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Kennedy B, Wernroth ML, Batra G, Hammar U, Linroth C, Grönberg A, Byberg L, Fall T. Major cardiovascular events and death in parents of children with type 1 diabetes: a register-based matched cohort study in Sweden. Diabetologia 2024:10.1007/s00125-024-06200-w. [PMID: 38922417 DOI: 10.1007/s00125-024-06200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024]
Abstract
AIMS/HYPOTHESIS Parenting a child with type 1 diabetes has been associated with stress-related symptoms. This study aimed to elucidate the potential impact on parental risk of major cardiovascular events (MCE) and death. METHODS In this register-based study, we included the parents of 18,871 children, born 1987-2020 and diagnosed with type 1 diabetes in Sweden at <18 years. The median parental age at the child's diagnosis was 39.0 and 41.0 years for mothers and fathers, respectively. The cohort also encompassed 714,970 population-based matched parental control participants and 12,497 parental siblings. Cox proportional hazard regression models were employed to investigate the associations between having a child with type 1 diabetes and incident MCE and all-cause death, and, as secondary outcomes, acute coronary syndrome and ischaemic heart disease (IHD). We adjusted for potential confounders including parental type 1 diabetes and country of birth. RESULTS During follow-up (median 12 years, range 0-35), we detected no associations between parenting a child with type 1 diabetes and MCE in mothers (adjusted HR [aHR] 1.02; 95% CI 0.90, 1.15) or in fathers (aHR 1.01; 95% CI 0.94, 1.08). We noted an increased hazard of IHD in exposed mothers (aHR 1.21; 95% CI 1.05, 1.41) with no corresponding signal in fathers (aHR 0.97; 95% CI 0.89, 1.05). Parental sibling analysis did not confirm the association in exposed mothers (aHR 1.01; 95% CI 0.73, 1.41). We further observed a slightly increased hazard of all-cause death in exposed fathers (aHR 1.09; 95% CI 1.01, 1.18), with a similar but non-significant estimate noted in exposed mothers (aHR 1.07; 95% CI 0.96, 1.20). The estimates from the sibling analyses of all-cause death in fathers and mothers were 1.12 (95% CI 0.90, 1.38) and 0.73 (95% CI 0.55, 0.96), respectively. CONCLUSIONS/INTERPRETATION Having a child diagnosed with type 1 diabetes in Sweden was not associated with MCE, but possibly with all-cause mortality. Further studies are needed to disentangle potential underlying mechanisms, and to investigate parental health outcomes across the full lifespan.
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Affiliation(s)
- Beatrice Kennedy
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
- SciLifeLab, Uppsala University, Uppsala, Sweden.
| | | | - Gorav Batra
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ulf Hammar
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Cecilia Linroth
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Annika Grönberg
- Paediatric Inflammation, Metabolism and Child Health Research, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- SciLifeLab, Uppsala University, Uppsala, Sweden
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2
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Hamarneh A, Ho AFW, Bulluck H, Sivaraman V, Ricciardi F, Nicholas J, Shanahan H, Hardman EA, Wicks P, Ramlall M, Chung R, McGowan J, Cordery R, Lawrence D, Clayton T, Kyle B, Xenou M, Ariti C, Yellon DM, Hausenloy DJ. Negative interaction between nitrates and remote ischemic preconditioning in patients undergoing cardiac surgery: the ERIC-GTN and ERICCA studies. Basic Res Cardiol 2022; 117:31. [PMID: 35727392 PMCID: PMC9213287 DOI: 10.1007/s00395-022-00938-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
