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Predictors of Unfavorable Prognosis in Patients with Coronary Heart Disease Who Have Undergone Coronary Artery Bypass Grafting

https://doi.org/10.31550/1727-2378-2024-23-8-23-31

Abstract

Aim. To identify predictors of unfavorable course of coronary artery disease (CAD) in patients who underwent coronary artery bypass grafting (CABG).

Design. Prospective observation.

Materials and methods. A prospective observation of 24 months to identify predictors of unfavorable course of CAD included 98 patients who underwent CABG. Median age — 63 (56; 68) years. The concentration of blood plasma glucose, lipid parameters, insulin, uric acid, fatty acid binding protein 4 (FABP4) in the blood serum, the insulin resistance index, the level of expression of microRNA-21 in the blood plasma and myocardium, relative level of messenger RNA FABP4 gene in epicardial and subcutaneous adipose tissue were determined. The development of angina pectoris, myocardial infarction (MI), bypass thrombosis/functionally significant bypass restenosis, increase in myocardial dysfunction, acute ischemic cerebrovascular accident, and death were taken as the major adverse cardiac events (MACE).

Results. Over the course of 24 months, 15 (15.3%) patients (11 men (73.3%) and 4 (26.7%) women) with CAD who underwent CABG achieved the MACE. The median follow-up time before the occurrence of MACE was 11.1 (10.5; 11.9) months. Among all MACE, 7 patients had a fatal outcome, 3 had shunt thrombosis, 4 had hemodynamically significant stenosis of an artery that had not previously undergone bypass/stenting and underwent percutaneous coronary intervention, 1 had an acute ischemic cerebrovascular accident. The risk of the onset of MACE in patients with CAD who underwent CABG was determined by such factors as type 2 diabetes mellitus, the presence of zones of impaired local myocardial contractility, and the risk of the most “hard” end point — death, in addition to these factors was associated with obesity, hyperuricemia, with the onset of CAD with MI and an increase in the level of FABP4 in the blood serum. Increasing serum FABP4 levels significantly reduces the risk of death.

Conclusion. In patients with CAD who have undergone CABG, the most significant factors determining the onset of MACE during the first 24 months are type 2 diabetes mellitus and the presence of zones of impaired local myocardial contractility, which, along with such factors as obesity, hyperuricemia, and a history indicating the onset of CAD with MI and an increase in serum FABP4 levels are associated with an increased risk of death.

About the Authors

D. A. Kolodina
Pavlov First Saint Petersburg State Medical University
Russian Federation

Saint Petersburg



O. D. Belyaeva
Pavlov First Saint Petersburg State Medical University
Russian Federation

Saint Petersburg



O. A. Berkovich
Pavlov First Saint Petersburg State Medical University
Russian Federation

Saint Petersburg



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Review

For citations:


Kolodina D.A., Belyaeva O.D., Berkovich O.A. Predictors of Unfavorable Prognosis in Patients with Coronary Heart Disease Who Have Undergone Coronary Artery Bypass Grafting. Title. 2024;23(8):23-31. (In Russ.) https://doi.org/10.31550/1727-2378-2024-23-8-23-31

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ISSN 1727-2378 (Print)
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