Kim Olga Vladislavovna (1), Yunusova Nozima Dilshod kizi (2)
Cardiovascular diseases remain the leading cause of mortality worldwide, accounting for more than 20 million deaths annually, and coronary artery disease (CAD) constitutes the largest proportion of these cases. Surgical and interventional myocardial revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation, significantly improve survival and quality of life. However, postoperative cognitive impairment (POCI) has emerged as a frequent and clinically relevant complication. The present study aimed to evaluate the frequency, severity, and risk factors of cognitive impairment in patients undergoing CABG or PCI. A prospective observational study was conducted at the Central Clinical Hospital of “Temir Yo‘l Ijtimoiy Xizmatlar” LLC between 2025 and 2028. Sixty patients who underwent CABG or PCI were examined and compared with 30 age- and sex-matched controls. Neuropsychological, clinical, and laboratory assessments were performed. Cognitive impairment was identified in 38.3% of patients, with higher prevalence in the CABG group. Advanced age, diabetes mellitus, prolonged cardiopulmonary bypass time, and perioperative hypotension were significant predictors. Early identification of cognitive decline may improve long-term neurological and cardiovascular outcomes.
Evered, L., Silbert, B., Scott, D. A., Maruff, P., & Ames, D. (2011). Prevalence of dementia 7.5 years after coronary artery bypass graft surgery. Anesthesiology, 114(5), 1077–1086. https://doi.org/10.1097/ALN.0b013e31820d850f
Evered, L., Silbert, B., Knopman, D. S., Scott, D. A., DeKosky, S. T., Rasmussen, L. S., ... & Nomenclature Consensus Working Group. (2018). Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018. British Journal of Anaesthesia, 121(5), 1005–1012. https://doi.org/10.1016/j.bja.2017.11.087
Gottesman, R. F., Grega, M. A., Bailey, M. M., Pham, L. D., Zeger, S. L., Baumgartner, W. A., & McKhann, G. M. (2010). Association between hypotension, low ejection fraction and cognitive decline after cardiac surgery. Circulation, 122(14), 1423–1430. https://doi.org/10.1161/CIRCULATIONAHA.109.909291
Knipp, S. C., Matatko, N., Wilhelm, H., Schlamann, M., Thielmann, M., Lösch, C., ... & Jakob, H. (2013). Cognitive outcomes three years after coronary artery bypass surgery: Relation to diffusion-weighted MRI findings. Annals of Thoracic Surgery, 95(3), 872–879. https://doi.org/10.1016/j.athoracsur.2012.10.017
Rasmussen, L. S., Johnson, T., Kuipers, H. M., Kristensen, D., Siersma, V. D., Vila, P., ... & ISPOCD2 Investigators. (2003). Does anaesthesia cause postoperative cognitive dysfunction? Lancet, 351(9106), 857–861.
Selnes, O. A., Gottesman, R. F., Grega, M. A., Baumgartner, W. A., & Zeger, S. L. (2012). Cognitive and neurologic outcomes after coronary-artery bypass surgery. New England Journal of Medicine, 366(3), 250–257. https://doi.org/10.1056/NEJMra1100109
. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020; 383:1436-1446.
Butler J, Zannad F, Filippatos G, et al. Cardiovascular effects of SGLT2 inhibitors in heart failure: mechanisms and clinical implications. Nat Rev Cardiol. 2022; 19:279-294.
Bhatt DL, Szarek M, Steg PG, et al. Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med. 2021; 384:117-128.
Verma S, McMurray JJV. SGLT2 inhibitors and mechanisms of cardiovascular benefit: a state-of- the-art review. Diabetology. 2018; 61:2108-2117.