Remote ischaemic preconditioning (RIPC) using transient limb ischaemia failed to improve clinical outcomes following cardiac surgery and the reasons for this remain unclear. In the ERIC-GTN study, we evaluated whether concomitant nitrate therapy abrogated RIPC cardioprotection. We also undertook a post-hoc analysis of the ERICCA study, to investigate a potential negative interaction between RIPC and nitrates on clinical outcomes following cardiac surgery. In ERIC-GTN, 185 patients undergoing cardiac surgery were randomized to: (1) Control (no RIPC or nitrates); (2) RIPC alone; (3); Nitrates alone; and (4) RIPC + Nitrates. An intravenous infusion of nitrates (glyceryl trinitrate 1 mg/mL solution) was commenced on arrival at the operating theatre at a rate of 2-5 mL/h to maintain a mean arterial pressure between 60 and 70 mmHg and was stopped when the patient was taken off cardiopulmonary bypass. The primary endpoint was peri-operative myocardial injury (PMI) quantified by a 48-h area-under-the-curve high-sensitivity Troponin-T (48 h-AUC-hs-cTnT). In ERICCA, we analysed data for 1502 patients undergoing cardiac surgery to investigate for a potential negative interaction between RIPC and nitrates on clinical outcomes at 12-months. In ERIC-GTN, RIPC alone reduced 48 h-AUC-hs-cTnT by 37.1%, when compared to control (ratio of AUC 0.629 [95% CI 0.413-0.957], p = 0.031), and this cardioprotective effect was abrogated in the presence of nitrates. Treatment with nitrates alone did not reduce 48 h-AUC-hs-cTnT, when compared to control. In ERICCA there was a negative interaction between nitrate use and RIPC for all-cause and cardiovascular mortality at 12-months, and for risk of peri-operative myocardial infarction. RIPC alone reduced the risk of peri-operative myocardial infarction, compared to control, but no significant effect of RIPC was demonstrated for the other outcomes. When RIPC and nitrates were used together they had an adverse impact in patients undergoing cardiac surgery with the presence of nitrates abrogating RIPC-induced cardioprotection and increasing the risk of mortality at 12-months post-cardiac surgery in patients receiving RIPC.
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Affiliation(s)
- Ashraf Hamarneh
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-Hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Heerajnarain Bulluck
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vivek Sivaraman
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Jennifer Nicholas
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Hilary Shanahan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Peter Wicks
- University Hospital Southampton NHS Foundation Trust, London, UK
| | - Manish Ramlall
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Robin Chung
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - John McGowan
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Roger Cordery
- Barts Heart Centre, King's College London, London, UK
| | - David Lawrence
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Clayton
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Bonnie Kyle
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Maria Xenou
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Cono Ariti
- University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK
| | - Derek M Yellon
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Derek J Hausenloy
- Institute of Cardiovascular Sciences, The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK.
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan.
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Giang KW, Jeppsson A, Karlsson M, Hansson EC, Pivodic A, Skoog I, Lindgren M, Nielsen SJ. The risk of dementia after coronary artery bypass grafting in relation to age and sex. Alzheimers Dement 2021; 17:1042-1050. [PMID: 33663018 PMCID: PMC8251974 DOI: 10.1002/alz.12251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 01/15/2023]
Abstract
Introduction We examined the long‐term risk of dementia after coronary artery bypass grafting (CABG) in relation to age and sex. Methods All CABG patients in Sweden 1992–2015 (n = 111,335), and matched controls (n = 222,396) were included in a population‐based study. Adjusted hazard ratios (aHR) for all‐cause dementia, vascular dementia, and Alzheimer's disease were calculated. Results There was no difference in the risk for all‐cause dementia between CABG patients and control subjects (aHR 0.98 [95% confidence interval 0.95 to 1.02]). CABG patients <65 years and 65 to 74 years had higher risk (aHR 1.29 [1.17–1.42] and 1.08 [1.02–1.13], respectively), and patients ≥75 years had lower risk (aHR 0.76 [0.71–0.81]). The highest risk was observed in women <65 years (aHR 1.64 [1.31–2.05]). Discussion Overall, the long‐term risk for all‐cause dementia does not differ between CABG patients and the general population. Younger patients have a higher risk, while older patients have a lower risk, compared to controls.
