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Kemberi M, Urgesi E, Ng JY, Patel K, Khanji MY, Awad WI. Outcomes of Patients Presenting With Non-ST Elevation Myocardial Infarction Who Underwent Surgical Revascularization. Am J Cardiol 2024; 223:165-173. [PMID: 38777209 DOI: 10.1016/j.amjcard.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
Non-ST-segment elevation myocardial infarction (NSTEMI) is a leading cause of emergency hospitalization across Europe. This study evaluates the in-hospital and mid-term outcomes of patients who underwent coronary artery bypass graft (CABG) after NSTEMI. A retrospective analysis of all cases who underwent isolated CABG after NSTEMI from September 2017 to September 2022 at our center. Patients were stratified according to in-hospital survival. Patient characteristics, operative details, and procedural complications were compared between those who survived and those who did not. Predictors of in-hospital and mid-term mortality were evaluated using logistic and Cox regression modeling. Kaplan-Meier analysis was used to generate a survival curve for all alive patients at the time of discharge. Among 1,011 patients (median age 64 [56 to 72] years, 852 [84.3%] male), 735 (72.7%) underwent urgent, 239 (23.6%) elective, and 37 (3.7%) emergency CABG. The in-hospital mortality was 1.5% (15/1,011 patients). Those who died were more likely to be New York Heart Association class III/IV, have left ventricular ejection fraction <21%, severe renal impairment, peripheral vascular disease (PVD), or poor mobility. Emergency procedures, preoperative ventilation, inotropic support, and intra-aortic balloon pump (IABP) use were also more prevalent among those who died. Logistic regression modeling revealed new postoperative stroke (odds ratio 22.0, 95% confidence interval 3.6 to 135.5, p = 0.001), preoperative IABP use (11.4; 2.4 to 53.7, p = 0.002), new hemodialysis (9.6; 2.7 to 34.7, p <0.001), PVD (5.6; 1.6 to 20.0, p = 0.008), and poor mobility (odds ratio 4.8, 95% confidence interval 1.3 to 18.2, p = 0.022) as independent predictors of in-hospital mortality. In conclusion, new postoperative stroke, preoperative IABP use, new hemodialysis, PVD, and poor mobility are independent predictors of mortality in patients with NSTEMI who underwent isolated CABG.
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Affiliation(s)
- Marsioleda Kemberi
- Department of Cardiothoracic Surgery, Barts and the London Medical School, London, United Kingdom
| | - Eduardo Urgesi
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Jing Yong Ng
- Department of Cardiothoracic Surgery, Barts and the London Medical School, London, United Kingdom
| | - Kush Patel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | - Wael I Awad
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; William Harvey Research Institute, QMUL, London, United Kingdom.
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Agarwal R, Mudgal S, Arnav A, Ranjan N. Coronary artery bypass grafting in active or recent COVID-19 infection: a systematic review. Indian J Thorac Cardiovasc Surg 2023. [PMCID: PMC9995725 DOI: 10.1007/s12055-023-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Introduction Even though there have been few studies on coronary artery bypass grafting (CABG), data on patients with coronavirus disease-2019 (COVID-19) infection show that cardiac surgery has poor outcomes in this subset. From the available studies in the literature, we conducted a systematic review with the aim of determining the outcome of COVID-19 patients who underwent CABG. Methods Between December 2019 and October 2022, searches were conducted in PubMed, the Directory of Open Access Journals, and Google Scholar to find studies reporting results of COVID-19 patients undergoing CABG. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. The quality of the studies was assessed using a standardised tool. Results The total sample size across the 12 included studies was 99 patients who underwent CABG in active disease or within 30 days of COVID-19 infection. The median and interquartile range (IQR) for the length of time spent on a mechanical ventilator, stay in the intensive care unit (ICU), and the total hospital stay were 0.9 (0.47–2), 4.5 (2.5–8), and 12.5 (8.5–22.5) days respectively. Seventy-six patients developed postoperative complications, and there were eleven deaths. Conclusion The findings of the present study indicate that mortality risk goes down when the time between COVID-19 diagnosis and surgery increases. When compared to data from other high-risk urgent or emergent CABG patients around the world who were not infected with COVID-19, patients who underwent CABG in the COVID-19 subgroup had similar postoperative outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01495-7.
