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Nawrozi P, Ratschiller T, Schimetta W, Gierlinger G, Pirklbauer M, Müller H, Zierer A. Perioperative and Long-Term Outcomes in Patients Undergoing Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: A Single-Center Experience. Adv Ther 2024; 41:1911-1922. [PMID: 38480660 PMCID: PMC11052859 DOI: 10.1007/s12325-024-02805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/29/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Patients requiring coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) can be managed with staged (CEA before CABG), reverse staged (CABG before CEA) or synchronous treatment. This single-center retrospective study evaluated the outcomes in patients undergoing planned synchronous CEA and CABG. METHODS Between 2000 and 2020 a total of 185 patients with symptomatic triple-vessel or left main coronary artery disease associated with 70-99% asymptomatic or 50-99% symptomatic uni- or bilateral internal carotid artery (ICA) stenosis underwent synchronous CEA and CABG at our institution. Study endpoints were defined as mortality, stroke and myocardial infarction at 30 days. Additionally, the composite endpoint of these events was investigated. RESULTS At 30 days, mortality, stroke and myocardial infarction rates were 5.9%, 8.1% (permanent [unresolved deficit at discharge] 5.4%) and 3.8%, respectively, and the composite endpoint was reached in 13.0% of patients. Patients suffering from a stroke more frequently had a contralateral 70-99% ICA stenosis (60.0% vs. 17.3%; p < 0.001), peripheral artery disease (73.3% vs. 38.9%; p = 0.013) and prolonged cardiopulmonary bypass time (mean 119 ± 62 min vs. 84 ± 29 min; p = 0.012). Multivariate logistic regression analysis revealed the duration of cardiopulmonary bypass (odds ratio [OR] 1.024; 95% confidence interval [CI] 1.002-1.046; p = 0.034), a history of type 2 diabetes mellitus (OR 5.097; 95% CI 1.161-22.367; p = 0.031) and peripheral artery disease (OR 5.814; 95% CI 1.231-27.457; p = 0.026) as independent risk factors for reaching the composite endpoint. CONCLUSION Patients undergoing synchronous CEA and CABG face an elevated risk of perioperative cardiovascular events, particularly an increased stroke risk in patients with symptomatic and bilateral ICA stenosis. Graphical Abstract available for this article.
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Affiliation(s)
- Paimann Nawrozi
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 9, 4021, Linz, Austria.
- Medical Faculty, Johannes Kepler University, Linz, Austria.
| | - Thomas Ratschiller
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Wolfgang Schimetta
- Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
| | - Gregor Gierlinger
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Markus Pirklbauer
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Müller
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Andreas Zierer
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
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Kamal A, Kandil AM, Sadaka M, Ramadan B. Long-term effects of percutaneous coronary intervention versus coronary artery surgery in elderly with multi-vessel coronary artery disease. Egypt Heart J 2022; 74:86. [PMID: 36576658 PMCID: PMC9797625 DOI: 10.1186/s43044-022-00323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The most prevalent illness among the elderly is coronary artery disease (CAD), and most of this population present with multi-vessel CAD which constitutes a common management difficulty among elderly people. This study aimed to compare long-term consequences of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) revascularization in elderly patients with multi-vessel coronary artery disease. RESULTS This retrospective study evaluated 100 elderly patients with multi-vessel CAD divided into two groups, group 1 the PCI group and group 2 the CABG group. The main findings of the study showed that CABG group had a longer hospital stay than the PCI group (8.16 vs. 2.02 days; P < 0.001). A considerably higher mean residual SYNTAX score was observed in the PCI group than CABG group which was 1.15 and 0.2, respectively (p-value < 0.001). The in-hospital major adverse cardiac events rate (MACE) in both groups was not statistically significant. Regarding the in-hospital mortality rate, although it was higher in the CABG group (6%) versus 2% in the PCI group, yet it was not statistically significant. The long-term MACE in this study revealed that 12.2% of PCI patients had heart failure compared to 6.4% in the CABG group, which was statistically insignificant. In the long-term follow-up, the revascularization rate of CABG group was higher than the PCI group; however, it was statistically insignificant. CABG group had a higher rate of stroke than PCI group being 4.3% and 2%, respectively; yet this difference was not statistically considerable. The long-term mortality rate among the PCI and CABG group was 10.2% and 4.3%, respectively. CONCLUSIONS Elderly patients with multi-vessel CAD, PCI with stenting, and CABG were statistically equivalent in long-term death and MI rates, stroke, repeat revascularization. A non-statistically notable distinction between the two groups as regards MACE, composite of death or MI, and all-cause mortality was found. This may have implication on choice of management strategy among elderly patients with multi-vessel CAD.
