1
|
Zhu Y, Zhang W, Dimagli A, Han L, Cheng Z, Mei J, Chen X, Wang X, Zhou Y, Xue Q, Hu J, Tang M, Wang R, Song Y, Kang L, Redfors B, Gaudino M, Zhao Q. Antiplatelet therapy after coronary artery bypass surgery: five year follow-up of randomised DACAB trial. BMJ 2024; 385:e075707. [PMID: 38862179 PMCID: PMC11165385 DOI: 10.1136/bmj-2023-075707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To assess the effect of different antiplatelet strategies on clinical outcomes after coronary artery bypass grafting. DESIGN Five year follow-up of randomised Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Grafting (DACAB) trial. SETTING Six tertiary hospitals in China; enrolment between July 2014 and November 2015; completion of five year follow-up from August 2019 to June 2021. PARTICIPANTS 500 patients aged 18-80 years (including 91 (18.2%) women) who had elective coronary artery bypass grafting surgery and completed the DACAB trial. INTERVENTIONS Patients were randomised 1:1:1 to ticagrelor 90 mg twice daily plus aspirin 100 mg once daily (dual antiplatelet therapy; n=168), ticagrelor monotherapy 90 mg twice daily (n=166), or aspirin monotherapy 100 mg once daily (n=166) for one year after surgery. After the first year, antiplatelet therapy was prescribed according to standard of care by treating physicians. MAIN OUTCOME MEASURES The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularisation), analysed using the intention-to-treat principle. Time-to-event analysis was used to compare the risk between treatment groups. Multiple post hoc sensitivity analyses examined the robustness of the findings. RESULTS Follow-up at five years for major adverse cardiovascular events was completed for 477 (95.4%) of 500 patients; 148 patients had major adverse cardiovascular events, including 39 in the dual antiplatelet therapy group, 54 in the ticagrelor monotherapy group, and 55 in the aspirin monotherapy group. Risk of major adverse cardiovascular events at five years was significantly lower with dual antiplatelet therapy versus aspirin monotherapy (22.6% v 29.9%; hazard ratio 0.65, 95% confidence interval 0.43 to 0.99; P=0.04) and versus ticagrelor monotherapy (22.6% v 32.9%; 0.66, 0.44 to 1.00; P=0.05). Results were consistent in all sensitivity analyses. CONCLUSIONS Treatment with ticagrelor dual antiplatelet therapy for one year after surgery reduced the risk of major adverse cardiovascular events at five years after coronary artery bypass grafting compared with aspirin monotherapy or ticagrelor monotherapy. TRIAL REGISTRATION NCT03987373ClinicalTrials.gov NCT03987373.
Collapse
Affiliation(s)
- Yunpeng Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Arnaldo Dimagli
- Department of Cardio-thoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Lin Han
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai, 200433, China
| | - Zhaoyun Cheng
- Department of Cardiac Surgery, Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 451464, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xin Chen
- Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yanzai Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qing Xue
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai, 200433, China
| | - Junlong Hu
- Department of Cardiac Surgery, Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 451464, China
| | - Min Tang
- Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Rui Wang
- Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Yuanyuan Song
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Lei Kang
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 41345, Sweden
| | - Mario Gaudino
- Department of Cardio-thoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| |
Collapse
|
2
|
Aboul-Hassan SS, Stankowski T, Perek B, Olasinska-Wisniewska A, Urbanowicz T, Jemielity M, Moskal L, Majchrowicz W, Pompeu Sá M, Awad AK, Torregrossa G, Cichon R. Coronary Artery Bypass Surgery: Comparing the Long-Term Impact of Total Arterial Grafting With Multiarterial Plus Saphenous Vein Grafting. J Surg Res 2023; 290:276-284. [PMID: 37321148 DOI: 10.1016/j.jss.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION This study aimed to compare the long-term outcomes in a propensity matched population receiving total arterial grafting (TAG) and multiple arterial grafts (MAG) in addition to saphenous vein graft (SVG) following multivessel coronary artery bypass grafting requiring at least three distal anastomoses. METHODS In this retrospective study, 655 patients from two centers met the inclusion criteria and were divided into two groups: TAG group (n = 231) and MAG + SVG group (n = 424). Propensity score matching was performed resulting in 231 pairs. RESULTS No significant differences were observed between both groups in terms of early outcomes. Survival probabilities at 5, 10, and 15 y were 89.1% versus 94.2%, 76.2% versus 76.1%, and 66.7% versus 69.8% in the TAG and MAG + SVG groups, respectively (hazard ratio stratified on matched pairs: 0.90; 95% confidence interval [0.45-1.77]; P = 0.754). Freedom from major adverse cardiac and cerebral events (MACCE) in the matched cohort did not show any significant difference between both groups. Probabilities at 5, 10, and 15 y were 82.7% versus 85.6%, 62.2% versus 75.3%, and 48.8% versus 59.5% in the TAG and MAG + SVG groups, respectively (hazard ratio stratified on matched pairs: 1.12; 95% confidence interval [0.65-1.92]; P = 0.679). Subgroup analyses of the matched cohort showed no significant difference between TAR with three arterial conduits compared to TAR with two arterial conduits with sequential grafting and MAG + SVG in terms of long-term survival and freedom from MACCE. CONCLUSIONS Multiple arterial revascularizations in addition to SVG may yield comparable long-term outcomes in terms of survival and freedom from MACCE compared to total arterial revascularization.
