Parametri procene razvoja ranih kardiovaskularnih komplikacija kod rekonstrukcija velikih arterijskih krvnih sudova

Abstract

Introduction: Preoperative risk assessment for the development of cardiovascular complications (CV) is an essential component in patients with open surgical revascularization of multiple arterial vessels. The aim of this paper is to examine whether biomarkers are of better prognostic capacity than clinical scores and whether by analyzing their combinations we can get a model that can identify patients who are at increased risk of developing CV complications during 90days after surgery. Material and methods: The study was conducted as a prospective, observational study involving 122 patients in 2017 at the Clinic for Cardiac Surgery at the Clinical Center in Niš. The primary goal of monitoring patients is the development of cardiovascular complications (sudden cardiac death, myocardial infarction, lung edema, rhythm malignancies, unstable angina pectoris, acute cardiac decompensation). Patients with cardiovascular events were a clinical group, while all patients with cardiovascular complications were a control group. In this way, the design of the study envisages a "nested case control" study. Results: In the first three months, 29 patients (23.8%) had 50 cardiac complications. Preoperative N-terminal natriuretic peptide (NT pro-BNP) was statistically significantly higher in subjects who developed cardiac complications in the first three months. Patients who have the Revised Cardiologic Risk Ratio (RCRI) values ≥3 have a statistically significantly shorter time to develop cardiac complications in the first month compared to other patients. The best discriminatory ability for cardiac complications in the first three months has a combination of highly sensitive troponin I (cTnI), NTproBNP and Vascular Physiological and Operative Severity Score for the morphidity and morbidity (V-POSSUM). This model has high sensitivity and specificity when it comes to assessment of cardiac complications in the first three months. Conclusion: Based on the results of the experimental and clinical part of the study, it is concluded that the potential short-term assessment of cardiac complications is the best joint application of clinical scores (RCRI, V-POSSUM and biochemical parameters NTproBNP, cTnI). By applying these markers, patients can be classified into certain risk categories, or a personalized approach to the patient can be applied to a certain extent.