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Affiliation(s)
- Kok Wai Giang
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Karlsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Medicine, Skaraborg Hospital Lidköping, Lidköping, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health-AgeCap, University of Gothenburg, Mölndal, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nielsen S, Giang KW, Wallinder A, Rosengren A, Pivodic A, Jeppsson A, Karlsson M. Social Factors, Sex, and Mortality Risk After Coronary Artery Bypass Grafting: A Population-Based Cohort Study. J Am Heart Assoc 2020; 8:e011490. [PMID: 30852925 PMCID: PMC6475039 DOI: 10.1161/jaha.118.011490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Little is known of the impact of social factors on mortality after coronary artery bypass grafting ( CABG ). We explored sex- and age-specific associations between mortality risk after CABG and marital status, income, and education. Methods and Results This population-based register study included 110 742 CABG patients (21.3% women) from the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies) operated 1992 to 2015. Cox regression models were used to study the relation between social factors and all-cause mortality. Never having been married compared with being married/cohabiting was associated with a higher risk in women than in men (hazard ratio 1.32, 95% CI 1.20-1.44) versus 1.17 (1.13-1.22), P=0.030 between sex. The lowest income quintile, compared with the highest, was associated with higher risk in men than in women (hazard ratio 1.44 [1.38-1.51] versus 1.25 [1.14-1.38], P=0.0036). Lowest education level was associated with higher risk without sex difference (hazard ratio 1.15 [1.11-1.19] versus 1.25 [1.16-1.35], P=0.75). For unmarried women aged 60 years at surgery with low income and low education, mortality 10 years after surgery was 18%, compared with 11% in married women with high income and higher education level. The median life expectancy was 4.8 years shorter. Corresponding figures for 60-year-old men were 21% versus 12% mortality risk at 10 years and 5.0 years shorter life expectancy. Conclusions There are strong associations between social factors and mortality risk after CABG in both men and women. These results emphasize the importance of developing and implementing secondary prevention strategies for CABG patients with disadvantages in social factors.
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Affiliation(s)
- Susanne Nielsen
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Kok Wai Giang
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Andreas Wallinder
- 2 Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Annika Rosengren
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | | | - Anders Jeppsson
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,2 Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Martin Karlsson
- 1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,4 Department of Medicine Skaraborg Hospital Lidköping Lidköping Sweden
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Two early rehabilitation training models in male patients after coronary artery bypass surgery: application of continuous walking training as an alternative to interval cycle ergometer training. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:87-93. [PMID: 32728371 PMCID: PMC7379224 DOI: 10.5114/kitp.2020.97265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
Introduction Walking training is a good alternative to the commonly used cycle ergometer training. It is still necessary to develop rehabilitation programs based on walking characterized by a high degree of safety and effectiveness. Aim Application of continuous walking training as an alternative to interval cycle ergometer training in men after coronary artery bypass graft (CABG) surgery, using the 6-minute walk test (6-MWT) to determine the initial training load. Material and methods Forty-four men aged 45 to 76 years, up to 3 months after CABG surgery, were randomly assigned to continuous training on a treadmill (study group) or interval training on a cycle ergometer (control group), performed 6 times per week (12-15 sessions). Participants underwent the treadmill exercise stress test (TEST) and 6-MWT at the begining and after completion of the rehabilitation program. Before and 3 minutes after the 6th and 12th training session blood lactate concentration was determined. Results Energy expenditure in TEST increased from 4.4 to 6.3 MET in the study group and from 5.0 to 6.5 MET in the control group. Distance walked in 6-MWT increased from 420 to 519 m and from 438 to 510 m, respectively. Resting heart rate (HR) and double product (DP) decreased only in the study group as well as systolic blood pressure (SBP), HR and DP at peak exercise load in baseline TEST. Mean energy expenditure during training sessions was 2.6 MET in the study group and 2.8 MET in the control group (NS). Exercise blood lactate concentration did not exceed 2.0 mmol/l in both groups. Conclusions Both rehabilitation programs were of similar effectiveness and their intensity did not exceed the anaerobic threshold.
