PREDICTORS OF PROGRESSION OF CORONARY CALCIFICATION IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFTING
O.L. Barbarash, D.Yu. Sedykh, V.V. Kashtalap, O.N. Khryachkova, A.N. Kokov, I.A. Shibanova
Research Institute for Complex Issues of Cardiovascular Diseases, 650002, Kemerovo, Sosnoviy Blvd, 6
Keywords: коронарное шунтирование, коронарный кальциноз, прогноз, костный метаболизм, coronary artery bypass graft surgery, coronary calcification, prognosis, bone metabolism
Abstract
Aim: To assess predictors of progression of coronary artery calcification (CAC) in men with stable coronary heart disease (CHD) after coronary artery bypass graft surgery (CABG) based on long-term (5 years) follow-up. Materials and methods. The prospective study included 111 men who were hospitalized for planned CABG using cardiopulmonary bypass. All patients in the preoperative period underwent the following procedures: color duplex scanning (CDS) of the brachiocephalic arteries (BCA), multi-slice computed tomography (MSCT) coronary angiography to assess the degree of CAC using the Agatson method (calculation of the coronary artery calcium score - CAC) and estimation of femoral neck bone mineral density with the T-score calculation. The vital status of patients was ascertained after 3-5 years of follow-up after CABG, CDS of the BCA and MSCT-coronary angiography were repeated. To identify the most significant clinical and anamnestic risk factors and form a model of predictors of CAC progression, patients were divided into two groups depending on the high increase in CAC score (an increase in the score of more than 100 Agatston units (AU). Results. 16 (14.4 %) out of 111 patients failed to establish contact for the next stage of the study. In 4 (3.6%) cases death was registered (3 - fatal myocardial infarction, 1 - fatal stroke). The CAC progression was assessed in 91 patients (81.9 %). Patients who showed signs of CAC progression comprised a group of 60 (65.9 %) patients; without CAC progression - 31 (34.1 %) patients. The “end points” in the groups were comparable and were detected in 18 cases (19.7 %): recurrent angina in 16 patients ( p = 0.368), non-fatal myocardial infarction in 1 ( p = 0.162) and 1 emergency stenting ( р = 0,162) of the coronary artery that was not subjected to CABG. The five-year risk model for CAC progression included an initial decrease in femoral neck bone mineral density and nonadherence to statins for 5 years after CABG ( p = 0.001). Conclusions. 65.9 % of men with stable CHD showed the signs of CAC progression for 5 years after CABG, according to MSCT. The main predictors were: nonadherence to statins after CABG and initial low femoral neck bone mineral density.
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