Influence of extracorporeal autohemomagnetotherapy on central hemo-dynamics, survival and medical costs during coronary artery bypass grafting in patients with identified gene polymorphisms

Objective. To study the parameters of systolic and diastolic blood pressure during coronary artery bypass grafting (CABG) under artificial circulation (AC) with extracorporeal autohemomagnetic therapy (EAHMT) in patients with coronary artery disease with the presence of gene polymorphisms of angiotensin-1 receptor (AGT2R1 A1166C) (rs 5186), endothelin-1 (Lys198asn) (rs 5370), endothelial nitric oxide synthase (NOS3 C786T) (rs 2070744). To calculate the cost-effectiveness and length of stay (bed-days) of patients in the Anesthesiology and Resuscitation Department No. 1, cardiac surgery hospital after the use of EAHMT.
Materials and methods. All patients were divided into two groups. Group 1 (60 patients) included standard anesthesia for CABG under cardiopulmonary bypass without the use of EAGMT. Group 2 (63 patients) included standard anesthesia for CABG under cardiopulmonary bypass with the use of EAGMT. Systolic (SBP), diastolic (DBP), and central venous (CVP) pressures were assessed. The relative change in SBP, DBP, and CVP was calculated individually for each patient. Then, using Statistica 10.0 (Statsoft Inc., USA), descriptive statistics of the specified parameters were obtained in the form of Me [Q1; Q3] (where Me is the median, Q1 is the first quartile 25 %; Q3 is the third quartile 75 %) or M [min; max] (where M is the mean value, min is the minimum; max is the maximum). The statistical significance of the change in the numerical parameter in the group was determined using the nonparametric paired Wilcoxon test. When comparing two independent groups by a numerical indicator, the nonparametric Mann-Whitney U-test was used. To analyze the length of patients’ stay in hospital, Kaplan-Meier survival curves were constructed using the licensed IBM SPSS Statistics 27.0 (Free trial) program. The log-rank criterion was used to compare survival curves. All patients in both groups underwent intraoperative venous blood sampling from a central venous catheter. Then, using the polymerase chain reaction method and the Rotor Gene Q 5plex HRM apparatus (QIAGEN, Germany), a study of the genotypes of the polymorphisms of the genes of the angiotensin-1 receptor (AGTR1 A1166C), endothelin-1 (EDN1 Lys198Asn), endothelial nitric oxide synthase (NOS3 C786T) was performed with further processing of the obtained results (Pearson chi-square, odds ratio, Akaike and Bayesian information criteria, Hardy-Weinberg equilibrium) using the SNPStats online service.
Results. When using EAGMT in addition to standard anesthesia, a statistically significant improvement in the studied parameters (SBP, DBP) was observed, as well as a relative change in these parameters. No changes in CVP or a relative change in this parameter were observed. No relationship was found between the polymorphisms of the genes of the angiotensin-1 receptor (AGT2R1 A1166C) (rs 5186), endothelin-1 (Lys198asn) (rs 5370), endothelial nitric oxide synthase (NOS3 C786T) (rs 2070744) and the SBP and DBP parameters. Not only a statistically significant decrease in bed days in the Anesthesiology and Intensive Care Unit No. 1 and in the cardiac surgery hospital in group 2 compared with group 1 was noted, but also a decrease in the costs of the treatment performed in group 2.
Conclusions. The use of EAGMT is not only effective in maintaining systemic hemodynamic parameters, which proves the absence of a negative effect of this method in the intraoperative period during CABG under CPB conditions. The use of this technique helps to reduce the length of hospital stays and save money on patients’ stays in hospital. Genotypes of polymorphisms of the genes of the angiotensin-1 receptor (AGT2R1 A1166C) (rs 5186), endothelin-1 (Lys198asn) (rs 5370), endothelial nitric oxide synthase (NOS3 C786T) (rs 2070744) do not affect the studied parameters of invasive hemodynamics.

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