CLINICAL AND FUNCTIONAL CHARACTERISTICS OF WOMEN WITH ISCHEMIC HEART DISEASE IN THE SELECTION OF MYOCARDIAL REVASCULARIZATION METHODS
Keywords:
ischemic heart disease, coronary artery bypass grafting, coronary artery stenting, spirometry, echocardiography, multislice computed tomography coronary angiographyAbstract
Objective. To assess the clinical and functional characteristics of women with ischemic heart disease (IHD), including the pattern of comorbidities, and to determine the choice of revascularization method—coronary artery stenting (CAS) or coronary artery bypass grafting (CABG).
Materials and Methods. This retrospective study included 302 women with IHD. 198 patients underwent CAS, and 104 underwent CABG. All patients underwent: assessment of comorbidities, anthropometry with calculation of body mass index (BMI), echocardiography, multislice computed tomography coronary angiography with calculation of the coronary calcium score (CCS) according to Agatston, spirometry, and calculation of the oxygen delivery index (DO2). Statistical analysis included the chi-square test, calculation of odds ratios (OR) with a 95% confidence interval (CI), and Student’s t-test.
Results. The leading comorbid conditions were hypertension (96%), post-infarction cardiosclerosis (51%), diabetes mellitus (36.7%), and obesity grades I–III (44,1%). An analysis of BMI revealed that being overweight is statistically significantly associated with a preference for CAS (OR = 2.48; 95% CI 1.28–4.81). When assessing the CCS index, a strong statistically significant association was found with the choice of revascularization method (χ² = 96.47; p<0.001). A CCS of 0 was associated with CAS (OR = 8.80; 95% CI 4.42–17.51), whereas a CCS > 400 was associated with CABG (OR = 0.025; 95% CI 0.006–0.107). Echocardiography revealed a moderate decrease in ejection fraction (EF = 54.4 ± 0.65%) and signs of left ventricular remodeling (myocardial mass index 102.75 ± 2.1 g/m²). The oxygen delivery index (DO2) averaged 803.0 ± 186.0 mL/min, indicating compensated but reduced oxygen transport capacity. Spirometry revealed a moderate decrease in FEV1 (forced expiratory volume in 1 second, 2.3 ± 0.5L) and FEV1/FVC (ratio-76.6 ± 16.6%) with preserved FVC (forced vital capacity-3.0 ± 0.6 L), indicating subclinical obstructive abnormalities.
Conclusion. In women with coronary artery disease, a high prevalence of comorbid conditions is associated with obesity, moderate systolic dysfunction, myocardial remodeling, reduced oxygen-carrying capacity, and subclinical obstructive abnormalities of respiratory function (RF). The coronary calcium index is a powerful predictor for selecting a revascularization method. The data obtained support the need for a multidisciplinary approach with mandatory assessment of the CCS, RF, and DO2 when planning revascularization for this category of patients.
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