1
|
Lazar HL. Commentary: Developing accurate tools for predicting outcomes following coronary artery bypass graft surgery: More data are needed. J Thorac Cardiovasc Surg 2023; 166:801-804. [PMID: 34998591 DOI: 10.1016/j.jtcvs.2021.12.022] [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: 12/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Mass.
| |
Collapse
|
2
|
Hardiman SC, Villan Villan YF, Conway JM, Sheehan KJ, Sobolev B. Factors affecting mortality after coronary bypass surgery: a scoping review. J Cardiothorac Surg 2022; 17:45. [PMID: 35313895 PMCID: PMC8935749 DOI: 10.1186/s13019-022-01784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Previous research reports numerous factors of post-operative mortality in patients undergoing isolated coronary artery bypass graft surgery. However, this evidence has not been mapped to the conceptual framework of care improvement. Without such mapping, interventions designed to improve care quality remain unfounded. Methods We identified reported factors of in-hospital mortality post isolated coronary artery bypass graft surgery in adults over the age of 19, published in English between January 1, 2000 and December 31, 2019, indexed in PubMed, CINAHL, and EMBASE. We grouped factors and their underlying mechanism for association with in-hospital mortality according to the augmented Donabedian framework for quality of care. Results We selected 52 factors reported in 83 articles and mapped them by case-mix, structure, process, and intermediary outcomes. The most reported factors were related to case-mix (characteristics of patients, their disease, and their preoperative health status) (37 articles, 27 factors). Factors related to care processes (27 articles, 12 factors) and structures (11 articles, 6 factors) were reported less frequently; most proposed mechanisms for their mortality effects. Conclusions Few papers reported on factors of in-hospital mortality related to structures and processes of care, where intervention for care quality improvement is possible. Therefore, there is limited evidence to support quality improvement efforts that will reduce variation in mortality after coronary artery bypass graft surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01784-z.
Collapse
|
3
|
Thielmann M, Wendt D, Slottosch I, Welp H, Schiller W, Tsagakis K, Schmack B, Weymann A, Martens S, Neuhäuser M, Wahlers T, Choi YH, Ruhparwar A, Liakopoulos OJ. Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North-Rhine Westphalia Surgical Myocardial Infarction Registry. J Am Heart Assoc 2021; 10:e021182. [PMID: 34514809 PMCID: PMC8649544 DOI: 10.1161/jaha.121.021182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coronary artery bypass grafting has remained an important treatment option for acute coronary syndromes, particularly in patients (1) with ongoing ischemia and large areas of jeopardized myocardium, if percutaneous coronary intervention (PCI) cannot be performed; (2) following successful PCI of the culprit lesion with further indication for coronary artery bypass grafting; and (3) where PCI is incomplete, not sufficient, or failed. Methods and Results We aimed to analyze coronary artery bypass grafting outcome following prior PCI in acute coronary syndromes from the North-Rhine-Westphalia surgical myocardial infarction registry comprising 2616 patients. Primary end points were in-hospital all-cause mortality and major adverse cardio-cerebral event. Patients were 68±11 years of age, had 3-vessel and left main-stem disease in 80.4% and 45.3%, presenting a logistic EuroSCORE of 15.1% in unstable angina, 20.3% in non-ST-segment-elevation myocardial infarction, and 23.5% in ST-segment-elevation myocardial infarction. A history of PCI was present in 36.2% and PCI was performed within 24 hours before surgery in 5.2% in unstable angina, 5.9% in non-ST-segment-elevation myocardial infarction, and 16.1% in ST-segment-elevation myocardial infarction. PCI failed in 5.3% in unstable angina, 6.8% in non-ST-segment-elevation myocardial infarction and 17.2% in ST-segment-elevation myocardial infarction, and 28.8% of patients presented with cardiogenic shock. In-hospital mortality without PCI was 7.4%, but increased to 8.7% with prior PCI >24 hours, 14.5% with prior PCI <24 hours, and 14.1% with failed PCI (P<0.003). The in-hospital major adverse cardio-cerebral event rate was 16.4% without PCI, but 17.4% with prior PCI >24 hours, 25.6% with prior PCI <24 hours, and 41.3% with failed PCI (P=0.014). Multivariable logistic regression analysis showed prior PCI (P=0.039), as well as failed PCI (P=0.001) to be predictors for in-hospital all-cause mortality and major adverse cardio-cerebral event. Conclusions In the current PCI era, immediately prior or failed PCI before coronary artery bypass grafting in acute coronary syndromes is associated with high perioperative risk, cardiogenic shock, and increased morbidity and mortality.
Collapse
Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany
| | - Henryk Welp
- Department of Cardiac Surgery University Hospital Münster Münster Germany
| | | | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Sven Martens
- Department of Cardiac Surgery University Hospital Münster Münster Germany
| | - Markus Neuhäuser
- Department of Mathematics and Technique Koblenz University of Applied Science Remagen Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany.,Department of Cardiac Surgery Campus Kerckhoff University of Giessen Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Oliver-J Liakopoulos
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany.,Department of Cardiac Surgery Campus Kerckhoff University of Giessen Germany
| |
Collapse
|
4
|
Wang J, Wang X, Yu W, Zhang K, Wei Y. Obstructive sleep apnea-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients. J Thorac Dis 2020; 12:5603-5616. [PMID: 33209393 PMCID: PMC7656408 DOI: 10.21037/jtd-20-2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG). Methods Electronic literature databases were searched manually and automatically for relevant English articles. All of the included articles focused on a comparison of the incidence of postoperative parameters of multi-organ function in CHD patients undergoing elective CABG with and without OSA. Studies were excluded if they met any one of the following criteria: (I) duplicate publication; (II) ongoing or unpublished studies; (III) only published as abstracts or conference proceedings; and (IV) less than 30 patients in the patient cohort. Results A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls [odds risk (OR), 1.97; 95% CI, 1.50 to 2.59, P<0.0001]. In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, P<0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased 243% (OR, 3.43; 95% CI, 1.35 to 8.71; P=0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; P=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P<0.0001). Conclusions OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications.
