Nishonov A B, Tarasov R S, Ivanov S V, Barbarash L S
Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
Angiol Sosud Khir. 2020;26(4):132-140. doi: 10.33529/ANGIO2020407.
The purpose of this study was to assess the perioperative clinical, demographic and anatomo-angiographic factors in patients presenting with non-ST-segment elevation acute coronary syndrome and being candidates for coronary artery bypass grafting, depending on the presence or absence of myocardial infarction.
Over the period from 2017 to 2018 within the framework of a single-centre register, the study enrolled a total of 166 consecutive patients admitted with non-ST segment elevation acute coronary syndrome and recommended by the cardiosurgical team to undergo coronary artery bypass grafting. Depending on the outcome of acute coronary syndrome, the patients were divided into 2 groups: Group One included 98 (59%) patients with unstable angina pectoris and Group Two comprised 68 (41%) patients with myocardial infarction. A lethal outcome occurred in 2 (3%) Group Two patients prior to revascularization, hence they were not included into the analysis comparing the results of surgery in both groups, however these data were taken into consideration, being analysed separately.
The group of patients with myocardial infarction appeared to include significantly more female patients (20 (30.3%) versus 15 (15.3%) in the group of patients with unstable angina pectoris, p=0.02). However, by such parameters as the average age, left ventricular ejection fraction, and the frequency of diabetes mellitus the compared groups did not differ. The group with myocardial infarction was characterised by a severe clinico-angiographic status: more frequently encountered was stage II obesity (3%, n=3 in the first group and 10.6% n=7 in the second group, p=0.04). On the whole, the majority of patients were at intermediate and high risk (44.7% in the group with unstable angina pectoris versus 81.8% in the group of myocardial infarction, p<0.05). Group Two patients significantly more often presented with three-vessel lesions of the coronary bed (40 (40.8%) and 39 (59%), p=0.02). The level of low-density lipoproteins appeared to be significantly higher in patients with myocardial infarction (3.3±1 mmol/l and 2.9±0.9, p=0.04). In the same group more often encountered were peripheral artery lesions (28 (21%) and 12 (11.3%), p=0.04). In its turn, in the group of unstable angina pectoris, there were significantly more patients having received dual antithrombotic therapy prior to surgery (44 (44.9%) and 17 (25%), p=0.01). Approximately half of the patients in the first group (53%, n=52) had a history of myocardial infarction (p=0.001).
The obtained findings suggested that amongst the patients with non-ST-elevation acute coronary syndrome resulting in myocardial infarction prevailing were those of female gender, with obesity, as a consequence, hyperholesterolaemia and triple-vessel disease. At the same time, postinfarction cardiosclerosis, renal dysfunction, and haemodynamically significant lesions of lower-extremity arteries were encountered in the group of unstable angina pectoris.
本研究旨在评估非ST段抬高型急性冠状动脉综合征患者且拟行冠状动脉旁路移植术者的围手术期临床、人口统计学及解剖血管造影因素，根据有无心肌梗死进行分析。
在2017年至2018年期间，在单中心登记框架内，本研究共纳入166例连续收治的非ST段抬高型急性冠状动脉综合征患者，且心脏外科团队建议其接受冠状动脉旁路移植术。根据急性冠状动脉综合征的结果，将患者分为2组：第一组包括98例（59%）不稳定型心绞痛患者，第二组包括68例（41%）心肌梗死患者。2例（3%）第二组患者在血运重建前出现致命结局，因此未纳入两组手术结果比较分析，但这些数据被单独分析并予以考虑。
心肌梗死患者组女性患者明显更多（20例（30.3%），而不稳定型心绞痛患者组为15例（15.3%），p = 0.02）。然而，在平均年龄、左心室射血分数和糖尿病发生率等参数方面，比较组之间无差异。心肌梗死组的临床血管造影状况严重：II期肥胖更为常见（第一组3%，n = 3；第二组10.6%，n = 7，p = 0.04）。总体而言，大多数患者处于中高危状态（不稳定型心绞痛组为44.7%，心肌梗死组为81.8%，p < 0.05）。第二组患者冠状动脉床三支血管病变明显更常见（40例（40.8%）和39例（59%），p = 0.02）。心肌梗死患者的低密度脂蛋白水平明显更高（3.3±1 mmol/l和2.9±0.9，p = 0.04）。同一组中周围动脉病变更常见（28例（21%）和12例（11.3%），p = 0.04）。反过来，在不稳定型心绞痛组中，术前接受双联抗栓治疗的患者明显更多（44例（44.9%）和17例（25%），p = 0.01）。第一组约一半患者（53%，n = 52）有心肌梗死病史（p = 0.001）。
所得结果表明，在导致心肌梗死的非ST段抬高型急性冠状动脉综合征患者中，女性、肥胖、高胆固醇血症和三支血管病变较为普遍。同时，在不稳定型心绞痛组中发现有心肌梗死后心肌硬化、肾功能不全及下肢动脉血流动力学显著病变。
