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Screening and management for ischemic heart disease in patients undergoing emergency surgery for a type A acute

Mitsumasa Hata1, Motomi Shiono, Hiroaki Hata

  • 1Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan, cvshata@aol.com.

Surgery Today
|October 23, 2013
PubMed

Insights

Coronary artery disease (CAD) screening is vital after emergency surgery for type A acute aortic dissection, especially for patients with atherosclerosis risk factors. Lower high-density lipoprotein cholesterol and thicker carotid intima-media thickness predict CAD in these patients.

Area of Science:

  • Cardiovascular Surgery
  • Diagnostic Imaging
  • Vascular Medicine

Background:

  • Type A acute aortic dissection requires emergency surgery, posing significant risks.
  • Post-operative complications, including coronary artery disease (CAD), can occur.
  • Early detection of CAD is crucial for patient management and outcomes.

Purpose of the Study:

  • To assess the incidence of coronary artery disease (CAD) in patients hospitalized after emergency surgery for type A acute aortic dissection.
  • To identify predictors of CAD in this patient population.

Main Methods:

  • 123 patients underwent multi-slice computed tomography (MSCT) scans post-surgery.
  • Patients were categorized into two groups: those with significant coronary artery stenosis (>75%) and those without.
  • Logistic regression analysis was used to identify CAD predictors.

Main Results:

  • 11.4% of patients had significant coronary artery stenosis.
  • Higher prevalence of diabetes, dyslipidemia, and smoking history in the CAD group.
  • Lower high-density lipoprotein cholesterol (HDL) levels and thicker carotid intima-media thickness (IMT) were associated with CAD.
  • Carotid IMT > 1.1 mm and HDL < 40 mg/dl were identified as predictors for CAD.

Conclusions:

  • Coronary artery disease screening is recommended for patients with aortic dissection and atherosclerosis risk factors, even after emergency surgery.
  • Identifying patients with lower HDL and increased carotid IMT can aid in early CAD detection.
  • Proactive screening can improve management strategies for post-operative cardiovascular complications.
Abstract

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