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Feng X, Wu F, Wu Y, Ding S, Tao X, Li J, Liu W, Ma R, Chen Y. A Prediction Rule Including Interleukin-6 in Pericardial Drainage Improves Prediction of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2021; 36:1975-1984. [PMID: 34763978 DOI: 10.1053/j.jvca.2021.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that a prediction rule including levels of interleukin-6 in pericardial drainage (pdIL-6) would improve the discrimination in classifying patients undergoing coronary artery bypass grafting (CABG) into different postoperative atrial fibrillation (POAF) risk levels. DESIGN Prospective cohort study. SETTING A university-affiliated tertiary hospital. PARTICIPANTS Patients undergoing CABG. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We prospectively recruited patients who underwent CABG into derivation and validation cohorts. The independent predictors were identified in the derivation cohort using multiple logistic regression and tested in the validation cohort. The performance of the predictive model was tested using area under the receiver operating characteristic curve (AUC) in both cohorts. A prediction rule was created by assigning points to each predictor. Patients were classified in various risk levels according to their total risk scores. We enrolled 302 and 207 patients in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified six predictors: age ≥61 y, left atrial diameter ≥49 mm, right atrial diameter ≥45 mm, number of grafts ≥3, and serum uric acid ≥226 µmol/L and pdIL-6 levels ≥166 ng/mL at postoperative 12 h. The AUC of the model was 0.78 and 0.77 for the derivation and validation cohort, respectively, which was greatly increased by adding pdIL-6. Patients were stratified into low-risk, moderate-risk and high-risk groups. CONCLUSIONS A POAF prediction rule including pdIL-6 had good performance for stratifying CABG patients into various risk groups for POAF. The inclusion of pdIL-6 resulted in clinically meaningful improvement in risk prediction.
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Affiliation(s)
- Xinwei Feng
- School of Nursing, Capital Medical University, Beijing, China
| | - Fangqin Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China.
| | - Shu Ding
- Beijing Chao-yang Hospital affiliated with Capital Medical University, Beijing, China
| | - Xiangjun Tao
- Beijing Chao-yang Hospital affiliated with Capital Medical University, Beijing, China
| | - Jinglian Li
- Beijing Tian-tan Hospital, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ruiying Ma
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuling Chen
- School of Nursing, Capital Medical University, Beijing, China
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Kandimalla J, Hussain Z, Piriyawat P, Rodriguez G, Maud A, Khatri R, Cruz-Flores S, Vellipuram AR. Stroke Rates Following Surgical Versus Percutaneous Revascularization for Ischemic Heart Disease. Curr Cardiol Rep 2021; 23:45. [PMID: 33721116 DOI: 10.1007/s11886-021-01471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Coronary revascularization is a commonly performed major procedure in the hospitals. Stroke is one of the dreaded complications after coronary revascularization procedures. The focus of this review is to understand the stroke risk in percutaneous cutaneous intervention (PCI) and coronary artery bypass grafting (CABG) procedures. RECENT FINDINGS Available data show that PCI offers less procedural stroke risk compared to CABG although the survival benefits of CABG are better in certain scenarios. Innovative advancements in techniques, pre-procedural optimum medical therapy (OMT), intraoperative neuro-monitoring, and multidisciplinary post procedural care are the few strategies in early detection and reduce stroke risk. Despite several innovations and strategies, it is evident that there is not enough data available to make concrete conclusions related to stroke risk after coronary revascularization, which warrants further investigation.
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Affiliation(s)
- Jithendhar Kandimalla
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Zain Hussain
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Paisith Piriyawat
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Gustavo Rodriguez
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Rakesh Khatri
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Anantha R Vellipuram
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA.
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Dzhioeva ON, Drapkina OM. Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications. It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.
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Affiliation(s)
- O. N. Dzhioeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Pooria A, Pourya A, Gheini A. Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions. Future Cardiol 2020; 16:481-496. [PMID: 32495650 DOI: 10.2217/fca-2019-0049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary artery disease is one of the commonest surgery demanding cardiovascular diseases. Coronary artery bypass graft surgery is practiced all over the world for the treatment of coronary artery disease. Systemic trauma during the surgery is associated with a wide range of complications, some of which are fatal. Preoperative risk factors such as age, previous illness and obesity are common predictors of these adverse events. Advances in therapeutic medicine have allowed timely treatment of these adverse events and co-morbidities. This review summarizes some of the most occurring complications associated with coronary artery bypass graft and corresponding treatment options.