Collapse
Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.,Center for Cardiac Intensive Care, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xinxin Wang
- Department of General Surgery, Chinese PLA general hospital, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Influence of Prior Coronary Stenting on the Immediate and Mid-term Outcome of Isolated Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 2:217-25. [DOI: 10.1097/imi.0b013e31815bdbc1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background There has been little emphasis on the possible consequences of prior stent placement on the outcome of coronary bypass surgery (CABG). We compared the results of isolated CABG patients who had prior stents with those who had not with respect to preoperative status, operative procedure, and postoperative immediate and long-term outcome. Methods Records of 1471 patients undergoing isolated CABG at our institution between January 1, 2000, and March 31, 2005, were reviewed. Patients were divided into three groups. Group I had no stents (n = 1317). Group II had one to three stents (n = 137). Group III had more than three stents (n = 17). Groups were compared with respect to preoperative risk factors, operative procedures, and postoperative results. Long-term survival data were obtained on 97.6% of patients with a mean follow-up, 4.1 ± 2.3 years. Results Stented patients were younger (66.1 ± 10.8 vs. 69.1 ± 10.8 years, P = 0.006), had more unstable angina (68.2% vs. 58.9%, P = 0.02), hypercholesterolemia (83.8% vs. 61.2%, P = 0.00), chronic obstructive pulmonary disease (13.6% vs. 8.4%, P = 0.03), peripheral vascular disease (15.2% vs. 8.4%, P = 0.00), and previous CABG (10.1% vs. 4.2%, P = 0.00), fewer low ejection fractions (1.3% vs. 5.2%, P = 0.02), left main disease (25.3% vs. 32.6%, P = 0.04), diabetes (31.2% vs. 40.8%, P = 0.01), or diffuse disease (19.5 ± 10.5 vs. 22.5 ± 10.9, P = 0.00), had more off pump procedures (53.2% vs. 45.3%, P = 0.03), fewer internal thoracic artery grafts (80.5% vs. 86.6%, P = 0.03), fewer grafts placed (>3: 52.6% vs. 61.8%, P = 0.02), more complications (76.5% vs. 42.6%, P = 0.005), atrial fibrillation (47.1% vs. 19.7%, P = 0.011), longer hospital stays (12.2 vs. 8.3 days, P = 0.019). Percentage survival for groups I, II, and III at 60 months was 82.1%, 84.7%, and 72.6%, respectively. Conclusions Stents placed before surgery in isolated CABG patients may be associated with higher preoperative risk, altered operative procedures, more postoperative complications, longer hospitalizations, and more readmissions. Overall, stented patients experienced more preoperative hospitalizations, catheterizations, and percutaneous coronary interventions (PCIs) than nonstented patients. Survival for those with more than three stents may be diminished.
Collapse
|
6
|
Farsky PS, Hirata MH, Arnoni RT, Almeida AFS, Issa M, Lima PHO, Higuchi MDL, Lin-Wang HT. Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent. Arq Bras Cardiol 2018; 111:134-141. [PMID: 30020327 PMCID: PMC6122910 DOI: 10.5935/abc.20180119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 02/23/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Studies have pointed out a higher mortality after coronary artery bypass surgery (CABG) in patients with stent. OBJECTIVE To evaluate inflammatory markers in peripheral blood cells and in coronary artery tissue samples obtained during CABG in patients with stent compared to controls. METHODS The case series consisted of two groups, one with previous stent implantation (n = 41) and one control (n = 26). The expression of the LIGHT, IL-6, ICAM, VCAM, CD40, NFKB, TNF, IFNG genes was analyzed in peripheral blood cells collected preoperatively. The coronary artery was evaluated for: interleukin-6, ICAM, VCAM, CD40, NFKB, TNF-alpha and IFN-gamma by immunohistochemistry. A total of 176 tissue samples were grouped for analysis in: A1- arteries with stent (n = 38); A2- native arteries from patients with stent in another artery (n = 68); and A3- arteries without stent from controls undergoing routinely CABG surgery (n = 70). A significance level of 0.05 was adopted. RESULTS Patients with stent showed higher TNF (p = 0.03) and lower CD40 gene expression (p = 0.01) in peripheral blood cells than controls without stent. In coronary artery samples, the TNF-alpha protein staining was higher in the group A1, not only in the intima-media layer (5.16 ± 5.05 vs 1.90 ± 2.27; p = 0.02), but also in the adipose tissue (6.69 ± 3.87 vs 2.27 ± 4.00; p < 0.001). Furthermore, group A1 had a higher interleukin-6 protein staining in adipose tissue than group A3 (p = 0.04). CONCLUSION We observed a persistently higher systemic TNF expression associated with exacerbated TNF-alpha and interleukin-6 local production in patients with stents. This finding may contribute to a worse clinical outcome.
Collapse
Affiliation(s)
| | - Mario H Hirata
- Laboratório de Investigação Molecular em Cardiologia, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
| | | | | | - Mario Issa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
| | | | - Maria de Lourdes Higuchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Hui T Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
| |
Collapse
|
7
|
Multiple coronary stenting negatively affects myocardial recovery after coronary bypass grafting. Gen Thorac Cardiovasc Surg 2018; 66:446-455. [DOI: 10.1007/s11748-018-0937-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/06/2018] [Indexed: 11/26/2022]
|
8
|
Neuhäuser M, Thielmann M, Ruxton GD. The number of strata in propensity score stratification for a binary outcome. Arch Med Sci 2018; 14:695-700. [PMID: 29765459 PMCID: PMC5949912 DOI: 10.5114/aoms.2016.61813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Non-interventional and other observational studies have become important in medical research. In such observational, non-randomized studies, groups usually differ in some baseline covariates. Propensity scores are increasingly being used in the statistical analysis of these studies. Stratification, also called subclassification, based on propensity scores is one of the possible methods. There is the quasi-standard of using five strata. In this paper we focus on a binary outcome and evaluate the above-mentioned standard of using five strata. MATERIAL AND METHODS Bias and power for different numbers of strata are investigated with a simulation study. The methods are illustrated using data from a study where patients with diabetes mellitus and triple vessel disease undergoing coronary artery bypass surgery with and without previous percutaneous coronary intervention were compared. RESULTS We show that more than five strata can be more powerful and give less biased results. However, using more than ten strata hardly gives any further benefit. CONCLUSIONS When applying a stratification, more than five strata may be preferable, especially because of increased power. Our simulation study does not show a clear winner; hence a useful strategy could be to work with five as well as with ten strata.
