Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery · 2026
[Factors of unfavorable outcome of emergency coronary artery bypass grafting in high-risk acute non-ST elevation coronary syndrome].
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Nishonov A B, Khorlampenko A A, Velieva R M, Danilovich A I, Tarasov R S
Аннотация
INTRODUCTION: Acute coronary syndrome without ST-segment elevation remains a highly relevant problem due to the heterogeneity of the patient population and the poor prognosis in high-risk groups. Identifying risk factors in this patient group will improve the outcomes of open myocardial revascularization. Aim - to identify factors for adverse outcome of coronary artery bypass grafting in patients with high-risk non-ST-segment elevation acute coronary syndrome.
MATERIAL AND METHODS: Over an eight-year period, 209 emergency coronary artery bypass grafting surgeries were performed within the first 24 hours of admission for high-risk non-ST-segment elevation acute coronary syndrome. Two groups were formed based on the development of major cardiovascular events in the postoperative period: those with such events (Group 1, n=20) and those with a favorable hospital course (Group 2, n=189). Univariate and multivariate regression analyses were conducted, and a prognostic model was developed.
RESULTS: Univariate analysis showed that age over 67 years, Syntax score over 30 points, residual Syntax score over 5, GRACE over 155 points, EuroSCORE II over 4.1%, cardiopulmonary bypass time over 80 minutes, post-CABG urea over 8.3 mmol/l, and glomerular filtration rate under 67 ml/min were factors for unfavorable outcome. A prognostic model was developed, according to which the need for transfusions after surgery increased the risk of unfavorable outcome by 6.5 times, EuroSCORE II over 4.1% by 5.7 times, GRACE over 155 points by 7.4 times, and Syntax score over 30 points by 4 times Conclusion. Independent predictors of the development of MACE after urgent coronary artery bypass grafting for high-risk acute coronary syndrome without ST segment elevation are: high risk according to the GRACE (>155 points) and EuroSCORE II (>4.1%) scales, severe coronary artery disease (SYNTAX >30 points), as well as the development of the need for transfusions of blood components in the postoperative period.
MATERIAL AND METHODS: Over an eight-year period, 209 emergency coronary artery bypass grafting surgeries were performed within the first 24 hours of admission for high-risk non-ST-segment elevation acute coronary syndrome. Two groups were formed based on the development of major cardiovascular events in the postoperative period: those with such events (Group 1, n=20) and those with a favorable hospital course (Group 2, n=189). Univariate and multivariate regression analyses were conducted, and a prognostic model was developed.
RESULTS: Univariate analysis showed that age over 67 years, Syntax score over 30 points, residual Syntax score over 5, GRACE over 155 points, EuroSCORE II over 4.1%, cardiopulmonary bypass time over 80 minutes, post-CABG urea over 8.3 mmol/l, and glomerular filtration rate under 67 ml/min were factors for unfavorable outcome. A prognostic model was developed, according to which the need for transfusions after surgery increased the risk of unfavorable outcome by 6.5 times, EuroSCORE II over 4.1% by 5.7 times, GRACE over 155 points by 7.4 times, and Syntax score over 30 points by 4 times Conclusion. Independent predictors of the development of MACE after urgent coronary artery bypass grafting for high-risk acute coronary syndrome without ST segment elevation are: high risk according to the GRACE (>155 points) and EuroSCORE II (>4.1%) scales, severe coronary artery disease (SYNTAX >30 points), as well as the development of the need for transfusions of blood components in the postoperative period.