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Affiliation(s)
- Amr Kamal
- grid.7155.60000 0001 2260 6941Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria, Egypt
| | - Abdel Megeid Kandil
- grid.7155.60000 0001 2260 6941Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria, Egypt
| | - Mohamed Sadaka
- grid.7155.60000 0001 2260 6941Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria, Egypt
| | - Basem Ramadan
- grid.7155.60000 0001 2260 6941Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Kim JH, Lee PH, Kim HJ, Kim JB, Park S, Kyoung DS, Kang SJ, Lee SW, Kim YH, Lee CW, Chung CH, Lee JW, Park SW. Incidence and predictors of intracranial bleeding after coronary artery bypass graft surgery. Front Cardiovasc Med 2022; 9:863590. [PMID: 36035927 PMCID: PMC9411799 DOI: 10.3389/fcvm.2022.863590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background There is a paucity of direct data on the incidence and predictors of intracranial bleeding (ICB) after coronary artery bypass graft surgery (CABG). Methods The Korean National Health Insurance database was used to identify patients without prior ICB who underwent CABG. The outcomes of interest were the time-dependent incidence rates of ICB and the associated mortality. Results Among 35,021 patients who underwent CABG between 2007 and 2018, 895 (2.6%) experienced an ICB during a median follow-up of 6.0 years. The 1-year cumulative incidence of ICB was 0.76%, with a relatively high incidence rate (9.93 cases per 1,000 person-years) within the first 1–30 days. Subsequent incidence rates showed a sharp decline until 3 years, followed by a steady decrease up to 10 years. The 1-year mortality rate after ICB was 38.1%, with most deaths occurring within 30 days (23.6%). The predictors of ICB after CABG were age ≥ 75 years, hypertension, pre-existing dementia, history of ischemic stroke or transient ischemic attack, and end-stage renal disease. Conclusions In an unselected nationwide population undergoing CABG, the incidence of ICB was non-negligible and showed a relatively high incidence rate during the early postoperative period. Post-CABG ICB was associated with a high risk of premature death. Further research is needed to stratify high-risk patients and personalize therapeutic decisions for preventing ICB after CABG.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Pil Hyung Lee,
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
| | - Dae-Sung Kyoung
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Shah SMA, Rehman MU, Awan NI, Jan A. To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting. Pak J Med Sci 2021; 37:261-266. [PMID: 33437288 PMCID: PMC7794131 DOI: 10.12669/pjms.37.1.3242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting. METHODS This study was conducted at Cardiothoracic Surgery Department, Rehman Medical Institute, Peshawar. Study design was descriptive cross sectional study and the duration of the study was six months. The total sample size was 183 cases using 8.3% frequency of stroke after coronary artery bypass grafting, 95% confidence interval, 4% margin of error, using WHO sample size calculator. RESULTS In this study mean age was 45 years with SD ± 1.26. Seventy five percent patients were male while 46(25%) females. Six patients (3%) patients had stroke while 177(97%) patients did not have any stroke. Among the six patients who were analyzed, all of them had Diabetes Mellitus and 50% patients had recent AMI, while only one patient had prior history of Atrial Fibrillation. CONCLUSIONS Diabetes Mellitus is an independent risk factor for stroke after CABG surgery. whereas, recent MI is also associated with increased incidence of stroke in post CABG patients.