Collapse
Affiliation(s)
- Markus Neuhäuser
- RheinAhrCampus, Koblenz University of Applied Sciences, Remagen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart Centre, University Hospital Essen, Essen, Germany
| | - Graeme D. Ruxton
- School of Biology, University of St. Andrews, St. Andrews, Scotland, UK
| |
Collapse
|
9
|
Mariscalco G, Rosato S, Serraino GF, Maselli D, Dalén M, Airaksinen JK, Reichart D, Zanobini M, Onorati F, De Feo M, Gherli R, Santarpino G, Rubino AS, Gatti G, Nicolini F, Santini F, Perrotti A, Bruno VD, Ruggieri VG, Biancari F, Ahmed A, Masala N, Dominici C, Nardella S, Khodabandeh S, Svenarud P, Gulbins H, Saccocci M, Faggian G, Franzese I, Bancone C, Della Ratta EE, Musumeci F, Gazdag L, Fischlein T, Mignosa C, Pappalardo A, Gherli T, Salsano A, Olivieri G, Bounader K, Verhoye JP, Chocron S, Tauriainen T, Kinnunen EM. Prior Percutaneous Coronary Intervention and Mortality in Patients Undergoing Surgical Myocardial Revascularization. Circ Cardiovasc Interv 2018; 11:e005650. [DOI: 10.1161/circinterventions.117.005650] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Giovanni Mariscalco
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Stefano Rosato
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Giuseppe F. Serraino
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Daniele Maselli
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Magnus Dalén
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Juhani K.E. Airaksinen
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Daniel Reichart
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Marco Zanobini
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Francesco Onorati
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Marisa De Feo
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Riccardo Gherli
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Giuseppe Santarpino
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Antonino S. Rubino
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Giuseppe Gatti
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Francesco Nicolini
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Francesco Santini
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Andrea Perrotti
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Vito D. Bruno
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Vito G. Ruggieri
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Fausto Biancari
- From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and
| | - Aamer Ahmed
- Department of Cardiovascular Surgery and Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Nicola Masala
- Department of Cardiovascular Surgery and Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Carmelo Dominici
- Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
| | - Saverio Nardella
- Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
| | - Sorosh Khodabandeh
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Svenarud
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Matteo Saccocci
- Department of Cardiac Surgery, Fondazione Monzino IRCCS, University of Milan, Italy
| | - Giuseppe Faggian
- Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
| | - Ilaria Franzese
- Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
| | - Ciro Bancone
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Ester E. Della Ratta
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | | | - Laszlo Gazdag
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Carmelo Mignosa
- Centro Clinico Diagnostico G.B. Morgagni, Centro Cuore, Pedara, Italy
| | | | - Tiziano Gherli
- Division of Cardiac Surgery, University of Parma, Parma, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, University of Genoa, Genoa, Italy
| | - Guido Olivieri
- Division of Cardiac Surgery, University of Genoa, Genoa, Italy
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean P. Verhoye
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | | | | |
Collapse
|
10
|
Ueki C, Miyata H, Motomura N, Sakaguchi G, Akimoto T, Takamoto S. Previous Percutaneous Coronary Intervention Does Not Increase Adverse Events After Coronary Artery Bypass Surgery. Ann Thorac Surg 2017; 104:56-61. [DOI: 10.1016/j.athoracsur.2016.10.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/04/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
|
11
|
Nauffal V, Schwann TA, Yammine MB, El-Hage-Sleiman AKM, El Zein MH, Kabour A, Engoren MC, Habib RH. Impact of prior intracoronary stenting on late outcomes of coronary artery bypass surgery in diabetics with triple-vessel disease. J Thorac Cardiovasc Surg 2015; 149:1302-9. [PMID: 25772280 DOI: 10.1016/j.jtcvs.2015.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/07/2015] [Accepted: 01/24/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Recent studies have indicated that coronary artery bypass grafting (CABG) outcomes in patients with prior stents are suboptimal. We aimed to study the impact of prior percutaneous coronary intervention (PCI) with stenting (PCI-S) on late CABG mortality in diabetic patients with triple-vessel disease. METHODS We reviewed the primary nonemergency CABG experience from a single U.S. institution (n = 7005; 1996-2007, Toledo, Ohio). Diabetics with triple-vessel disease (n = 1583) were identified and divided into 2 groups: (1) prior PCI-S (n = 202); and (2) no prior PCI (No-PCI [n = 1381]). Hierarchic Cox proportional hazards models were used to assess the effect of prior PCI-S on 5-year mortality after CABG. A propensity score for PCI-S and No-PCI patients was derived using a nonparsimonious logistic regression and used to generate a 1:1 (PCI-S to No-PCI) matched cohort. RESULTS In model 1, after adjusting for preoperative clinical characteristics, medications, off-pump surgery, and isolated CABG surgery status, prior PCI-S was associated with a 39% increased risk of mortality (hazard ratio [HR] = 1.39, with 95% confidence interval [CI; 1.02, 1.90]; P = .04). Further adjustment for date of surgery (model 2) (HR = 1.39, with 95% CI [1.02, 1.91]; P = .04) or operative parameters (model 3) (HR = 1.38, with 95% CI [1.01, 1.88]; P = .046) did not alter the association. The 1:1 matched-cohort analysis confirmed the increased risk associated with PCI-S (HR = 1.61, with 95% CI [1.03, 2.51]; P = .037). CONCLUSIONS Patients who have both diabetes and triple-vessel disease, and have undergone prior PCI-S, have poorer long-term outcomes after CABG compared with those who have had no prior PCI-S.
