Abstract
Aim : To develop a prediction model for selecting op-timal revascularization strategy for patients with polyvascular disease based on the evaluation of hospital out-comes of various surgical treatment strategies for patients with simultaneous coronary and carotid artery disease. Methods : 391 patients with combined hemodynamically significant atherosclerotic lesions of the coronary and internal carotid arteries underwent reconstruction heart surgeries. Group 1 patients (n = 151, 38.6%) underwent coronary artery bypass grafting (CABG) and subsequent carotid endarterectomy (CEA). Group 2 patients (n = 141, 36%) underwent combined CABG and CEA. Group 3 patients (n = 28, 7.2%) underwent hybrid percutaneous coronary intervention (PCI) and CEA. Group 4 patients (n = 71, 18.2%) underwent CEA and subsequent CABG. 3 groups of risk factors (clinical and demographic risk factors, risk factors of coronary and cerebrovascular adverse events), were selected to develop the prediction model for evaluating the probability of in-hospital complications, such as death, myocardial infarction, acute cerebrovascular accident / transient ischemic attack, significant hemorrhagic complications > BARC type 3 bleeding. The prognostic coefficients of all risk factors for each surgical treatment strategy were evaluated to select optimal revascularization strategy. Then, the integrated indicators, representing a comprehensive assessment of the risk factors related to each surgical treatment strategy, were calculated. The ROC-analysis was performed to set a threshold allowing improving the quality of the prognosis (sensitivity and specificity). Results: Clinical and demographic factors and cere-brovascular risk factors were significantly associated with adverse prognosis in Group 1 and 2 patients according to the regression analysis. Coronary and cerebrovascular factors were reported to affect prognosis in patients undergoing hybrid revascularization, whereas clinical and demographic risk factors and cerebrovascular risk factors worsen the prognosis of patients undergoing CEA and subsequent CABG. The prediction model allowed creating an interactive calculator able to determine the probability of adverse cardiovascular events in patients with polyvascular disease undergoing four types of surgical treatment strategies and to select the optimal one that will be associated with a minimal risk of in-hospital complications. Conclusion: The prediction model and personalized calculator for selecting an optimal surgical treatment strategy based on the comprehensive risk assessment for adverse outcomes (clinical and demographic factors, cor-onary and cerebrovascular factors) allows predicting the probability of adverse cardiovascular events in patients with simultaneous carotid and coronary artery disease.
Highlights
For citation: Tarasov R.S., Kazantsev A.N., Kagan E.S., Glinchikov K.E., Barbarash L.S
Примечание: «0» - отсутствие признака; «1» - наличие признака; «1, 2, 3, 4» - различные градации признака; Возраст: «1» - не пожилые; «2» - пожилые (с 60 лет); Пол: «1» - мужской; «2» -женский; ФК - функциональный класс стенокардии; Фракции выброса - фракция выброса левого желудочка: «1» - 40 - 54%; «2» - менее 40% - выраженно снижена; «3» - 55% и более; Аневризма ЛЖ - аневризма левого желудочка; ХПН - хроническая почечная недостаточность; СД - сахарный диабет; ПИКС - постинфарктный кардиосклероз; Реваскуляризация ранее - наличии реконструктивных операций на сосудистых бассейнах ранее; Коронарный атеросклероз - по данным коронарографии «1» - однососудистое поражение; «2» - двухсосудистое поражение; «3» - трехсосудистое поражение; «4» - поражение ствола левой коронарной артерии изолированно либо в комбинации с другими коронарными артериями Note: "0" is the absence o f thesing; " 1" - the presence o f the sign; "1, 2, 3, 4" - different grades o f the sign;Age: "1" - patients under 60 years o f age; "2"- patients over 60years o f age;Gender: "1" - male; "2" - female;FC - functional class o f angina pectoris; Left ventricular ejection fraction: "1" - 40 - 54%; "2" - less than 40% - significantly reduced; "3" - > 55;LV aneurysm - left ventricular aneurysm; CRF - chronic renal failure; DM - diabetes mellitus; PICS - postinfarction cardiosclerosis; Coronary atherosclerosis according to the coronary angiography findings: "1" - one-vessel disease; "2" - two-vessel disease; "3" - three-vessel disease; "4"-isolated lesion ofleft main coronary artery or combined with other coronary artery lesions ризация в объеме КШ+каротидной эндартерэктомии (КЭЭ) (ХТ2), то переменные принимают значения: Х2=0, Х3=1, Х4=0
Его прогрессирующее развитие может приводить к формированию критических состояний, таких как инфаркт миокарда (ИМ) и острое наруше ние мозгового кровообращения (ОНМК) [2, 3, 4]
Summary
To develop a prediction model for selecting op timal revascularization strategy for patients with polyvascular disease based on the evaluation of hospital out comes ofvarious surgical treatment strategies for patients with simultaneous coronary and carotid artery disease
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