Long-term results of myocardial revascularization in patients with multivessel disease.

BACKGROUND: Choosing the method of revascularization - coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) - remains debatable. METHODS: We selected 406 patients with multivessel disease who underwent PCI with a drug-eluting stent (DES) (n = 200, 100 with a SYNTAX score (SS) ≤ 22 and 100 with a SS 23-32); and CABG (n = 206, 100 with a SS ≤ 22 and 106 with a SS 23-32). The mean follow-up period was 9±1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events (МАССЕ), a repeat revascularization (RR), diminished left ventricular ejection fraction (LVEF), and high SS in dynamics. RESULTS: Patients with an intermediate SS needed RR more often with PCI than after CABG (64 % vs 22.6 %; HR: 3.52; CI: 2.19-5.66; р < 0.001). We found no significant differences for other MACCE between the groups. The decrease in LVEF was greater in the low SS subgroup in operated patients than after PCI (39.5 % vs 27.7 %; HR: 0.57; CI: 0.34-0.98; p = 0.04). The difference between the initial and final SS, was greater after the CABG than after PCI (43.5 % vs 10.9 %; HR: 0.26; CI: 0.14-0.47; р < 0.001). CONCLUSIONS: After 9 ± 1.9 years in intermediate SS group CABG exhibited an advantage over PCI with DES in terms of the MACCE indicators due to a smaller number of RR in the CABG group. The CABG group showed a more significant progression of atherosclerosis, and more heart failure cases (Tab. 2, Fig. 4, Ref. 29). Text in PDF www.elis.sk Keywords: coronary artery disease, coronary artery bypass grafting, percutaneous coronary intervention, SYNTAX score.

Outcomes of myocardial revascularization in patients with obesity and multivessel coronary artery disease.

BACKGROUND: There is uncertainty regarding the best revascularization approach-whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)-for obese patients suffering from multi-vessel coronary artery disease. RESULTS: 406 patients with low and intermediate SYNTAX scores (SS) underwent PCI with drug-eluting stents (n = 200, 100 with SS ≤ 22, and 100 with SS 23-32) and CABG (n = 206, 100 with SS ≤ 22, and 106 with SS 23-32). Patients were also categorized by body mass index (BMI): normal weight (12%, 48 patients), overweight (41.6%, 169 patients), and obese (46.6%, 189 patients). The follow-up period averaged 9 ± 1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events, a repeat revascularization, diminished left ventricular ejection fraction (LVEF), and high SS (≥ 33) observed over time. When comparing PCI and CABG in overweight individuals, the risk of myocardial infarction (MI) following PCI was greater than after CABG (Hazard Ratio [HR] 2.7, 95% Confidence Interval [CI] 1.1-6.7, p = 0.03). In patients with overweight and Class I obesity, CABG was associated with the risk of coronary atherosclerosis progression (SS ≥ 33) (HR 4.4, 95% CI 1.5-13, p = 0.009 and HR 4.9, 95% CI 1.9-12, p = 0.001, respectively); whereas PCI was connected with the likelihood of repeat revascularization (HR 2.7, 95% CI 1.6-4.55, p < 0.0001 and HR 2, 95% CI 1.3-3.1, p = 0.002, respectively). At the same time, for stented patients, Class III obesity was associated with the risk of repeat revascularization (HR 2.5, 95% CI 1.02-6, p = 0.044). CONCLUSION: There were no significant weight-related impacts on long-term outcomes among patients who underwent surgery. Whereas in stented patients, Class III obesity was associated with the risk of repeat revascularization. When comparing PCI and CABG, for overweight and Class I obesity patients, CABG was associated with a likelihood of coronary atherosclerosis progression (SS ≥ 33), while PCI was linked to the risk of repeat revascularization. For overweight patients, CABG outperformed PCI in terms of the risk of MI. For other adverse events in patients of different weight categories, PCI and CABG did not reveal any significant benefits.

ALCAPA in adult asymptomatic patient: A case report.