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Commentary: Surgical results for prosthetic valve endocarditis: Early pain but long-term gain. J Thorac Cardiovasc Surg 2020; 161:620-621. [PMID: 31918848 DOI: 10.1016/j.jtcvs.2019.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/23/2022]
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Commentary: Post-30-day mortality: I guess no one is coming…. J Thorac Cardiovasc Surg 2019; 159:538-539. [PMID: 31202449 DOI: 10.1016/j.jtcvs.2019.02.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/23/2022]
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Sef D, Szavits-Nossan J, Predrijevac M, Golubic R, Sipic T, Stambuk K, Korda Z, Meier P, Turina MI. Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery. Open Heart 2019; 6:e001027. [PMID: 31168389 PMCID: PMC6519404 DOI: 10.1136/openhrt-2019-001027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives Updated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome. Methods Among 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints. Results Overall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op). Conclusions Urgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.
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Affiliation(s)
| | - Janko Szavits-Nossan
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Mladen Predrijevac
- J.J. Strossmayer University, Osijek, Croatia.,Department of Cardiovascular Surgery, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Rajna Golubic
- Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Tomislav Sipic
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Kresimir Stambuk
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Zvonimir Korda
- Department of Cardiovascular Surgery, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Pascal Meier
- Royal Brompton and Harefield NHS Foundation Trust, London, London, UK.,Kantonsspital Graubunden, Chur, GR, Switzerland
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Barbarash OL, Zhidkova II, Shibanova IA, Ivanov SV, Sumin AN, Samorodskaya IV, Barbarash LS. The impact of comorbidities and age on the nosocomial outcomes of patients undergoing coronary artery bypass grafting. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-2-58-64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - I. I. Zhidkova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - I. A. Shibanova
- L.S. Barbarash Kemerovo Regional Clinical Cardiology Dispensary
| | - S. V. Ivanov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. N. Sumin
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | - L. S. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Brieger DB, Ng ACC, Chow V, D'Souza M, Hyun K, Bannon PG, Kritharides L. Falling hospital and postdischarge mortality following CABG in New South Wales from 2000 to 2013. Open Heart 2019; 6:e000959. [PMID: 31168375 PMCID: PMC6519410 DOI: 10.1136/openhrt-2018-000959] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/24/2019] [Accepted: 02/10/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives To describe changes in mortality among patients undergoing coronary artery bypass grafting (CABG) in New South Wales (NSW) Australia from 2000 to 2013. Methods Patients undergoing CABG were identified from the NSW Admission Patient Data Collection (APDC) registry, linked to the NSW state-wide death registry database. Changes in all-cause mortality over time were observed following stratification of the study cohort into two year groups. Results We identified 54 767 patients undergoing CABG during the study period. The risk profile of patients increased over time with significant increases in age, comorbidities and concomitant valve surgery (all p < 0.0001). During a median follow-up period of 6 years, a total 12 161 (22.2%) of patients had died. Survival curves and adjusted analyses showed a steady fall in mortality rate: those operated on during 2012–2013 had 40 % lower mortality than those operated on during 2000–2001 (HR 0.61; 95% CI 0.53 to 0.69). This was contributed to both by a fall in mortality both in hospital (HR 0.48, 95% CI 0.37 to 0.62) and postdischarge (HR 0.73; 95% CI 0.61 to 0.86). Conclusions We report a consistent reduction in medium-term mortality among a large unselected cohort of NSW patients undergoing CABG between 2000 and 2013. This fall is attributable both to an improvement in outcomes in hospital and in the postdischarge period.