Collapse
Affiliation(s)
- Sleiman Sebastian Aboul-Hassan
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland.
| | - Tomasz Stankowski
- Department of Cardiac Surgery, Sana-Heart Center Cottbus, Cottbus, Germany
| | - Bartlomiej Perek
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz Moskal
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland
| | - Weronika Majchrowicz
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Michel Pompeu Sá
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Ahmed K Awad
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Gianluca Torregrossa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Romuald Cichon
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland; Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland
| |
Collapse
|
3
|
Kulik A, Abreu AM, Boronat V, Kouchoukos NT, Ruel M. Ticagrelor versus aspirin 2 years after coronary bypass: Observational analysis from the TARGET trial. J Card Surg 2022; 37:1969-1977. [PMID: 35397138 DOI: 10.1111/jocs.16492] [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: 02/16/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared to conventional aspirin therapy, ticagrelor did not improve vein graft patency 1 year after coronary bypass surgery (CABG) in the ticagrelor antiplatelet therapy to reduce graft events and thrombosis (TARGET) trial. However, it is unknown whether ticagrelor may impact graft patency long-term following surgery. METHODS In the TARGET multicenter trial, 250 CABG patients were randomized to aspirin 81 mg or ticagrelor 90 mg twice daily. In this observational analysis, 2 years after surgery, vein graft occlusion and clinical events were compared among subjects who agreed to a second year of double-blind study drug administration (N = 156). RESULTS Two-year graft assessment was performed for 142 patients (80 aspirin patients, 62 ticagrelor patients, 425 total grafts), with an overall 2-year graft occlusion rate of 10.6%. Vein graft occlusion at 2 years, the primary outcome of this study, did not significantly differ between the two groups (15.7% vs. 13.2%, aspirin vs. ticagrelor, p = .71). The incidence of vein grafts with any disease (stenosis or occlusion) did not significantly differ between the groups (19.4% vs. 19.8%, aspirin vs. ticagrelor, p = 1.00), and the number of patients with vein graft disease did not significantly differ between the groups (30.0% vs. 29.0%, aspirin vs. ticagrelor, p = 1.00). Vein grafts developing new disease did not significantly differ between the two groups (1.5% vs. 3.8%, aspirin vs. ticagrelor, p = .41). Freedom from major adverse cardiovascular events at 2 years was similar between the groups (p = .75). CONCLUSION Compared to conventional aspirin therapy, ticagrelor did not significantly reduce vein graft disease 2 years after CABG.
Collapse
Affiliation(s)
- Alexander Kulik
- Division of Cardiac Surgery, Department of Clinical Research, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA
| | - Amy M Abreu
- Division of Cardiac Surgery, Department of Clinical Research, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA
| | - Viviana Boronat
- Division of Cardiac Surgery, Department of Clinical Research, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA
| | - Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri, USA
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
4
|
Zuo HJ, Nan N, Yang HX, Wang JW, Song XT. Impact of Conventional Cardiovascular Risk Factors on Left Internal Mammary Artery Graft Disease. Front Cardiovasc Med 2022; 8:705765. [PMID: 35096986 PMCID: PMC8795621 DOI: 10.3389/fcvm.2021.705765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background:The development of atherosclerosis was considered as the common cause of the stenosis of coronary artery grafts. Left internal mammary artery (LIMA) was the best artery graft for further effectiveness of coronary artery bypass grafting (CABG). We sought to assess the impact of known conventional cardiovascular risk factors (RFs) on LIMA graft stenosis.Methods:A retrospective study including 618 participants, who had recurrence of chest pain after CABG, aged ≥18 years, hospitalized for coronary angiography in Beijing Anzhen hospital between 2010 and 2017 was performed. All the participants were confirmed to have LIMA graft. Multivariate analysis was conducted to determine the relationship between conventional RFs and LIMA graft stenosis.Results:Of the study, 220 (35.6%) participants continued to smoke, 504 (81.6%) were overweight or obese, and 411 (66.5%) and 242 (39.2%) reported concomitant hypertension and diabetes, respectively. LIMA graft stenosis occurred in 161 participants (26.1%). Postoperative smoking, a CABG duration of ≥10 years and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis, the odds ratio (OR) was 1.86 [95% confidence interval (CI): 1.26–2.78], 2.24 (95%CI:1.33–3.478), and 2.44(95% CI:1.39–4.32), respectively. Statin use (OR, 0.28; 95% CI: 0.25–0.5) and low-density lipoprotein cholesterol (LDL-C) < 1.8 mmol/L (OR, 0.27; 95% CI: 0.14–0.53) had a significantly decreased risk of LIMA graft stenosis. While, only 15.4% (95/618) achieved the target LDL-C level.Conclusions:Postoperative smoking and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis. Statin use and LDL-C <1.8 mmol/L decreased the risk.