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Affiliation(s)
- Sayed Mumtaz Anwar Shah
- Dr. Sayed Mumtaz Anwar Shah, FCPS. Assistant Professor, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
| | - Mujeeb Ur Rehman
- Dr. Mujeeb Ur Rehman, MS. Senior Medical Officer, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
| | - Nabil I Awan
- Dr. Nabil I Awan MBBS. Post-Graduate Resident, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
| | - Azam Jan
- Dr. Azam Jan, ABTS, Head of Department, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
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Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, Fremes SE, Holmes D, Girardi LN, Nakamura S, Head SJ, Park S, Mack M, Serruys PW, Ruel M, Stone GW, Tam DY, Vallely M, Taggart DP. Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes. J Am Heart Assoc 2019; 8:e013032. [PMID: 31242821 PMCID: PMC6662343 DOI: 10.1161/jaha.119.013032] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew YorkNY
| | | | | | - Davide Capodanno
- Division of CardiologyC.A.S.T., P.O. “Rodolico”Azienda Ospedaliero‐Universitaria “Policlinico‐Vittorio Emanuele”University of CataniaItaly
| | | | - Michael E. Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar CentreUniversity of TorontoOntarioCanada
| | - Stephen E. Fremes
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | | | | | | | - Stuart J. Head
- Department of Cardiothoracic SurgeryErasmus University Medical CentreRotterdamThe Netherlands
| | - Seung‐Jung Park
- Department of CardiologyHeart InstituteUniversity of Ulsan College of MedicineAsian Medical CenterSeoulKorea
| | | | | | - Marc Ruel
- Division of Cardiac SurgeryUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | | | - Derrick Y. Tam
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - Michael Vallely
- Sydney Medical SchoolThe University of SydneyNew South WalesAustralia
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Ivascu NS, Khan FM, Rahouma M, Hameed I, Abouarab A, Segal AZ, Gaudino MFL, Girardi LN. Characteristics and anatomic distribution of early vs late stroke after cardiac surgery. J Card Surg 2019; 34:684-689. [DOI: 10.1111/jocs.14121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Natalia S. Ivascu
- Department of AnesthesiologyWeill Cornell Medicine New York New York
| | - Faiza M. Khan
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
| | - Mohammed Rahouma
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
| | - Irbaz Hameed
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
| | - Ahmed Abouarab
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
| | - Alan Z. Segal
- Department of NeurologyWeill Cornell Medicine New York New York
| | - Mario F. L. Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
| | - Leonard N. Girardi
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
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Hu WS, Lin CL. Postoperative ischemic stroke and death prediction with CHA 2DS 2-VASc score in patients having coronary artery bypass grafting surgery: A nationwide cohort study. Int J Cardiol 2017; 241:120-123. [PMID: 28214079 DOI: 10.1016/j.ijcard.2017.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This nationwide cohort study was attempted to address the predictive ability of CHA2DS2-VASc score in both ischemic stroke and death in patients undergoing coronary artery bypass grafting (CABG) surgery. METHODS We identified patients aged ≥18years undergoing de novo CABG between January 1, 2000 and December 31, 2011. We calculated CHA2DS2-VASc score for each study patient. We used univariable and multivariable Cox proportional hazards regression models to measure the hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke and death associated with CHA2DS2-VASc score in the study patients. We used the area under the curve of receiver-operating characteristic (C-statistic) to calculate the predictive power of CHA2DS2-VASc score with respect to ischemic stroke and death in patients having CABG. RESULTS A total of 43,694 patients aged ≥18years receiving de novo CABG were included in the study cohort. The incidence and risk of ischemic stroke and death were positively associated with CHA2DS2-VASc score in patients receiving CABG. In addition, the discriminatory properties of the score resulted in C-statistics of 0.60 (95% CI=0.59-0.61) and 0.63 (95% CI=0.62-0.64) for the prediction of ischemic stroke and death in patients undergoing CABG, respectively. CONCLUSIONS The present study is the first nationwide cohort study to investigate the performance of CHA2DS2-VASc score for the prediction of ischemic stroke and death in patients receiving CABG. However, the discriminative power was modest, and the predictive role of CHA2DS2-VASc score in this population remained to be determined.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan
