Role of coronary angiography in decreasing cardiac complications rate during vascular operations

Barbarash L.S., Sumin A.N., Evdokimov D.O., Bezdenezhnykh A.V., Korok E.V., Ivanov S.V., Moiseenkov G.В., Barbarash O.L.

Research Institute for Integrated Problems of Cardiovascular Diseases under the Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo, Russia

In order to assess the prevalence of coronary artery lesions in patients running various clinical risks of cardiovascular complications prior to surgical interventions on cardiac vascular basins, we performed a retrospective analysis of 392 case histories (340 men and 52 women, mean age 61.0±8.5 years). All patients in the preoperative period underwent coronary angiography (CAG). For the analytical purposes, the patients were subdivided into four groups. Group One (n=44) comprised patients without clinical risk factors, Group Two (n=184) was composed of those diagnosed as having one clinical risk factor. Group Three (n=122) comprised those with two clinical risk factors, and finally Group Four (n=42) was composed of those presenting with three and more clinical risk factors. CAG revealed that 91% of patients had coronary artery lesions. Haemodynamically significant lesions of three coronary arteries and/or stenosis of the left coronary artery trunk were observed in 15.6% of patients with no clinical risk factors of cardiac complications, in 19.0% of patients with one such factor, in 28.5% of those with two risk factors, and in 42.2% of patients with three and more risk factors. Preventive myocardial revascularization was performed in 22.7% of cases, more often in Group Three and Group Four patients. The number of postoperative complications in the groups did not differ significantly.

The total hospital mortality rate was low (0.8%), with all 3 lethal outcomes observed amongst the patients with one clinical risk factor (1.6%). Hence, clinical preoperative stratification of the risk by means of the Lee index prior to vascular operations fails to reveal a considerable part of patients with prognostically unfavourable lesions of coronary arteries, and thus it should seemingly be used in this patient cohort with caution.

KEY WORDS: clinical assessment of risk, coronary angiography, cardiac vascular complications.

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