Collapse
Affiliation(s)
- Victor Nauffal
- Department of Internal Medicine, Outcomes Research Unit and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon; Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Md
| | - Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Maroun B Yammine
- Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Abdul-Karim M El-Hage-Sleiman
- Department of Internal Medicine, Outcomes Research Unit and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon
| | - Mohamad H El Zein
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Md
| | - Ameer Kabour
- Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Milo C Engoren
- Department of Anesthesia, University of Michigan, Ann Arbor, Mich
| | - Robert H Habib
- Department of Internal Medicine, Outcomes Research Unit and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon.
| |
Collapse
|
12
|
Negargar S, Anvari S, Abbasi K, Enamzadeh E. Immediate Postoperative Complications in Patients Undergoing CABG; Investigating the Role of Prior Coronary Stenting. J Cardiovasc Thorac Res 2014; 6:229-34. [PMID: 25610554 PMCID: PMC4291601 DOI: 10.15171/jcvtr.2014.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/21/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction: Approximately 15 to 30% of patients undergoing percutaneous coronary intervention (PCI) will require repeated revascularization. There is an ongoing debate concerning the impact of prior PCI on subsequent coronary artery bypass graft (CABG) surgery. This study sought to compare immediate post-CABG complications between patients with and without previous coronary stenting.
Methods: A total of 556 CABG candidates including 73 patients with previous coronary stenting and 483 patients without prior stenting were enrolled in this retrospective-prospective study. Demographic information, cardiac markers (CK-MB, Troponin T), and postoperative data including inotrope administration, intra-aortic balloon pump (IABP) use, bleeding, pathological electrocardiography (ECG) changes, and overall complications were compared between the two groups.
Results: The mean age of the patients in stented group was significantly higher than that in unstented group (63.49±7.71 vs. 61.37±9.80 years, p=0.05). The mean serum level of Troponin T 12 h postoperation was significantly higher in the same group (323.26±33.16 vs. 243.30±11.52 ng/dL; p=0.03). Comparing the stented and unstented groups, the rates of inotrope use (17.8% vs. 7.2%; p=0.003), significant bleeding (15.1% vs. 4.3%; p=0.001), and overall complications (32.9% vs. 11.6%; odds ratio: 3.74 with 95% confidence interval of 2.13-6.55, p<0.001) were significantly higher in the former group. The association between overall complications and prior stenting was independent (odd ratio: 3.06). No significant connections were found between postoperative complications and stent number or type.
Conclusion: A positive history of previous coronary stenting significantly increases the risk of immediate post-CABG complications.
Collapse
Affiliation(s)
- Sohrab Negargar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahriar Anvari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kyomars Abbasi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elgar Enamzadeh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
13
|
Dou K, Xu B, Yang Y, Chen J, Qiao S, Wang Y, Li J, Qin X, Yao M, Liu H, Wu Y, Chen J, Yuan J, You S, Gao R. Comparison of procedural and long-term outcomes between transradial and transfemoral approach in one-stage intervention for triple vessel coronary artery disease. J Interv Cardiol 2014; 27:108-16. [PMID: 24588842 DOI: 10.1111/joic.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of the present study was to evaluate the safety, feasibility, procedural, and long-term outcomes by the transradial (TR) approach as compared to transfemoral (TF) approach in patients with triple vessel coronary artery disease undergoing one-stage percutaneous coronary intervention. BACKGROUND The feasibility, safety, and efficacy between the TR and TF approach for coronary interventional treatment have been compared in some complex situations including AMI and unprotected left main disease. However, in terms of triple vessel disease (3VD) intervention, there has been no comparison regarding procedural and long-term outcomes between the TR and TF approach. METHODS A total of 4,974 consecutive patients (TR n = 3,856, TF n = 1,118), who were diagnosed with 3VD without LM disease and underwent one-stage percutaneous revascularization, were enrolled in the study. Procedural results and clinical outcomes were obtained through database and follow-up. We used the propensity score matching method and obtained 930 pairs of patients with comparable baseline data in order to compare the procedural and long-term outcome between TR and TF groups. In the study cohort, risk reduction of all the clinical outcomes were evaluated with Cox's proportional-hazards models. Cumulative incidences concerning safety and efficacy of the cohort were estimated by the Kaplan-Meier method and a comparison was made utilizing the log-rank test. RESULTS After propensity score matching, the baseline clinical and angiographic characteristics were similar between the 2 groups. Regarding procedural results, no significant differences were observed between the 2 groups, with the exception of a decreased hospital stay (TR 7.49 ± 4.46 days vs. TF 8.63 ± 6.23 days, P < 0.0001) and fewer bleedings (TR 1.0% vs. TF 2.9, P = 0.003) in the TRI group. After an average 21-month follow-up, the all-cause mortality (TR 1.7% vs. TF 4.2%, P = 0.0014; HR 0.44, 0.25-0.79) was significantly lower with TRI patients. Other clinical outcomes were comparable between the 2 groups. CONCLUSIONS As compared to TFI, TRI for 3VD intervention is feasible, safe, and associated with similar procedural success, shorter hospitalization, reduced bleeding, lower incidence of death, and comparable long-term efficacy.
Collapse
Affiliation(s)
- Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Hoffman DM, Tranbaugh RF. Interventions for coronary artery disease (surgery vs angioplasty) in diabetic patients. Endocrinol Metab Clin North Am 2014; 43:59-73. [PMID: 24582092 DOI: 10.1016/j.ecl.2013.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with diabetes develop more widespread and more severe atherosclerotic coronary artery disease than patients without diabetes. Medical management of this coronary disease is inferior to revascularization for more complex or more widespread disease. Revascularization by percutaneous intervention (PCI) for patients with diabetes is associated with high mortality and complication rates. Surgical revascularization by coronary artery bypass grafting, yields superior results to PCI for patients with diabetes and coronary artery disease. Patients with diabetes benefit from the same medical management of their coronary artery disease and secondary risk modification as patients without diabetes.