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Affiliation(s)
- Ali Pooria
- Department of Cardiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Afsoun Pourya
- Student of Research committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Gheini
- Department of Cardiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Kanametov TN, Shvartz VA, Oltarzhevskaya ND, Bockeria OL. Effect of epicardial application of amiodarone-releasing hydrogel on heart rate in an animal model. Cardiovasc Diagn Ther 2019; 9:328-336. [PMID: 31555537 PMCID: PMC6732076 DOI: 10.21037/cdt.2019.04.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of the experiment was to study the safety of local epicardial use of the hydrogel with amiodarone, as well as the influence of its different dosages on the heart rate of mongrel rabbits. METHODS The epicardial application of the hydrogel material with amiodarone was performed in 46 rabbits. Rabbits were divided into 5 groups: Group No. 1-dose of amiodarone in the hydrogel 1 mg, Group No. 2-dose 3 mg; Group No. 3-dose 6 mg; Group No. 4-hydrogel without amiodarone; Group No. 5-amiodarone intravenously, 60 mg. RESULTS The application of hydrogel with amiodarone is not accompanied by a systemic inflammatory reaction. In group No. 2, there was a significant reduction in the heart rate (before surgery: 158±16, after: 130±11, (P<0,001), without any disturbances to the conduction system of the heart functioning. With an increase in amiodarone concentration (Group No. 3), significant atrial and atrioventricular (AV) conduction defects (up to 70%) were noted; when the dosage of amiodarone (Group No. 1) was reduced, there was no influence on the heart rate reduction. The hydrogel without amiodarone has no effect on the conductive system. CONCLUSIONS The method of local epicardial delivery of amiodarone in the form of a hydrogel material is safe. The hydrogel with amiodarone is effective for the heart rate reduction (according to the experiment on animals), compared to the control group and the group with intravenous drug administration. The optimal dosage of amiodarone in the hydrogel is 3 mg.
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Affiliation(s)
- Teymuraz N Kanametov
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia
| | - Vladimir A Shvartz
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia
| | | | - Olga L Bockeria
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia
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Epicardial Application of Hydrogel with Amiodarone for Prevention of Postoperative Atrial Fibrillation in Patients After Coronary Artery Bypass Grafting. J Cardiovasc Transl Res 2019; 13:191-198. [PMID: 31367901 DOI: 10.1007/s12265-019-09905-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/25/2019] [Indexed: 02/01/2023]
Abstract
The objective of this study was to assess the safety and efficacy of local epicardial application of amiodarone-releasing hydrogel for prevention of postoperative atrial fibrillation (POAF) in patients after coronary artery bypass grafting. Patients were randomized into two groups: with the application of amiodarone-releasing hydrogel and the control group. It included 60 patients (47 males, 13 females) (mean age of 62 ± 8.5). POAF incidence differences were statistically significant between two groups: in the study group, the POAF incidence was 3.3%, while in the control group, the POAF incidence was 37% (p < 0.001). Statistically significant differences were revealed in the PQ interval duration. The risk of POAF incidence was calculated using the Cox regression model: the age and the application of amiodarone-releasing hydrogel application were statistically significant. Hospital length of stay in two groups was also different (р < 0.001). The age and the application of amiodarone-releasing hydrogel were statistically significant for POAF incidence.
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Allah EA, Kamel EZ, Osman HM, Abd-Elshafy SK, Nabil F, Elmelegy TTH, Elkhayat H, Ibrahim AS, Minshawy AA. Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery? J Cardiothorac Vasc Anesth 2019; 33:3340-3347. [PMID: 31178259 DOI: 10.1053/j.jvca.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the role of prophylactic high-dose atorvastatin for prevention of postoperative atrial fibrillation (POAF), inflammatory response attenuation, and myocardial protection after valve replacement cardiac surgery. DESIGN Randomized controlled trial. SETTING Assiut University Hospitals. PARTICIPANTS Sixty-four adult patients undergoing cardiac valve replacement surgery. INTERVENTIONS The participants were equally divided into 2 groups. Group S received 80 mg of atorvastatin (oral tablets), 12 and 2 hours preoperatively, and on the 2nd, 3rd, 4th, and 5th postoperative days. Control group C received placebo at the same time periods. MEASUREMENTS The incidence of POAF, postoperative white blood cell count, serum C-reactive protein, interleukin 6, and troponin I. MAIN RESULTS Group S patients showed a lower incidence of POAF compared with the placebo group (p = 0.031). The white blood cell count showed significant reductions in group S compared with group C on the second, third, fourth, and fifth postoperative days. The C-reactive protein level showed significant reductions on the third, fourth, and fifth postoperative days in group S compared with group C (p = 0.001, 0.001, and 0.001, respectively). The serum level of interleukin 6 showed a significant reduction on the fifth postoperative day in group S compared with group C (p = 0.001). There was no significant difference between the 2 groups regarding the troponin I level and inotropic score. CONCLUSION Prophylactic use of high dose atorvastatin can decrease the incidence of POAF and attenuate the inflammatory process in adult patients undergoing isolated rheumatic cardiac valve replacement surgery.
