Faculty of Medicine
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Item type:Publication, Carotid ultrasound, blood lipids and waist determination can predict a future coronary revascularisation in the type 2 diabetic cohort(Macedonian Academy of Science and Art (MANU), 2007-12-28); ; ; The aim of the study was to identify incremental values of carotid ultrasound measurements (carotid plaques and stenosis) on the prediction of future coronary revascularization among type 2 diabetic patients. The second objective was to determine the predictive value of the assessment of blood lipids, BMI, abdominal obesity and the ankle-brachial index (ABI). Three hundred and thirty three (333) patients with type 2 diabetes and manifested coronary artery disease were randomly selected in a cohort prospective study. Univariate and multivariate logistic regression analyses were conducted to identify variables predictive of the need for future revascularization: percutaneus coronary interventions (PCI) or coronary bypass surgery (CABG) followed 24 months after the study starting point. The presence of arterial hypertension, hyperlipidemia, physical inactivity, intermittent claudication, the value of systolic pressure, BMI, waist and hip measurement, glycemia and blood lipid fraction (total cholesterol, HDL, LDL, non-HDL, triglycerides) were entered in a model. Ultrasound measurements: carotid IMT, presence of carotid plaques and stenosis, and ABI were also included in the analysis. Based on the univariate and multivariate findings, the presence of internal carotid artery (ICA) stenosis (OR 4,562, 95% CI 1,327-15,687), carotid plaque (OR 1,465, 95% CI 0,829-2,591), and increased waist measurement (OR 1,371, 95% CI 0,757-2,483) were found as significant independent predictors of future PCI. LDL and non HDL cholesterol were found to be factors independently associated with the need for future CABG by univariate analysis, which was not confirmed by multivariate analysis. In conclusion, the current study has provided an identification of predisposing factors for the future need of coronary revascularization among type 2 diabetic patients that permits risk stratification and may facilitate improved patient selection or optimization. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Arterial hypertension in patients with coronary artery disease treated with surgical myocardial revascularization(AEP Press, 2007-07); ; ; Taneva, BObjectives: To evaluate the incidence and prognostic power of arterial hypertension in patients with coronary artery disease treated with surgical myocardial revascularisation, before and after the operation. Background: Arterial hypertension is one of the leading modifiable risk factors in CAD patients who underwent CABG surgery with the major impact on clinical outcome in these patients. Methods: 749 patients with mean age of 55 +/- 8 years, (639 male/119 female) were analyzed for their preoperative: demographic, clinical, left ventricular morphologic and functional and angiographic, perioperative: type of operation, type and number of applied conduits, in-hospital morbidity and mortality, and post-operative: demographic, clinical, left ventricular morphologic and functional and angiographic characteristics. Mean postoperative follow-up period was 5.97 +/- 4.27 years. Results: Hypertension was found in 52.7% of patients before the operation, and it was the most frequent risk factor, without any differences between different age groups, but significantly more often in females (p = 0.0001), diabetics (p = 0.0001), and patients with preserved LV function (p = 0.011). Although significantly correlated with in-hospital morbidity (r = 0.085 and p = 0.023), HTA was not identified as independent predictor. The most predictable was the occurrence of early neurological complications. HTA was also found to be a predictor of long life prognosis in CABG patients, but not as independent prognostic factor. Significant reduction in incidence was found in post-CABG patients (30.1%), which is most likely a result of applied pharmacologic treatment. ACE-inhibitors, Ca-antagonists and B-blockers were applied in 39.44%, 30.1% and 33.6% of patients respectively, with significant positive correlations found for all of them as follows: r = 0.221, p = 0.0001, r = 0.316, p = 000.1 and r = 0.093, p = 0.031. Conclusion: Hypertension is the most powerful risk factor in CAD patients who undergo CABG surgery in our country, and a powerful prognostic factor of early and late clinical outcome. There is a trend toward decreasing the incidence of HTA in post-CABG patients, as a result of improved pharmacologic treatment after the operation (Tab. 5, Fig. 1, Ref. 13). Full Text (Free, PDF) www.bmj.sk. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Predictors of in-hospital morbidity and mortality in patients with coronary artery disease treated with coronary artery bypass surgery(Macedonian Academy of Science and Art (MANU), 2006-12-27); ; ; Borozanov, VAim of the study: The aim of our study was to identify markers that can predict early morbidity and mortality in patients with coronary artery disease who underwent coronary artery bypass surgery (CABG) for myocardial revascularization. Material and methods: 749 patients (pts) were enrolled in the study at mean age 55 +/- 8 years, 639 male and 119 female. We analyzed pre-operative demographic, clinical, left ventricular morphologic and functional and angiographic variables, per-operative characteristics, and we registered occurrence of hospital complications including cardiac death during the first 30 days after the operation. Results: Hospital complications were registered in 173 (23.1%) patients, including cardiac death registered in two (3%) patients during the first 30 days after the operation. The most common complications were: pericardial effusion (8.4%), supraventricular arrhythmias (6.3%) and pleural effusion (5.6%), followed by more serious complications like infections, acute renal failure and stroke. Advanced age (>or=65 years), coexisting morbidities and risk factors: cerebrovascular disease (CVD), peripheral vascular disease (PVD), chronic obstructive pulmonary disease (COPD), hypertension (HTA), previous myocardial infarction (MI), heart failure before the operation, extensive coronary artery disease (CAD) (angiographicly identified), low left ventricular ejection fraction (LVEF), and high WMSS index were identified as predictors of in-hospital morbidity. Advanced age, Mod Gensini score (as marker of angiographic severity of CAD) and WMSS index were found to be independent predictors of in-hospital morbidity, while advanced age, heart failure before CABG and in-hospital complications were found to be independent predictors of in-hospital mortality. Conclusion: In patients with coronary artery disease who underwent CABG surgery, preoperative variables and operative technique can predict occurrence of in-hospital morbidity, while early complications can strongly predict in-hospital mortality.