Multifocality and progression of non-coronary atherosclerosis in patients undergoing coronary artery bypass grafting

Abstract

Purpose: To investigate the prevalence and progression of polyvascular disease (PolyVD) one year after coronary artery surgery (CABG).
Patients and methods. 732 consecutive patients (586 males, 146 females, age median 59 yrs), underwent CABG. After One year after CABG 504 patients (391 men and 113 women) were succeeded to invite clinic for examination. Patients are divided into groups based on the preoperative amount of affected arterial beds: Group 1 (n=243) – lesion of one region; Group 2 (n=178) – lesion of two regions, group 3 (n = 83) – lesion of three or more arterial beds. Any stenosis of 30% or more, and non-cardiac vascular surgery previously carried were considered as an arterial bed lesion. The PolyVD diagnosis was considered in case of two or more affected regions detection. The progression of PolyVD was estimated.
Results. There was a trend to an increase in patients age with a raise of the number of affected beds (p=0.006). Glomerular filtration rate (GFR) was lower in patients with PolyVD as before surgery (р=0,036), and 1 year after it (р=0,041). The logical trend of increasing the intima-media thickness with the number of affected arterial beds affected (p<0.001) was revealed. Within 1 year after CABG PolyVD progression occurred in 33 (6.5%) patients. Progression of atherosclerosis was significantly more frequent in patients with PolyVD: the increase in non-coronary artery stenosis was detected in 0.8% of patients with lesions of the pool (group 1), at 10.1% and 15.7% of patients of groups 2 and 3, respectively (p <0,001 when compared to group 1). In a univariate analysis, the likelihood of PolyVD progression increases in case of presence of history of stroke (OR 5.716, 95% CI 2.430–13.444, p=0.001), with a decrease in GFR (OR 0.982, 95% CI 0.968–0.997, p=0.015) and the preoperative PolyVD presence (OR 3.358, 95% CI 2.046–5.513, p<0.001). In multivariate analysis, statistically significant effect on the probability of detecting the progression of IPA preserved defeat several arterial regions (OR 3.064, 95% CI 1.649–5.592, p<0.001) and the presence of suffering a stroke earlier (OR 3.670, 95% CI 1.151–11.699, p=0.027).
Conclusions. One year after CABG non-coronary atherosclerosis progression observed in 6.5% of patients. Factors influencing the likelihood of progression of atherosclerosis are stroke history and preoperative presence of PolyVD.