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Affiliation(s)
- David B Brieger
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Hospital and The University of Sydney, Concord, New South Wales, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, The University of Sydney and ANZAC Medical Research Institute, Sydney, New South Wales, Australia
| | - Mario D'Souza
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul G Bannon
- Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
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12
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Dadkhah-Tirani H, Hasandokht T, Agostoni P, Salari A, Shad B, Soltanipour S. Comparison of cardiovascular risk factors among coronary artery bypass graft patients in 2010 and 2016: A single-center study in Guilan province, Iran. ARYA ATHEROSCLEROSIS 2019; 14:205-211. [PMID: 30783410 PMCID: PMC6368195 DOI: 10.22122/arya.v14i5.1740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There has been a change in the risk factor profile of patients with coronary artery disease (CAD) in the western world. We sought to compare the risk factor profile of patients undergoing coronary artery bypass graft (CABG) surgery in northern part of Iran in 2010 and 2016. METHODS In a cross-sectional study, medical records of 296 CABG patients in 2010 and 500 patients in 2016 were collected from a referral university hospital in Guilan province, Iran. We compared the risk factor profile using chi-square test or independent t-test as needed in the two time points, 2010 and 2016. RESULTS The age of CABG patients significantly decreased from 62.49 ± 8.05 to 58.09 ± 9.20 over time. The frequency of hypertension (HTN) (66.2% vs. 59.1%, P = 0.045), diabetes mellitus (DM) (51.8% vs. 43.6%, P = 0.025), smoking (35.6% vs. 28.0%, P = 0.028), and patients with multimorbidity (31.8% vs. 26.7%, P = 0.001) increased in the second period compared to the first period of study. Whereas, the prevalence of hypercholesterolemia and positive family history of coronary heart disease (CHD) remained stable over time (49.6% vs. 49.0%, P = 0.870; 10.5% vs. 11.1%, P = 0.810, respectively). CONCLUSION We observed a dramatic increase in DM, HTN, and cigarette smoking as well as the multimorbidity prevalence in 2016 compared to 2010. Even with considering all study limitations, primary and secondary prevention program to decrease cardiovascular disease is required.
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Affiliation(s)
- Heidar Dadkhah-Tirani
- Assistant Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Tolou Hasandokht
- Assistant Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Piergiuseppe Agostoni
- Professor, Centro Cardiologico Monzino IRCCS AND Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Arsalan Salari
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Bijan Shad
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Soltanipour
- Associate Professor, Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Baber U, Dangas GD. Left Main PCI With DES Versus CABG: Cautionary Note or Cause for Concern? J Am Coll Cardiol 2018; 72:2823-2825. [PMID: 30522645 DOI: 10.1016/j.jacc.2018.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Usman Baber
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - George D Dangas
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Literaturübersicht 2017 zur Koronarchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Doenst T, Kirov H, Moschovas A, Gonzalez-Lopez D, Safarov R, Diab M, Bargenda S, Faerber G. Cardiac surgery 2017 reviewed. Clin Res Cardiol 2018; 107:1087-1102. [PMID: 29777372 DOI: 10.1007/s00392-018-1280-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
Abstract
For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term "cardiac surgery". This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier. The field of coronary bypass surgery was primarily filled with confirmatory evidence for the beneficial role of coronary artery bypass grafting for complex coronary disease and equal outcomes for percutaneous coronary intervention for less complex disease including main stem lesions. For aortic valve treatment, the new guidelines provide an equal recommendation for surgical and transcatheter aortic valve replacement for high and intermediate risk giving specific check lists to individualize decision-making by the heart team. For low-risk aortic stenosis, surgical valve replacement remains the primary indication. For the mitral valve, the importance of surgical experience of the individual surgeon on short- and long-term outcome was presented and the prognostic impact of mitral repair for primary mitral regurgitation was emphasized. In addition, there were many relevant and interesting other contributions from the purely operative arena in the fields of tricuspid disease as well as terminal heart failure (i.e., transplantation and ventricular assist devices). While this article attempts to summarize the most pertinent publications, it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Rauf Safarov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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Martinelli L. Coronary artery bypass graft: Is it still an elixir of life? Int J Cardiol 2017; 244:333-334. [PMID: 28784452 DOI: 10.1016/j.ijcard.2017.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Luigi Martinelli
- Cardiac Surgery Division, ICLAS - Istituto Clinico Ligure di Alta Specialità, Rapallo, Italy
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Affiliation(s)
- Rebecca F Gottesman
- From the Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD.
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