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Head SJ, Kieser TM, Falk V, Huysmans HA, Kappetein AP. Coronary artery bypass grafting: Part 1--the evolution over the first 50 years. Eur Heart J 2014; 34:2862-72. [PMID: 24086085 DOI: 10.1093/eurheartj/eht330] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Surgical treatment for angina pectoris was first proposed in 1899. Decades of experimental surgery for coronary artery disease finally led to the introduction of coronary artery bypass grafting (CABG) in 1964. Now that we are approaching 50 years of CABG experience, it is appropriate to summarize the advancement of CABG into a procedure that is safe and efficient. This review provides a historical recapitulation of experimental surgery, the evolution of the surgical techniques and the utilization of CABG. Furthermore, data on contemporary clinical outcomes are discussed.
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Affiliation(s)
- Stuart J Head
- Department of cardiothoracic surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Influencing factors for early acute cerebrovascular accidents in patients with stroke history following off-pump coronary artery bypass grafting. Heart Lung Circ 2014; 23:560-5. [PMID: 24513488 DOI: 10.1016/j.hlc.2013.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 10/27/2013] [Accepted: 11/24/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyse risk factors for early acute cerebrovascular accidents following off-pump coronary artery bypass grafting (OPCAB) in patients with stroke history, and to propose preventive measures to reduce the incidence of these events. METHODS A total of 468 patients with a history of stroke underwent OPCAB surgery in Beijing Anzhen Hospital of China from January 2010 to September 2012. They were retrospectively divided into two groups according to the occurrence of early acute cerebrovascular accidents within 48 hours following OPCAB. Multivariate logistic regression analysis was used to find risk or protective factors for early acute cerebrovascular accidents following the OPCAB. RESULTS Fifty-two patients (11.1%) suffered from early acute cerebrovascular accidents in 468 patients, including 39 cases of cerebral infarction, two cases of cerebral haemorrhage, 11 cases of transient ischaemic attack (TIA). There were significant differences between the two groups in preoperative left ventricular ejection fraction ≤ 35%, severe bilateral carotid artery stenosis, poorly controlled hypertension, intraoperative application of Enclose® II proximal anastomotic device, postoperative acute myocardial infarction, atrial fibrillation, hypotension, ventilation time > 48h, ICU duration >48h and mortality. Multivariate logistic regression analysis showed that preoperative severe bilateral carotid stenosis (OR=6.378, 95%CI: 2.278-20.987) and preoperative left ventricular ejection fraction ≤ 35% (OR=2.737, 95%CI: 1.267-6.389), postoperative acute myocardial infarction (OR=3.644, 95%CI: 1.928-6.876), postoperative atrial fibrillation (OR=3.104, 95%CI:1.135∼8.016) and postoperative hypotension (OR=4.173, 95%CI: 1.836∼9.701) were independent risk factors for early acute cerebrovascular accidents in patients with a history of stroke following OPCAB procedures, while intraoperative application of Enclose® II proximal anastomotic device was protective factor (OR=0.556, 95%CI: 0.337-0.925). CONCLUSIONS This study indicated that patients with severe bilateral carotid stenosis, the left ventricular ejection fraction ≤35%, the postoperative acute myocardial infarction, postoperative atrial fibrillation and postoperative hypotension were more likely to suffer from early acute cerebrovascular accidents when they received OPCAB. Application of Enclose® II proximal anastomotic device may decrease the incidence of early acute cerebrovascular accidents during OPCAB.