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Affiliation(s)
- Essam Abd Allah
- Anesthesia and ICU department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Emad Zarief Kamel
- Anesthesia and ICU department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Hany M Osman
- Anesthesia and ICU department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Fatma Nabil
- Anesthesia and ICU department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Hussein Elkhayat
- Cardiothoracic Surgery department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed Al Minshawy
- Cardiothoracic Surgery department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Ma B, Sun J, Diao S, Zheng B, Li H. Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis. Ann Med 2018; 50:402-409. [PMID: 29741972 DOI: 10.1080/07853890.2018.1471217] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes. OBJECTIVE We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery. METHODS Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes. RESULTS Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR) = 0.460, 95% confidence interval (CI) = 0.324-0.653, p = 0 for myocardial infarction; OR = 0.617, 95% CI = 0.476-0.801, p = 0 for composite of death/myocardial infarction/stroke; OR = 0.406, 95% CI = 0.247-0.666, p = 0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms. CONCLUSIONS This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery. Key Messages Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.
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Affiliation(s)
- Baoxin Ma
- a Department of Cardiology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China
| | - Jingwu Sun
- a Department of Cardiology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China
| | - Shuling Diao
- a Department of Cardiology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China
| | - Bo Zheng
- a Department of Cardiology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China
| | - Hua Li
- b Department of Oncology , The Affiliated Hospital of Binzhou Medical University , Binzhou , Shandong , China
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Rajabi M, Safarpoor G, Borzou SR, Farhadian M, Arabi A, Moeinipour A, Manafi B. Association between incidence of atrial fibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery (CABG): a cohort study. Electron Physician 2018; 10:6624-6630. [PMID: 29881524 PMCID: PMC5984016 DOI: 10.19082/6624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/22/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Open heart surgery is one of the most common and valuable treatment methods for cardiovascular diseases, a common side effect of which is atrial fibrillation that occurs due to various reasons. OBJECTIVE To determine the relationship between incidence of atrial fibrillation (AF) and duration of cardiopulmonary bypass (CPB) in patients after open heart surgery. METHODS The present retrospective cohort study was conducted on 330 patients in Farshchian Heart Center through census. The required data were collected from medical records of the patients undergoing coronary bypass surgery using data collection between April 2015 and March 2015. Then, data analysis was performed using SPSS software (ver.16) at error level of p<0.05. The tests used in this study included independent-samples t-test, Mann-Whitney, and chi-squared tests. RESULTS Based on the results, mean age of the patients was 61.76±9.2, the majority of the patients (70.1%) were male. The association between Incidence of Atrial Fibrillation and cardiopulmonary pump time (minute) was not meaningful. Incidence of atrial fibrillation had statistically significant relationship with variables of mean age, BMI, PAC, PVC, creatinine and duration of hospitalization (p<0.05); on the other hand, variables of gender, cross clamp time (minute), intubation time (hour), and clinical history had no effect on atrial fibrillation incidence rate (p>0.05). CONCLUSION Since the pathogenesis of AF after cardiac surgery is believed to be multifactorial, including clinical variables and technical intraoperative factors, the relation between incidence of AF with mean age, BMI, PAC, PVC, creatinine and duration of hospitalization was significant. But AF was not related to cardiopulmonary pump time (minute). It is necessary to conduct further research on factors affecting incidence of atrial fibrillation.
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Affiliation(s)
- Maryam Rajabi
- M.Sc. in Nursing, Nursing and Midwifery School, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Gholamreza Safarpoor
- Assistant Professor, Department of Cardiac Surgery, Faculty of Medical Sciences, Farshchian Heart Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Seyed Reza Borzou
- Assistant Professor, Department of Medical Surgical Nursing, Member of Chronic Disease (Home Care) Research Center, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Maryam Farhadian
- Assistant Professor of Biostatistics, Modeling of Non Communicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Arezo Arabi
- Master of Epidemiology, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Aliasghar Moeinipour
- Assistant Professor of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Manafi
- Assistant Professor of Cardiovascular Surgery, Faculty of Medicine, Hamedan University of Medical Sciences. Iran
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