The Risks of Developing Adverse Outcomes According to Geriatric Status in Patients with Coronary Heart Disease with Plannedaorto-coronary Artery Bypass Grafting

Author Name(s): Ninа I. Zhernakova, Andrey A. Chmelnickii, Andrey N. Il'nickii, Elvira E. Satardinova, Tichon Yu.Lebedev
Author Email: zhernakova@bsu.edu.ru

Abstract

The article assesses the risks of developing adverse outcomes in patients with coronary heart disease who underwent planned aorto-coronary artery bypass grafting according to geriatric status using such scales as the Cardiovascular Health Study frailty criteria (CHS-NHLBI),the MacArthur Study of Successful Aging, as well as 5 meter gait speed. We determined the cumulative indexof “lethal outcome + myocardial infarction + acute cerebral circulation disorder” in the early postoperative period in such patients.We proved in this article that the presence of senile asthenia syndrome and its progress was important in the increase in the risk of development of adverse outcomes after aorto-coronary artery bypass grafting.

Introduction

Coronary heart disease ranks first in cardiovascular mortality – more than 53% in the leading position among causes of death, hospitalizations and disability. Despite the myocardial revascularization, primarily aorto-coronary artery bypass grafting, it has become a routine method for treating the CHD in recent decades, which significantly reduces mortality and improves the quality of life of patients in older age groups; but the socioeconomic efficiency of aorto-coronary arterybypass grafting remains low, since it does not lead to a decrease in the number of disabled people [1, 2, 3].

An increase in the average life expectancy in the developed countries leads to an increase in the total population of elderly patients with coronary heart disease [4, 5]. As a consequence, the proportion of patients of older age groups undergoing the aorto-coronary artery bypass grafting increases. Age is one of the significant factors that determine the increased risk of aorto-coronary artery bypass grafting, which is included in all prognostic scales. The issue of whether the adverse effect of age on the number of cardiovascular complications persists after the completion of the stage of surgical revascularization has not been fully investigated. There are still some debates on the clinical, ethical and socio-economic feasibility of performing the surgical myocardial revascularization in patients of older age groups [1, 6, 7].

An increase in safety and clinical efficacy, as well as the improvement of surgical techniques, enabled to expand indications for interventions and significantly increase the number of patients undergoing aorto-coronary artery bypass grafting in the Russian Federation. However, the urgency of the selection of patients, the validity of surgical intervention and the commitment of doctors to adhere to the international recommendations for myocardial revascularization increase in connection with the increased availability of such surgeries. A special group in these questions is represented by elderly and senile patients [4, 5, 6, 8]. The surgery of aorto-coronary artery bypass grafting removes the symptoms of angina pectoris, improves the tolerability of physical activity, improves the quality of life, reduces mortality in some groups of patients [2]. However, the myocardial revascularization is often accompanied by the complications, the most frequent of which are the myocardium damage and the myocardial infarction. According to the data of different authors, the proportion of patients with perioperative MI, which has developed in connection with the surgery, ranges from 2% to 20% [2, 3, 7] – the intraoperative myocardial damage is detected in the prevailing number of patients [2].

Thus, in connection with the above, the assessment of the risks of adverse outcomes development according to the geriatric status in patients with the coronary heart disease, which are indicated for planned aorto-coronary artery bypass grafting, is of high practical importance.

Summary

  1. Among the criteria included in the scale of cardiovascular health assessment, the presence of senile asthenia syndrome significantly correlated with the following criteria in comparison with patients without senile asthenia syndrome: postoperative cognitive deficits (r =+0.914, p<0.02); LDL level is higher than 3.5 mmol/l (r =+0.850, p<0.03); left ventricular ejection fraction is less than 50% (r =+0.765, p<0.002); body mass deficit (r =+0.718, p<0.05).
  2. Among the criteria included in the scale of healthy aging assessment, the following indicators associated with the development of senile asthenia syndrome correlated with a high risk of adverse outcomes: a decrease in 5 meter gait speed (r =+0.816, p<0.05), postoperative cognitive deficits (r =+0.904, p<0.03).
  3. The cumulative index of “lethal outcome + myocardial infarction + acute cerebral circulation disorder” in the early postoperative period (30 days) in older patients with senile asthenia was greater than that in older patients without senile asthenia by 2.5 times and in comparison with middle-aged patients – by 3.8 times.»
  4. The important thing was not only the absence of senile asthenia syndrome, but also the lack of its progressionin the formation of the degree of risk of adverse outcomes development after the aorto-coronary artery bypass grafting.

References

[1]Ruda, M.Ya., 2007. Myocardial Infarction with ST Segment Elevation.Manual on Atherosclerosis and Coronary Heart Disease.Edited by E.I. Chazov, V.V. Kukharchuk, S.A. Boytsov.М., 2007: 626-725.

[2]Yakovleva, L.N., Peremot, Ya.O., 2013. Factors Affecting the Long-Term Forecast in Patients with Coronary Heart Disease who Underwent the Aorto-Coronary Artery Bypass Grafting. Emergency Medicine, 7(54): 128-133.

[3]Reffelmann, Т.,Kloner, R.A., 2006. The no-reflow phenomenon: A basic mechanism of myocardial ischemia and reperfusion. Basic Res. Cardiol., 101: 359–372.

[4]Ilnitsky, A.N., Proschayev, K.I., 2012. Specialized Geriatric Examination. Gerontological Journal named afterrV.F. Kuprevich, 4-5: 66-84.

[5]Berrut, G., Andrieu, S., Bergma, H., Cassim, B., Cerreta, F., Cesari, M., Cha, H.B., Chen, L.K., Cherubini, A., Forette, F., Franco, A., Guimaraes, R., Robledo, L.M., Jauregui, J., Khavinson, V., Lee, W.J., Benetos, A., 2013. Promoting access to innovation for frail old persons. The Journal of Nutrition, Health & Aging, 17(8): 688-693.

[6]Proshchayev, K.I., Ilnitsky, A.N., Krivetsky, V.V., Varavina, L.Yu., Kolpina, L.V., Gorelik, S.G., Fesenko, V.V., Krivtsunov, A.N., 2013. Features of Clinical Examination of Elderly and Senile Patients. The Successes of Gerontology, 3: 79-82.

[7] Roffi, M., Patrono, C., Collet, J-P. et al., 2016. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients presenting without Persistent ST-Segment Elevation. European Heart Journal, 37(3):267-315. doi: 10.1093/eurheartj/ehv320.

[8] Armstrong, P.W., Gershlick, A.H., Goldstein, P., Wilcox, R., Danays, T., Lambert, Y., Sulimov, V., Rosell Ortiz, F., Ostojic, M., Welsh, R.C., Carvalho, A.C., Nanas, J., Arntz, H.R., Halvorsen, S., Huber, K., Grajek, S., Fresco, C., Bluhmki, E., Regelin, A., Vandenberghe, K., Bogaerts, K., Van de Werf, F., 2013. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N. Engl. J. Med., 368(15): 1379-1387.

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