PREDICTION OF STAGED SURGICAL TREATMENT OUTCOME IN PATIENTS WITH CONCOMITANT CAROTID AND CORONARY ATHEROSCLEROTIC...

Objective - to assess the impact of perioperative factors on the treatment response in patients with concomitant carotid and coronary atherosclerotic arterial disease who underwent the first stage of revascularization and to build an outcome prediction model based on those factors.The prediction models were based on treatment outcomes in 204 patients with concomitant coronary and carotid atherosclerotic arterial disease, who are subject to surgical revascularization of both vascular beds and who underwent the first stage of treatment.The treatment outcomes were individually influenced by both preoperative factors [limb movement disorders, 0.247 (p=0.004); cardiac arrhythmias, 0.202 (p=0.038); surgery type, 0.229 (p=0.001)] and intra- and postoperative factors (cardiovascular complications, 0.369 (p<0.00001), including acute coronary syndrome and acute cerebrovascular disorders). Two binary logistic regression models were built in order to predict treatment outcomes and assess the comprehensive impact of perioperative factors. The first model is designed to distinguish an unfavorable outcome from a favorable one. The recognition quality of the model is 97%; its sensitivity is 75%; specificity - 97%. The second model makes it possible to predict whether a condition of a patient with a favorable outcome will improve or remain unchanged vs. complete or partial regression of neurological/cardiologic symptoms. The overall correct prediction percentage of the model is 62%. According to the second model, treatment outcomes were influenced by age (OR=0.96 [0.94; 0.99]), vertebral artery disorder (OR=2.3 [1.12; 4.84]), and surgery type (OR=0.34 [0.15; 0.79]). The key risk factors of unfavourable outcome as for the revascularization of the first bed when revascularization of both beds is required in patients with concomitant carotid and coronary atherosclerotic arterial disease who are subject to the staged surgical treatment tactics are cardiovascular complications in the preoperative period, i. e. acute coronary syndrome and acute cerebrovascular disorders. Postinfarction cardiosclerosis in women is an additional risk factor for an unfavorable outcome. Functional treatment outcomes are affected by age and vertebral artery stenosis, both independently and in combination with other factors. The built model allows predicting treatment outcomes taking into account risk factors involved.