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Predictors of rapid progression of carotid atherosclerosis in patients with stable coronary artery disease after myocardial revascularization

Authors: Sokolova N.Yu. 1, Bakulina A.V. 1 3, Magomedova N.M. 2, Kazanovskaya S.N. 2, Golukhova E.Z. 2

Company: 1 Tver’ «Regional clinical hospital», Peterburgskoe shosse, 105, Tver’, Region Tver’, 170036, Russian Federation;
2 Bakoulev National Scientific and Practical Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
3 Tver’ State Medical University of Ministry of Health of the Russian Federation, ulitsa Sovetskaya, 4, Tver’, 170100, Russian Federation

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Type:  Ischemic heart disease


DOI: https://doi.org/10.24022/1997-3187-2017-11-3-222-234

For citation: Sokolova N.Yu., Bakulina A.V., Magomedova N.M., Kazanovskaya S.N., Golukhova E.Z. Predictors of rapid progression of carotid atherosclerosis in patients with stable coronary artery disease after myocardial revascularization. Kreativnaya Kardiologiya (Creative Cardiology). 2017; 11 (3): 222–34 (in Russ.). DOI: 10.24022/1997-3187-2017-11-3-222-234

Received / Accepted:  August 03, 2017 / August 11, 2017

Keywords: coronary artery disease stenosis of the internal carotid artery accelerated atherosclerosis systemic inflammatory response

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Abstract

Objective. To identify predictors of rapid progression of carotid atherosclerosis in patients with stable coronary artery disease (SCAD) after different methods of myocardial revascularization.

Material and methods. The study included 111 patients with SCAD without hemodynamically significant lesions of the internal carotid artery (ICA) who underwent myocardial revascularization. The criteria for inclusion in this study was the indication for myocardial revascularization, the exclusion criteria – severe heart valves dysfunction, left ventricular (LV) aneurysm, acute myocardial infarction, severe systolic left ventricular dysfunction (ejection fraction less 35%), significant ICA stenosis, age more than 80 years, pre-operative acute neurological disease associated with cancer and rheumatologic diseases. Myocardial revascularization in patients with stable coronary artery disease and concomitant non-significant lesion of the brachiocephalic arteries was performed using coronary artery bypass grafting (CABG), including on-pump CABG (n=32), off-pump CABG (n=30); percutaneous coronary intervention (PCI) (n=49) with drug-eluting stents implantation. The mean age was 60.2±8.1 years; all clinical characteristics were comparable among 3 groups. The average follow-up period was 37.9±6 months.

Results. Conducted univariate logistic regression analysis revealed a correlation of accelerated progression of the brachiocephalic atherosclerosis after surgical and interventional procedures in patients with concomitant diabetes (HbA1c more 7,5% (p=0.038), elevated high-sensitivity CRP (p=0.041), smoking continuation (p=0.046), I (p=0.049) and IV types (p=0.034) atherosclerotic plaques in the ICA, elevated values of metalloproteinase-9 (MMP-9) (p=0.017) and myocardial revascularization with on-pump CABG (p=0.029).

Сonclusion. Syndrome of accelerated atherosclerosis of ICA was observed in patients with complex morphology of brachiocephalic stenosis, chronic nicotine consumption, a concomitant poorly controlled diabetes, high values of inflammation markers (hs-CRP and MMP-9) and on-pump CABG.

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About Authors

  • Sokolova Natal'ya Yur'evna, Cand. Med. Sc., Cardiologist, orcid.org/0000-0002-5720-304X;
  • Bakulina Aleksandra Vladimirovna, Cardiovascular Surgeon;
  • Magomedova Nargiz Magomedovna, Junior Researcher;
  • Kazanovskaya Svetlana Nikolaevna, Junior Researcher;
  • Golukhova Elena Zelikovna, Dr Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Department, orcid.org/0000-0002-6252-0322

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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