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Athappan G, Chacko P, Patvardhan E, Gajulapalli RD, Tuzcu EM, Kapadia SR. Late stroke: comparison of percutaneous coronary intervention versus coronary artery bypass grafting in patients with multivessel disease and unprotected left main disease: a meta-analysis and review of literature. Stroke 2013; 45:185-93. [PMID: 24281230 DOI: 10.1161/strokeaha.113.003323] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Studies have suggested that the early excess risk of stroke in coronary artery bypass grafting (CABG) may be compensated for by a slow but progressive catch-up phenomenon in patients undergoing percutaneous coronary intervention (PCI). We therefore undertook this analysis to compare the temporal stroke risk between PCI and CABG in patients with unprotected left main stenosis and multivessel coronary artery disease. METHODS Studies of PCI versus CABG for unprotected left main stenosis and multivessel disease published between January 1994 (stent era) and July 2013 were identified using an electronic search and reviewed using meta-analytic techniques. RESULTS We selected 57 reports for the meta-analysis by applying the inclusion and exclusion criteria. The analysis was performed on 80,314 patient records. There was a significantly lower risk of cumulative stroke in patients undergoing PCI with stenting at 1 year (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.42-0.71), 2 years (OR, 0.78; 95% CI, 0.66-0.92), 3 years (OR, 0.79; 95% CI, 0.67-0.92), 4 years (OR, 0.74; 95% CI, 0.56-0.97), and 5 years (OR, 0.79; 95% CI, 0.69-0.91). There was no significant difference in the incidence of stroke because of the small sample size (OR, 0.71; 95% CI, 0.46-1.08) at >5 years between PCI and CABG. Similar results were observed on subgroup analysis (multi-vessel coronary artery disease, unprotected left main, diabetics, and randomized trials) and for stroke within 30 days. Late stroke (stroke>30 days) was similar between the 2 groups. CONCLUSIONS There is a significantly lower risk of stroke within 30 days and cumulative stroke with PCI as compared with CABG up to year 5. There is no late catch up of stroke in the PCI arm. The risk of stroke should be weighed in deciding between revascularization strategies.
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Affiliation(s)
- Ganesh Athappan
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Case Western Reserve University, MetroHealth Campus, Cleveland, OH (G.A., P.C.); Department of Cardiovascular Medicine, Tufts School of Medicine, Boston, MA (E.P.); and Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (R.D.G., E.M.T., S.R.K.)
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Biancari F, Asim Mahar MA, Kangasniemi OP. CHADS2 and CHA2DS2-VASc Scores for Prediction of Immediate and Late Stroke after Coronary Artery Bypass Graft Surgery. J Stroke Cerebrovasc Dis 2013; 22:1304-11. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/31/2012] [Accepted: 11/05/2012] [Indexed: 01/29/2023] Open
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Cerebrovascular atherosclerosis and stroke in patients after coronary artery bypass graft surgery. J Am Coll Cardiol 2011; 58:2545-6; author reply 2546. [PMID: 22133858 DOI: 10.1016/j.jacc.2011.06.070] [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: 05/31/2011] [Accepted: 06/07/2011] [Indexed: 11/21/2022]
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Dafer RM. Risk Estimates of Stroke After Coronary Artery Bypass Graft and Carotid Endarterectomy. Neurol Clin 2006; 24:795-806, xi. [PMID: 16935204 DOI: 10.1016/j.ncl.2006.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neurologic complications of cardiovascular surgeries are well documented in the literature. Neurologic deficits may be mild and reversible or may be associated with permanent neurologic deficit. The incidence and severity of such complications vary according to the type of surgical procedure and usually correlate with patients' preoperative general medical condition, duration of surgeries, and intraoperative complications.
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Affiliation(s)
- Rima M Dafer
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA.
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Affiliation(s)
- Prem S Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
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