SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE VOLUME 21 NUMBER 1 • November 2024 7 Discussion This study aimed to assess the impact of an abnormal CIMT on intra- and postoperative variables in ACS patients receiving CABG surgery. It was hypothesised that patients with pronounced/thickened CIMTs would present with worse intra- and postoperative measurable abnormalities, outcomes and complications. The study results showed that patients with abnormal CIMTs had more pre-operative risk factors than patients with normal CIMTs. However, no significant differences were observed between intra- and postoperative variables when comparing the normal and abnormal CIMT groups, even at a higher abnormal CIMT cut-off value of ≥ 0.09 cm. The anthropometric analysis showed that patients with an abnormal CIMT had a significantly higher BMI and were significantly more overweight than patients with a normal CIMT. This finding is in agreement with studies conducted by Rashid and Mahmud28 and El Jalbout et al.,29 who reported an increased CIMT in adolescents with an increased BMI. In this cohort, 69% of ACS patients who required CPB surgery due to severe CAD had an abnormal CIMT. This finding concurs with several other studies that concluded that CIMT is elevated with advanced CAD.6,30 In our study, in patients with an abnormal CIMT, risk factors such as hypertension, diabetes and increased NT-proBNP levels were significantly more frequent than in those with a normal CIMT. Diabetes directly impacts on CIMT due to vascular endothelial dysfunction.31 Baba et al. reported that patients presenting with diabetes had higher CIMT values than healthy Table 4. Post-operative outcomes of normal and abnormal CIMT groups Group 1 Group 2 normal CIMT abnormal CIMT Variables (n = 28, 31%) (n = 61, 69%) p-value Peak lactate (> 4 mmol/dl), mean ± SD 5.3 ± 3.4 5.8 ±3.2 0.52 Length of stay in ICU > 3 days, mean ± SD 3.1 ± 0.7 3.13 ± 2.2 0.63 n (%) 6 (21.4) 9 (14.8) Length of stay in ICU > 3 days, mean ± SD 2.94 ± 0.1 3.54 ± 0.6 0.33 Mortality, n (%) 0 (0) 1 (2) – Normal CIMT males < 0.07 cm; abnormal CIMT males ≥ 0.07 cm; normal CIMT females < 0.065 cm; abnormal CIMT females ≥ 0.065 cm. CIMT, carotid intima–media thickness; SD, standard deviation. *Statistically significant p-value < 0.05. Table 5. Pre-, intra- and postoperative outcomes compared to normal (< 0.09 cm) and abnormal (≥ 0.09 cm) CIMT values regardless of gender Group 1 Group 2 normal CIMT abnormal CIMT Variables (n = 61, 68.5%) (n = 28, 31.5%) p-value Pre-operative clinical data, mean ± SD NT-proBNP (ng/l), 936.1 ± 165.7 1391 ± 650.5 0.51 LVEF 53.6 ± 1.7 52.1 ± 3.3 0.69 CK-MB isoform (ng/ml) 21.8 ± 10.3 36.10 ± 27.9 0.62 Intra-operative clinical data, mean ± SD Peak lactate (mmol/dl) 4.3 ± 0.2 3.9 ± 0.4 0.29 Cumulative bypass time (min) 112.9 ± 3.8 109.6 ± 6.6 0.66 Postoperative outcomes, mean ± SD Peak lactate (> 4 mmol/dl) 5.8 ± 0.4 5.69 ± 0.70 0.93 Normal CIMT < 0.09 cm; abnormal CIMT ≥ 0.09 cm. CIMT, carotid intima–media thickness; SD, standard deviation. *Statistically significant p-value < 0.05. Fig. 1. Post-operative complications of normal and abnormal CIMT groups.
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