Prognosis Of Revascularization Research Articles

Zinc-aspirin preconditioning reduces endothelial damage of arterial grafts in a rodent model of revascularization.

Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure. The prognosis of revascularization via CABG is determined by the patency of the used grafts, for which an intact endothelium is essential. The degree of ischemia-reperfusion injury (IRI), which occurs during the harvest and implantation of the grafts, is an important determinant of graft patency. Preconditioning with aspirin, a nonsteroidal anti-inflammatory drug has been shown to reduce the functional and molecular damage of arterial grafts in a rodent model. Studies have found that the zinc-aspirin complex may be able to exert an even better protective effect in pathological cardiovascular conditions. Thus, our aim was to characterize the protective effect of zinc-aspirin complex on free arterial grafts in a rodent model of revascularization. Donor Lewis rats were treated with either zinc-aspirin, aspirin, or placebo (n = 8) for 5 days, then the aortic arches were harvested and stored in cold preservation solution and implanted heterotopically in the abdominal cavity of the recipient rats, followed by 2 h of reperfusion. There was also a non-ischemia-reperfusion control group (n = 8). Functional measurements using organ bath and histomorphological changes using immunohistochemistry were analyzed. The endothelium dependent maximal vasorelaxation was improved (non-transplanted control group: 82% ± 3%, transplanted control group: 14% ± 2%, aspirin group: 31% ± 4%, zinc-aspirin group: 52% ± 4%), the nitro-oxidative stress and cell apoptosis decreased, and significant endothelial protection was shown in the groups preconditioned with aspirin or zinc-aspirin. However, zinc-aspirin proved to be more effective in the reduction of IRI, than aspirin alone. Preconditioning with zinc-aspirin could be a promising way to protect the function and structural integrity of free arterial grafts, thus improving the outcomes of CABG.

Aspirin Reduces Ischemia-Reperfusion Injury Induced Endothelial Cell Damage of Arterial Grafts in a Rodent Model.

Long-term graft patency determines the prognosis of revascularization after coronary artery bypass grafting (CABG). Ischemia-reperfusion (I/R) injury of the graft suffered during harvesting and after implantation might influence graft patency. Aspirin, a nonsteroidal anti-inflammatory drug improves the long-term patency of vein grafts. Whether aspirin has the same effect on arterial grafts is questionable. We aimed to characterize the beneficial effects of aspirin on arterial bypass grafts in a rodent revascularization model. We gave Lewis rats oral pretreatment of either aspirin (n = 8) or saline (n = 8) for 5 days, then aortic arches were explanted and stored in cold preservation solution. The third group (n = 8) was a non-ischemia-reperfusion control. Afterwards the aortic arches were implanted into the abdominal aorta of recipient rats followed by 2 h of reperfusion. Endothelium-dependent vasorelaxation was examined with organ bath experiments. Immunohistochemical staining were carried out. Endothelium-dependent maximal vasorelaxation improved, nitro-oxidative stress and cell apoptosis decreased, and significant endothelial protection was shown in the aspirin preconditioned group, compared to the transplanted control group. Significantly improved endothelial function and reduced I/R injury induced structural damage were observed in free arterial grafts after oral administration of aspirin. Aspirin preconditioning before elective CABG might be beneficial on free arterial graft patency.

Percutaneous coronary intervention for patients with type 2 diabetes mellitus: risks and novel way to manage

The article is a literature review devoted to issues of planned percutaneous coronary intervention for patients with type 2 diabetes mellitus. Pathogenetic base of poor prognosis and new ways to pharmacological risk correction are described.
 The article highlights the trends in the incidence of carbohydrate metabolism disorders, their role in the development of complications of myocardial revascularization. The results of studies comparing different tactics of revascularization and their results in patients with different status of carbohydrate metabolism are presented.
 The article discusses the methods of risk management within percutaneous coronary revascularization, the role of glycemic metabolism in the risk of an poor prognosis of myocardial revascularization, describes the results of clinical trials of new drugs that can have a positive effect on the prognosis of revascularization in patients with carbohydrate metabolism disorders.

Coronary artery bypass grafting versus percutaneous coronary intervention in patients with noninsulin treated type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

The outcomes and prognosis of revascularization by either coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) in patients with noninsulin-treated type 2 diabetes mellitus (NITDM) have not yet been well established. Randomized controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and Cochrane library from inception until May 2016. Heterogeneity was evaluated, and the pooled hazard ratio (HR) was calculated by using a fixed-effect model. A random-effect model was used when statistically significant heterogeneity was observed (I2 ≥50%). All data analyses were carried out by using RevMan 5.3 and STATA software 12.0. A total of 4 RCTs involving 5 studies, consisting of 2270 patients with noninsulin-treated type 2 diabetes mellitus, were identified. Compared with CABG-treated patients, PCI-treated patients had significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P=.04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P=.0004), repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P<.00001), and major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI 1.20-1.87; P=.0004). However, PCI was associated with lower incidence of stoke (HR 0.47; 95% CI 0.24 to 0.90; P=.02). In NITDM patients, our study suggests that CABG surgery is associated with reduced risk of mortality and morbidity, although with increased incidence of stroke compared with percutaneous coronary intervention. The decision if to have percutaneous coronary intervention or CABG surgery should factor the risk for stroke of the patients when considering CABG over percutaneous coronary intervention. Adequately powered RCTs are needed to confirm the results of this meta-analysis.

E0376 Effect of metabolic syndrome on prognosis of revascularization in patients with coronary artery disease

BackgroundThe prevalence of the cardiovascular risk factors is growing. The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was...