INTRODUCTION: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease that usually presents with heart failure symptoms in infants. Without surgical correction, the condition has a high infant mortality rate. However, patients with ALCAPA can remain asymptomatic for decades in some cases, and the risk of sudden death decreases in adulthood. PRESENTATION OF CASE: We present the case of a 52-year-old female who was incidentally diagnosed with ALCAPA during a routine medical evaluation. As the patient age, was asymptomatic, had good coronary collateral circulation, a medical treatment strategy was chosen and the patient was discharged in a good physical condition. And during the three-month follow-up, no cardiovascular complications were observed. DISCUSSION: The appearance and severity of symptoms in patients with ALCAPA can vary depending on factors such as the closure of the patent ductus arteriosus (PDA), pressure gradient between arteries, collateral development, and coronary anatomy. Surgical intervention is typically recommended, but in select cases such us, conservative management may be considered for elderly patients due to increased surgical risks and potentially lower risk of sudden cardiac death. Individualized patient assessment is crucial in determining the optimal treatment strategy for ALCAPA, considering the available evidence and limitations. CONCLUSION: The management of asymptomatic patients with ALCAPA remains a subject of discussion, and further research is needed to standardize the clinical approach for this subgroup of patients and to compare survival rates between surgical correction and medical therapy.

Proposing new body mass index and waist circumference cut-offs based on cardiometabolic risks for a Central Asia population: A feasibility study.

Background: Lower BMI cutoffs as compared to standard cut-offs have been recommended to reduce the risk of obesity-related co-morbidities in some ethnic populations (e.g. south Asian and Chinese populations). Recent attempts have also been made to establish ethnicity-specific BMI cutoffs to identify individuals affected with obesity in relation to type 2 diabetes risk in multi-ethnic populations based in the UK and North America. However, to date, there is yet to have any published work done to identify these cut-offs in Central Asia populations nor specify any difference for genders even though the fat distribution varies amongst the different ethnic groups as well as between the genders. To the best of the authors' knowledge, this is the first study exploring new BMI and WC cut-offs in this population. Methods: To address this gap, we used a database of secondary care electronic health records from the National Research Cardiac Surgery Center to identify BMI and waist circumference cutoffs for obesity based on the risk of developing diabetes and other cardiometabolic disorders among 297 adults in Kazakhstan. Bivariate and multivariable logistic regression analysis were utilized to investigate the relationships between risk factors and type 2 diabetes mellitus (T2DM). BMI and WC thresholds were predicted using the Youden index. Results: For an equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m2 in White populations, we found higher BMI cutoffs for Kazakhstani women (30.5 kg/m2) but lower cut-offs for men (28·9 kg/m2). As for waist circumference, the cut-off points for females were 95cm and 104 cm for males. Conclusions: For Central Asia populations, the current recommended BMI and WC cutoffs may not be suitable and further work is needed to establish specific cut-offs for this population.

Individualised renal artery denervation improves blood pressure control in Kazakhstani patients with resistant hypertension.

BACKGROUND: The prevalence of hypertension in Kazakhstan is high, and the majority of patients are not adequately controlled. Treatment with renal artery denervation (RAD) could represent a useful therapeutic option for a subset of patients in Kazakhstan with resistant hypertension. AIM: To assess the impact of RAD in a cohort of patients from Kazakhstan with resistant hypertension. METHODS: Between March 2012 and December 2013, 63 patients underwent RAD at our tertiary care centre. Eligibility criteria were office blood pressure more than 160 mm Hg systolic (SBP) or more than 90 mm Hg diastolic (DBP) despite being treated with three or more antihypertensive medications, including a diuretic. Ambulatory blood pressure was measured at baseline and at month 12, and monitoring also included impact on insulin resistance and renal function. RESULTS: There were significant decreases of 25 ± 24 mm Hg for ambulatory SBP during the daytime and of 26 ± 23 mm Hg for ambulatory SBP during the nighttime (p < 0.0001). We observed significant decreases of 12 ± 14 mm Hg for ambula-tory daytime DBP and of 11 ± 14 mm Hg in ambulatory nighttime DBP (p < 0.0001). A decrease in creatinine clearance was observed from 100.2 ± 33.6 mL/min at baseline to 90.2 ± 22.8 mL/min at month 12 (p < 0.001). Homeostasis model assessment-insulin resistance (HOMA-IR) decreased from 3.0 ± 4.6 at baseline to 2.5 ± 3.7 at 12 months (p = 0.007). CONCLUSIONS: In this population RAD resulted in statistically and clinically significant blood pressure reduction at 12 months with minimal adverse events.