Peculiarities of the development of acute coronary syndrome in patients after coronary artery bypass grafting

AIM: The purpose of the study was to analyse clinical peculiarities of the development of acute coronary syndrome in patients after coronary artery bypass grafting procedures and to evaluate the in-hospital results of treatment PATIENTS AND METHODS: Within the frameworks of a single-centre register over the period from 2006 to 2016 the study included 81 patients (with a total of more than 5000 coronary artery bypass grafting operations performed during this period). We examined the preoperative, intraoperative, and in-hospital periods, as well as the patients' status at the moment of the development of the clinical course of acute coronary syndrome, its structure and terms of manifestation, the dynamics of the coronary bed condition, also carrying out the analysis of treatment strategies and the in-hospital outcomes thereof. RESULTS: The development of acute coronary syndrome after coronary artery bypass grafting procedures was revealed in patients with a mean age of 58 (52; 63) years, with a history of postinfarction cardiosclerosis (70.37%), arterial hypertension (92.59%), dyslipidemia (51.83%), obesity (77.78%) and a multiple-vessel lesion of the coronary bed (67.90%) of intermediate risk according to the SYNTAX score estimated as an average of 26 (22; 32) points. In the structure of acute coronary syndrome having developed in patients with previously endured coronary artery bypass grafting operations, prevailing was its form of non-ST-segment elevation (87.65%), predominantly of a low risk (61.73%) which manifested itself averagely 24 (12; 35) months after the operation. The main factor of the development of acute coronary syndrome was progression of atherosclerosis (60.49%). The dominating strategy of treatment was medicamentous therapy (55.56%). The in-hospital mortality rate amounted to 2.47%. In the dynamics of the clinical status of the patients prior to coronary artery bypass grafting by the moment of the manifestation of acute cardiac ischaemia there took place a significant decrease in the left ventricular ejection fraction (p=0.01) and progression of atherosclerosis to the multifocal status (p=0.004). CONCLUSION: Patients with acute coronary syndrome, having previously endured coronary artery bypass grafting procedures appear to belong to a special cohort presenting with a series of clinical peculiarities and despite satisfactory in-hospital results do require special attention, with the development of appropriate algorithms for risk stratification and optimal therapeutic decision-making.