Collapse
Affiliation(s)
- Darryl M Hoffman
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA.
| | - Robert F Tranbaugh
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA
| |
Collapse
|
15
|
Velicki L, Cemerlic-Adjic N, Panic G, Jung R, Redzek A, Nicin S. CABG mortality is not influenced by prior PCI in low risk patients. J Card Surg 2013; 28:353-8. [PMID: 23734606 DOI: 10.1111/jocs.12141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS An increasing number of patients referred for coronary artery bypass grafting (CABG) have had prior percutaneous coronary intervention (PCI). We sought to determine whether a relationship exists between increased postoperative mortality and morbidity following CABG procedure in patients with prior PCI. METHODS Over an 18-month period, 950 patients having first-time isolated CABG were divided into two groups based on absence (Group A, 819 patients--86.21%) or presence of a prior PCI (Group B, 131 patients--13.79%). RESULTS In the prior PCI population, 74 patients (56.4%) had only one stent, and only 6.8% had multiple admissions for PCI. The overall incidence of three vessel disease in the entire patient population was only 65% and the average ejection fraction was 52%. Multivariate analysis demonstrated age (OR 1.080; 95% CI: 1.020 to 1.145; p = 0.009), left ventricular ejection fraction (OR 0.939; 95% CI: 0.901 to 0.978; p = 0.002), and emergency surgery (OR 0.138; 95% CI: 0.0.045 to 0.424; p = 0.001) as risk factors for 30-day mortality, while age (OR 1.059; 95% CI: 1.016 to 1.104; p = 0.007) and emergency surgery (OR 0.205; 95% CI: 0.078 to 0.537; p = 0.001) predicted major adverse cardiac events (MACE). Prior PCI did not influence mortality or MACE at 30 days. CONCLUSION In this study involving low risk patients, a PCI prior to CABG did not increase morbidity or mortality.
Collapse
Affiliation(s)
- Lazar Velicki
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
| | | | | | | | | | | |
Collapse
|
16
|
Ghodbane W, Ragmoun W, Arbi R, Brahem W, Sahraoui C, Lejmi M, Taamallah K, Massoudi H, Lebbi A, Ziadi M, Lahdhili H, Bey M, Chenik S. [Correlation between previous coronary artery stenting and early mortality in patients undergoing coronary artery bypass graft surgery]. Ann Cardiol Angeiol (Paris) 2013; 62:429-34. [PMID: 23582999 DOI: 10.1016/j.ancard.2013.02.006] [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: 08/18/2012] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND In this study, we examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome in patients undergoing coronary artery bypass graft surgery (CABG). METHODS Outcomes of 240 CABG patients, collected consecutively in an observational study, were compared. Gp A (n=35) had prior PCI before CABG and Gp B (n=205) underwent primary CABG. RESULTS Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 48.6% vs 36.6% (P=0.003), distribution of CAD (P=0.0001), unstable angina: 45.7% vs 39% (P=0.04). For intraoperative data, the total number of established bypasses was 2.6 (GpA) vs 2.07 (Gp B) (P=0.017), with the number of arterial bypass grafts being: 20% vs 13% (P=ns). Regarding the postoperative course, no significant difference in troponine I rate, 24-hour bleeding: 962 ml (Gp A) vs 798 ml (Gp B) (P=0.004), transfusion (PRBC unit): 3.63 (Gp A) vs 2.5 (Gp B) (P=0.006). Previous PCI emerged as an independent predictor of postoperative in-hospital mortality (OR 2.24, 95% CI [1.52-2.75], P<0.01). CONCLUSION Patients with prior PCI presented for CABG with more severe CAD. Thirty-day mortality and morbidity were significantly higher in patients with prior PCI.
Collapse
Affiliation(s)
- W Ghodbane
- Service de chirurgie cardiothoracique, hôpital militaire de Tunis, 1008 Mont-Fleury, Tunis, Tunisie.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Drug-Eluting Stents Compared With Bilateral Internal Thoracic Artery Grafts for Diabetic Patients. Ann Thorac Surg 2012; 94:1455-62. [DOI: 10.1016/j.athoracsur.2012.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 12/22/2022]
|
19
|
Edelman JJB, Wilson MK, Bannon PG, Vallely MP. Cardiac surgery versus stenting: what is better for the patient? ANZ J Surg 2012; 82:792-8. [DOI: 10.1111/j.1445-2197.2012.06262.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/30/2022]
|
20
|
Carnero-Alcázar M, Alswies A, Villagrán Medinilla E, Maroto LC, Silva Guisasola JA, Cobiella Carnicer J, Tejerina Sánchez MT, Rodríguez Hernández JE. Mid-term outcomes after off-pump coronary surgery in patients with prior intracoronary stent. Eur J Cardiothorac Surg 2012; 41:1295-303. [PMID: 22219477 DOI: 10.1093/ejcts/ezr210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE An increasing number of patients undergoing heart surgery have had a prior coronary stent placement. This study was designed to examine the effect of this situation on the mid-term outcomes of off-pump coronary artery bypass graft (OP-CABG) surgery. METHODS A comparative retrospective non-randomized comparison was performed as follows: all patients undergoing OP-CABG from January 2005 to December 2009 at our centre were divided into two groups: those who did or did not have stents at the time of surgery. We compared the incidences of the following events: (i) death and (ii) combined major adverse cardiac events (MACEs): death, myocardial infarction (MI) and repeat revascularization. Cox's proportional hazards analysis adjusted by a propensity score (n:m) were performed to determine the effects of prior stent placement on the risks of such events. RESULTS A total of 1020 patients were included, of which 156 (15.6%) had at least one stent. The median follow-up was 32.32 months (interquartile rank 18.08-48). The overall 1, 3 and 5-year survival rates were 95, 92 and 91% for the without-stent group vs. 82, 77 and 74% for the with-stent group, respectively. The 1, 3 and 5-year survival rates free from MACEs were: 92, 87 and 76% for patients without stent vs. 77, 66 and 56% for those with stents. Patients with stent showed an increased risk of death [hazard ratio (HR) 3.631, 95% confidence interval (CI) 2.29-5.756] and MACEs (HR 2.784, 95% CI 1.962-3.951). When adjusted by the propensity score, prior stent placement continued to increase the risks of death (HR 3.795, 95% CI 2.319-6.21) and MACEs (HR 2.89, 95% CI 2.008-4.158). CONCLUSIONS Patients with intracoronary stents have a lower survival rate and a greater risk of death, MI or need for repeat revascularization during the mid-term follow-up after OP-CABG.
