipanov A.S., Orlov I.N., Krymov K.V. et al. Female gender as a factor of operational risk of coronary bypass surgery in patients with coronary artery disease. Bulletin NTSSSH them. A.N. Bakuleva RAMN. 2014; 1: 46-53. (In Russian)
14. Subherwal S., Bach R.G., Chen A.Y., Gage B.F., Rao S.V., Newby K. et al. Baseline risk of major bleeding in non-STsegment-elevation myocardial infarction. Circulation. 2009; 119: 1873-1882. doi: 10.1161/CIRCULATIONAHA.108.828541
Review
For citations:
Fokin A.A., Kireev K.A., Netisanov S.V. Gender differences in immediate outcomes of patients with acute non-ST-elevation myocardial infarction undergoing off-pump coronary artery bypass grafting. Complex Issues of Cardiovascular Diseases. 2020;9(1):25-33. (In Russ.) https://doi.org/10.17802/2306-1278-2020-9-1-25-33
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