[Role of coronary angiography in decreasing cardiac complications rate during vascular operations]

In order to assess the prevalence of coronary artery lesions in patients running various clinical risks of cardiovascular complications prior to surgical interventions on cardiac vascular basins, we performed a retrospective analysis of 392 case histories (340 men and 52 women, mean age 61.0±8.5 years). All patients in the preoperative period underwent coronary angiography (CAG). For the analytical purposes, the patients were subdivided into four groups. Group One (n=44) comprised patients without clinical risk factors, Group Two (n=184) was composed of those diagnosed as having one clinical risk factor. Group Three (n=122) comprised those with two clinical risk factors, and finally Group Four (n=42) was composed of those presenting with three and more clinical risk factors. CAG revealed that 91% of patients had coronary artery lesions. Haemodynamically significant lesions of three coronary arteries and/or stenosis of the left coronary artery trunk were observed in 15.6% of patients with no clinical risk factors of cardiac complications, in 19.0% of patients with one such factor, in 28.5% of those with two risk factors, and in 42.2% of patients with three and more risk factors. Preventive myocardial revascularization was performed in 22.7% of cases, more often in Group Three and Group Four patients. The number of postoperative complications in the groups did not differ significantly. The total hospital mortality rate was low (0.8%), with all 3 lethal outcomes observed amongst the patients with one clinical risk factor (1.6%). Hence, clinical preoperative stratification of the risk by means of the Lee index prior to vascular operations fails to reveal a considerable part of patients with prognostically unfavourable lesions of coronary arteries, and thus it should seemingly be used in this patient cohort with caution.