Collapse
|
21
|
Sakaguchi G, Shimamoto T, Komiya T. Impact of repeated percutaneous coronary intervention on long-term survival after subsequent coronary artery bypass surgery. J Cardiothorac Surg 2011; 6:107. [PMID: 21906320 PMCID: PMC3184044 DOI: 10.1186/1749-8090-6-107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/10/2011] [Indexed: 11/12/2022] Open
Abstract
(Background) In the current stent era, aggressive repeated percutaneous coronary intervention (PCI) has become more common. The aim of this study was to investigate the impact of previous repeated PCI on the subsequent coronary artery bypass grafting (CABG). (Methods) Between January 1990 and January 2008, a total of 894 patients underwent first-time isolated elective CABG. Among the 894 patients, 515 patients had had no PCI (group A), 179 patients had had single PCI (Group B), and 200 patients had had multiple PCI (2-15 times, mean 3.6 ± 2.3 times) (group C) before CABG. These groups were compared in terms of early and late clinical results. (Results) Preoperative left ventricular ejection fraction was significantly higher in group A (group A;58 ± 13%, group B;54 ± 12%, and group C;54 ± 12%). Number of bypass grafts was significantly smaller in group C (A:3.3 ± 1.0, B 3.4 ± 0.9, C 3.1 ± 1.0). Although there was no statistically significant difference among the groups, in-hospital mortality in group C was higher than that in group A and B (A:1.6%, B:1.1%, C:3.5%, p = 0.16). Survival analysis by Kaplan-Meier method (mean follow-up: 58 ± 43 methods) revealed that freedom from all-cause death and cardiac death was significantly lower in group C in comparison with group A. Freedom from cardiac event was significantly higher in group C than that in group A. Multivariate analysis identified a number of previous PCI as an independent risk factor for cardiac death. (Conclusions) Repeated PCI increased risk for long-term prognosis of subsequent CABG.
Collapse
Affiliation(s)
- Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Japan.
| | | | | |
Collapse
|
22
|
Boening A, Niemann B, Wiedemann A, Roth P, Bödeker RH, Scheibelhut C, Schönburg M. Coronary stenting before coronary artery bypass graft surgery in diabetic patients does not increase the perioperative risk of surgery. J Thorac Cardiovasc Surg 2011; 142:e53-7. [PMID: 21763871 DOI: 10.1016/j.jtcvs.2011.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/09/2010] [Accepted: 04/15/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A negative relationship between coronary stenting before coronary artery bypass graft (CABG) surgery and the perioperative mortality and morbidity has been shown in diabetic patients. We tried to assess this relationship in a 2-institution database. METHODS In the years 2005 and 2006, 1125 of 3311 patients undergoing CABG surgery had diabetes mellitus (33.9%), and 185 (16.4%) of the diabetic patients had at least 1 previous stent. There was no evidence of any clinically significant difference in the preoperative and intraoperative parameters between diabetics with or without previous stents. RESULTS Thirty-day mortality (no-stent group, 3.86%; stent group, 1.62%) and postoperative major adverse cardiovascular and cerebrovascular events (MACCEs; mortality, stroke, myocardial infarction, renal failure) (no-stent group, 12.2%; stent group, 5.9%) occurred more often in diabetic patients without coronary stents. Logistic regression for 30-day mortality using possible confounders including preoperative stent showed a significant positive effect of preoperative coronary stenting (OR, 0.157; 95% CI limits, 0.033-0.737). Taking percutaneous coronary intervention out of the calculation model, this positive effect was no longer significant (OR, 0.344; CI, 0.091-1.298). Logistic regression for perioperative MACCE, with as well as without percutaneous coronary intervention as a confounder, also showed a significant positive effect of preoperative coronary stenting (OR, 0.231; 95% CI, 0.091-0.590). CONCLUSIONS Coronary stenting before CAGB in diabetic patients does not predispose to a higher perioperative risk regarding mortality and morbidity after CABG surgery.
Collapse
Affiliation(s)
- Andreas Boening
- Department of Cardiovascular Surgery, University of Giessen, Germany.
| | | | | | | | | | | | | |
Collapse
|
23
|
Cikirikcioglu M, Cherian S, Schussler O, Kalangos A. Regarding "The EVEREST II Trial: design and rationale for a randomized study of the Evalve MitraClip system compared with mitral valve surgery for mitral regurgitation". Am Heart J 2011; 162:e11-2; author reply e13. [PMID: 21742074 DOI: 10.1016/j.ahj.2011.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
24
|
Bonaros N, Vill D, Wiedemann D, Fischler K, Friedrich G, Pachinger O, Grimm M, Schachner T. Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in patients with previous percutaneous intervention. Eur J Cardiothorac Surg 2011; 39:e164-9. [DOI: 10.1016/j.ejcts.2011.01.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 01/19/2011] [Accepted: 01/20/2011] [Indexed: 10/18/2022] Open
|
25
|
Stevens LM, Khairy P, Agnihotri AK. Coronary Artery Bypass Grafting After Recent or Remote Percutaneous Coronary Intervention in the Commonwealth of Massachusetts. Circ Cardiovasc Interv 2010; 3:460-7. [DOI: 10.1161/circinterventions.109.901637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In this study, we sought to characterize the outcomes after isolated coronary artery bypass grafting (CABG) in patients with a history of remote (≥14 days), and recent (<14 days), percutaneous coronary intervention (PCI).
Methods and Results—
Patients with PCI within 5 years of CABG were identified among 12 591 primary isolated CABG reported in the mandatory Massachusetts Adult Cardiac Surgery Database. Patients were excluded if they were out-of-state (n=1043, 8%), had undergone primary PCI for acute myocardial infarction (n=401, 3%), had a PCI-CABG interval >5 years or unknown (n=136 and n=673, 1% and 5%). Patients with a history of remote and recent PCI were analyzed separately. Each CABG patient with PCI was matched to 3 patients without PCI using a propensity score. Outcomes were analyzed using generalized estimating equations and stratified proportional hazards models, with a mean follow-up of 4.1±1.2 years. There were 1117 CABG patients (9%) with prior PCI (n
remote
=823; n
recent
=294). In matched CABG patients with remote prior PCI, no differences were found in 30-day mortality (1.1% versus 1.5%;
P
=0.432), hospital morbidity (41% versus 40%;
P
=0.385) and overall survival (hazard ratio, [95% confidence interval] for death for prior PCI, 0.93 [0.74 to 1.18];
P
=0.555). In matched CABG patients with recent prior PCI, hospital morbidity was higher (59% versus 45%;
P
<0.001), but no differences were found in 30-day mortality (3.5% versus 3.1%;
P
=0.754) and overall survival (HR, 1.18 [0.83 to 1.69];
P
=0.353).