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Affiliation(s)
- Rajat Agarwal
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences (AIIMS) Deoghar, PTI Campus, Jasidih, Deoghar, 814142 Jharkhand India
| | - Shiv Mudgal
- grid.413618.90000 0004 1767 6103College of Nursing, All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, Jharkhand 814142 India
| | - Amiy Arnav
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, Jharkhand 814142 India
| | - Nishit Ranjan
- grid.413618.90000 0004 1767 6103Department of General Surgery, All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, Jharkhand 814142 India
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Deharo P, Porto A, Bourguignon T, Herbert J, Etienne CS, Semaan C, Genet T, Jaussaud N, Morera P, Theron A, Gariboldi V, Collart F, Cuisset T, Fauchier L. Myocardial Revascularization Strategies in ST Elevation Myocardial Infarction Without Urgent Revascularization: Insight From a Nationwide Study. Mayo Clin Proc 2022; 97:905-918. [PMID: 35184879 DOI: 10.1016/j.mayocp.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/14/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the outcomes of patients presenting with ST-segment elevation myocardial infarction (STEMI) without early (<48 hours) revascularization, according to percutaneous versus surgical revascularization. PATIENTS AND METHODS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients seen for a STEMI in France between January 1, 2010, to June 31, 2019, who underwent either a first percutaneous coronary intervention (PCI) or a first coronary artery bypass graft between 48 hours and 90 days after the index hospitalization. Propensity score matching was used for the analysis of outcomes. RESULTS Of 71,365 patients with STEMI in the analysis, 59,340 patients underwent PCI and 12,025 patients underwent coronary artery bypass graft. In a matched analysis of 12,012 patients by arm, surgical revascularization was associated with lower rates of all cause (5.1% vs 7.1%; hazard ratio [HR], 0.70; 95% CI, 0.66 to 0.75) and cardiovascular (2.6% vs 3.1%; HR, 0.83; 95% CI, 0.76 to 0.91) death. Rehospitalization for heart failure was less often reported after surgery (5.5% vs 7.5%; HR, 0.76; 95% CI, 0.71 to 0.81) whereas stroke incidence was not statistically different between the two arms (2.1% vs 2.3%; HR, 0.90; 95% CI, 0.80 to 1.00). Major bleeding was less often reported in the PCI arm (4.6% vs 6.1%; HR, 1.31; 95% CI, 1.22 to 1.41). CONCLUSION In patients with STEMI who did not undergo urgent revascularization (ie, within 48 hours after presentation), surgical revascularization was associated with better outcomes and should be individually considered as an alternative to PCI.
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Affiliation(s)
- Pierre Deharo
- Département de Cardiologie, CHU Timone, Marseille, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France.
| | - Alizée Porto
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Thierry Bourguignon
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
| | - Carl Semaan
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
| | - Thibaud Genet
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
| | - Nicolas Jaussaud
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Pierre Morera
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Alexis Theron
- Aix-Marseille Université, Faculté de Médecine, Marseille, France; Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France; Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Frederic Collart
- Aix-Marseille Université, Faculté de Médecine, Marseille, France; Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France
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Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10112492. [PMID: 34199991 PMCID: PMC8200235 DOI: 10.3390/jcm10112492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA (n = 1090) treated with isolated SAVR for aortic valve stenosis. Propensity score-matching adjustment for baseline features was used to study the outcome differences in a median follow-up of 5.6 years. Results: Patients with RA had higher all-cause mortality (HR 1.76; CI 1.21–2.57; p = 0.003), higher incidence of major adverse cardiovascular events (HR 1.63; CI 1.06–2.49; p = 0.025), and they needed more often coronary artery revascularization for coronary artery disease (HR 3.96; CI 1.21–12.90; p = 0.027) in long-term follow-up after SAVR. As well, cardiovascular mortality rate was higher in patients with RA (35.7% vs. 23.4%, p = 0.023). There was no difference in 30-day mortality (2.8% vs. 1.8%, p = 0.518) or in the need for aortic valve reoperations (3.7% vs. 4.0%, p = 0.532). Conclusions: Patients with rheumatoid arthritis had impaired long-term results and increased cardiovascular mortality after SAVR for aortic valve stenosis. Special attention is needed to improve outcomes of aortic valve stenosis patients with RA after SAVR.
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