Conclusions—
In patients undergoing CABG, remote prior PCI (≥14 days) was not associated with adverse outcomes at 30 days or during long-term follow-up.
Collapse
Affiliation(s)
- Louis-Mathieu Stevens
- From the Division of Cardiac Surgery (L.-M.S.), Centre Hospitalier Universitaire de Montréal, Montreal, Quebec, Canada; the Division of Cardiac Surgery (L.-M.S., A.K.A.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiology (P.K.), Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- From the Division of Cardiac Surgery (L.-M.S.), Centre Hospitalier Universitaire de Montréal, Montreal, Quebec, Canada; the Division of Cardiac Surgery (L.-M.S., A.K.A.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiology (P.K.), Montreal Heart Institute, Montreal, Quebec, Canada
| | - Arvind K. Agnihotri
- From the Division of Cardiac Surgery (L.-M.S.), Centre Hospitalier Universitaire de Montréal, Montreal, Quebec, Canada; the Division of Cardiac Surgery (L.-M.S., A.K.A.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; and the Division of Cardiology (P.K.), Montreal Heart Institute, Montreal, Quebec, Canada
| |
Collapse
|
26
|
Impact of Previous PCI on Hospital Mortality After Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients With Multivessel Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:334-9. [PMID: 22437231 DOI: 10.1097/imi.0b013e3181c47194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Because percutaneous coronary intervention (PCI) has been performed excessively, many patients initially managed with PCI are being referred for coronary artery bypass grafting (CABG). The purpose of this study was to assess the impact of previous PCI on surgical mortality after off-pump CABG in diabetic patients with multivessel disease. METHODS : Between January 2002 and April 2008, 595 consecutive patients (99.8% off-pump) had isolated CABG by one single surgeon. Of these, 274 patients with diabetes mellitus and multivessel disease were retrospectively analyzed. Patients with previous PCI (n = 79) were compared with patients with no previous PCI (n = 196), and risk-adjusted impact of previous PCI on surgical mortality after CABG was determined using multivariate and propensity score analyses. RESULTS : All patients underwent off-pump CABG without conversion to cardiopulmonary bypass during operation. Patients with previous PCI had a significantly higher prevalence of history of myocardial infarction, renal dysfunction, and hemodialysis. Rates of surgical mortality were higher in patients with previous PCI (7.6% versus 1.0%, P = 0.008). After multivariate logistic regression analysis including all potential univariate predictors, previous PCI remained a strong predictor of surgical mortality [odds ratio (OR), 6.9; 95% confidence interval (CI), 1.2 to 42.1; P = 0.035]. After matching and regression adjustment by propensity score, the impact of previous PCI on surgical mortality was similar in direction (matching OR, 6.5; 95% CI, 0.8 to 55.0; P = 0.088; regression adjustment OR, 6.3; 95% CI, 1.2 to 33.6; P = 0.031). CONCLUSIONS : Previous PCI increases the risk of surgical mortality after off-pump CABG in diabetic patients with multivessel disease.
Collapse
|
27
|
Kinoshita T, Asai T, Murakami Y, Takashima N, Hosoba S, Nishimura O, Ikegami H, Hiramatsu N, Suzuki T, Kambara A, Matsubayashi K. Impact of Previous PCI on Hospital Mortality after Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients with Multivessel Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takeshi Kinoshita
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Tohru Asai
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Yoshitaka Murakami
- Departments of Health Statistics, Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Noriyuki Takashima
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Soh Hosoba
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Osamu Nishimura
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Hirohisa Ikegami
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Norihiko Hiramatsu
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Tomoaki Suzuki
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Atsushi Kambara
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| | - Keiji Matsubayashi
- Departments of Cardiovascular Surgery and Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan
| |
Collapse
|
28
|
Mack M. Does percutaneous coronary intervention compromise the outcome of subsequent coronary artery bypass grafting? JACC Cardiovasc Interv 2009; 2:765-6. [PMID: 19695545 DOI: 10.1016/j.jcin.2009.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 06/22/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
|
29
|
Yap CH, Yan BP, Akowuah E, Dinh DT, Smith JA, Shardey GC, Tatoulis J, Skillington PD, Newcomb A, Mohajeri M, Pick A, Seevanayagam S, Reid CM. Does Prior Percutaneous Coronary Intervention Adversely Affect Early and Mid-Term Survival After Coronary Artery Surgery? JACC Cardiovasc Interv 2009; 2:758-64. [DOI: 10.1016/j.jcin.2009.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/19/2009] [Indexed: 10/20/2022]
|
30
|
Lazar HL. Detrimental effects of coronary stenting on subsequent coronary artery bypass surgery: Is there another flag on the field? J Thorac Cardiovasc Surg 2009; 138:276-7. [DOI: 10.1016/j.jtcvs.2009.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 04/11/2009] [Indexed: 10/20/2022]
|
31
|
The effect of previous coronary artery stenting on short- and intermediate-term outcome after surgical revascularization in patients with diabetes mellitus. J Thorac Cardiovasc Surg 2009; 138:316-23. [PMID: 19619774 DOI: 10.1016/j.jtcvs.2009.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 02/20/2009] [Accepted: 03/08/2009] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Percutaneous intervention for coronary revascularization is associated with an increased risk of repeat revascularization, especially in patients with diabetes mellitus. In this study we sought to examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome and intermediate-term survival in patients undergoing coronary artery bypass surgery. METHODS Between January 1, 2001, and December 31, 2006, 1758 consecutive patients with diabetes mellitus who underwent first-time isolated coronary artery bypass surgery were identified. Survival and major perioperative complications for 1537 patients who did not have prior percutaneous intervention (group 1) were compared with those in 221 patients with prior percutaneous intervention (group 2) after adjusting for baseline risk factors. Vital status was determined by using the National Death Index and Social Security Death Index. Age-adjusted survival at 2 years' follow-up was calculated with the Cox singular proportional hazards model. RESULTS At baseline, group 2 patients had higher incidences of hypercholesterolemia and myocardial infarction. Compared with group 1 patient, group 2 patients had significantly higher operative mortality (adjusted odds ratio, 4.05; 95% confidence interval, 1.41-11.63), perioperative major adverse cardiac events (adjusted odds ratio, 2.72; 95% confidence interval, 1.08-6.85), and atrial fibrillation (adjusted odds ratio, 1.97; 95% confidence interval, 1.29-3.01). Group 2 patients had worse age-adjusted survival at 2 years' follow-up (93.4% vs 87.4%, P < .017). CONCLUSIONS Patients with diabetes mellitus and a history of percutaneous coronary stenting before coronary artery bypass surgery were found to have an increased risk of operative death, increased perioperative complications, and decreased age-adjusted survival at 2 years' follow-up.
Collapse
|
32
|
Carnero Alcázar M, Alswies A, Silva Guisasola JA, Reguillo Lacruz LF, Maroto Castellanos LC, Villagrán Medinilla E, O'Connor Vallejo LF, Cobiella Carnicer J, González Rocafort A, Alegría Landa VD, Castañón Cristóbal JL, Gil Aguado M, Rodríguez Hernández JE. Clinical outcomes with off-pump coronary surgery after angioplasty with stent. Rev Esp Cardiol 2009; 62:520-7. [PMID: 19406066 DOI: 10.1016/s1885-5857(09)71834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim was to determine whether prior coronary stent implantation affects postoperative outcomes in patients undergoing coronary artery bypass grafting. METHODS Between January 2005 and April 2008, a retrospective analysis was carried out to evaluate the effect of prior coronary stent implantation in patients undergoing off-pump coronary surgery on the incidence of major cardiovascular events in the postoperative period (i.e. at 30 days or during postoperative hospitalization). RESULTS In total, 796 consecutive patients underwent coronary artery bypass grafting. Of these, 116 (14.6%) had a coronary stent at the time of surgery. Patients with and without stents had similar levels of risk (i.e. EuroSCORE). Multivariate analysis, adjusted for the presence of confounding variables (i.e. preoperative left ventricular ejection fraction <40%, critical preoperative state, age, history of cerebrovascular accident, recent acute myocardial infarction, number of diseased coronary vessels, incomplete revascularization and on-pump conversion), showed that the presence of a stent was significantly associated with increased risks of postoperative myocardial infarction (relative risk [RR]=3.13; 95% confidence interval [CI], 1.75-5.96), in-hospital cardiac mortality (RR=4.62; 95% CI, 1.76-12.11) and in-hospital all-cause mortality (RR=3.65; 95% CI, 1.60-8.34). CONCLUSIONS In our experience, coronary artery stent implantation prior to coronary surgery was associated with increased risks of postoperative myocardial infarction, cardiac mortality and all-cause mortality in the postoperative period.
Collapse
|
33
|
Resultados de la cirugía coronaria sin circulación extracopórea tras angioplastia con stent. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71032-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
34
|
Massoudy P, Thielmann M, Lehmann N, Marr A, Kleikamp G, Maleszka A, Zittermann A, Körfer R, Radu M, Krian A, Litmathe J, Gams E, Sezer Ö, Scheld H, Schiller W, Welz A, Dohmen G, Autschbach R, Slottosch I, Wahlers T, Neuhäuser M, Jöckel KH, Jakob H. Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: A multicenter analysis. J Thorac Cardiovasc Surg 2009; 137:840-5. [DOI: 10.1016/j.jtcvs.2008.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/20/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
|
35
|
Bonaros N, Hennerbichler D, Friedrich G, Kocher A, Pachinger O, Laufer G, Bonatti J. Increased mortality and perioperative complications in patients with previous elective percutaneous coronary interventions undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg 2009; 137:846-52. [DOI: 10.1016/j.jtcvs.2008.09.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 07/20/2008] [Accepted: 09/16/2008] [Indexed: 11/28/2022]
|
36
|
Rao C, Athanasiou T, Chikwe J. Reply. Ann Thorac Surg 2008. [DOI: 10.1016/j.athoracsur.2008.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
37
|
Bhindi R, Van Gaal W, Testa L. Perspectives on patients with diabetes mellitus and triple-vessel disease undergoing coronary artery bypass grafting after previous percutaneous coronary intervention. J Thorac Cardiovasc Surg 2008; 135:1400. [PMID: 18544400 DOI: 10.1016/j.jtcvs.2007.09.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
|
38
|
Rao C, Stanbridge RDL, Chikwe J, Pepper J, Skapinakis P, Aziz O, Darzi A, Athanasiou T. Does Previous Percutaneous Coronary Stenting Compromise the Long-Term Efficacy of Subsequent Coronary Artery Bypass Surgery? A Microsimulation Study. Ann Thorac Surg 2008; 85:501-7. [DOI: 10.1016/j.athoracsur.2007.09.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/16/2007] [Accepted: 09/20/2007] [Indexed: 01/06/2023]
|
39
|
Pliam MB, Zapolanski A, Anastassiou P, Ryan CJ, Manila LL, Shaw RE, Pira BK. Influence of Prior Coronary Stenting on the Immediate and Mid-term Outcome of Isolated Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2007. [DOI: 10.1177/155698450700200501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael B. Pliam
- Department of Cardiovascular Surgery, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California
| | | | - Peter Anastassiou
- Department of Cardiovascular Surgery, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California
| | - Colman J. Ryan
- Department of Cardiovascular Surgery, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California
| | - Louis L. Manila
- Clinical Research and Operations, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California
| | - Richard E. Shaw
- Sutter Pacific Heart Centers, California Pacific Medical Center, San Francisco, California
| | - Bob-Kenneth Pira
- Clinical Database Analysis, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California
| |
Collapse
|