Collapse
Affiliation(s)
- Hui-Juan Zuo
- Department of Community Health Research, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
- *Correspondence: Hui-Juan Zuo
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong-Xia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jin-Wen Wang
- Department of Community Health Research, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Xian-Tao Song
| |
Collapse
|
5
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6524992. [DOI: 10.1093/ejcts/ezac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
|
6
|
Kulik A, Abreu AM, Boronat V, Kouchoukos NT, Ruel M. Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial. J Card Surg 2021; 37:563-570. [PMID: 34961950 DOI: 10.1111/jocs.16189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/21/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Antiplatelet therapy prevents saphenous vein graft (SVG) occlusion and improves outcomes after coronary artery bypass graft surgery (CABG). However, the optimal postoperative antiplatelet regimen remains unclear. The goal of the Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET) trial was to assess whether early postoperative ticagrelor reduces SVG occlusion compared to conventional aspirin therapy. METHODS In this multi-center double-blind randomized trial, 250 patients who had CABG with SVG were randomized to receive either aspirin 81 mg twice daily or ticagrelor 90 mg twice daily. The primary outcome was SVG occlusion at 1 year. RESULTS Altogether, 123 patients were randomized to aspirin and 127 received ticagrelor. One-year graft assessment was performed in 202 patients (80.8%), examining 588 grafts, yielding an overall graft occlusion rate of 10.9%. The primary outcome, SVG occlusion at 1 year, did not significantly differ between the two groups (17.4% vs. 13.2%, aspirin vs. ticagrelor, p = .30). The incidence of vein grafts with any disease (stenosis or occlusion) did not significantly differ between the groups (21.5% vs. 22.3%, aspirin vs. ticagrelor, p = .90), and the number of patients with vein graft disease did not significantly differ between the groups (29.4% vs. 28.0%, aspirin vs. ticagrelor, p = .88). Freedom from major adverse cardiovascular events at 1 year was similar between the groups (p = .60). CONCLUSIONS Compared to conventional aspirin therapy, ticagrelor did not significantly reduce vein graft occlusion 1 year after CABG. Further study will assess the impact of ticagrelor on 2-year graft patency for this cohort.
Collapse
Affiliation(s)
- Alexander Kulik
- Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic University, Boca Raton, Florida, USA
| | - Amy M Abreu
- Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic University, Boca Raton, Florida, USA
| | - Viviana Boronat
- Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic University, Boca Raton, Florida, USA
| | - Nicholas T Kouchoukos
- Division of Cardiac Surgery, Missouri Baptist Medical Center, St. Louis, Missouri, USA
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Seo EJ, Hong J, Lee HJ, Son YJ. Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review. BMC Cardiovasc Disord 2021; 21:418. [PMID: 34479482 PMCID: PMC8414730 DOI: 10.1186/s12872-021-02224-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after coronary artery bypass grafting (CABG). However, the risk factors for new-onset POAF after CABG during the perioperative period have yet to be clearly defined. Accordingly, the aim of our systematic review was to evaluate the perioperative predictors of new-onset POAF after isolated CABG. Method Our review methods adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched seven electronic databases (PubMed, Embase, CINAHL, PsycArticles, Cochrane, Web of Science, and SCOPUS) to identify all relevant English articles published up to January 2020. Identified studies were screened independently by two researchers for selection, according to predefined criteria. The Newcastle–Ottawa Scale was used to evaluate the quality of studies retained. Results After screening, nine studies were retained for analysis, including 4798 patients, of whom 1555 (32.4%) experienced new-onset POAF after CABG. The incidence rate of new-onset POAF ranged between 17.3% and 47.4%. The following risk factors were identified: old age (p < 0.001), a high preoperative serum creatinine level (p = 0.001), a low preoperative hemoglobin level (p = 0.007), a low left ventricle ejection fraction in Asian patients (p = 0.001), essential hypertension (p < 0.001), chronic obstructive pulmonary disease (p = 0.010), renal failure (p = 0.009), cardiopulmonary bypass use (p = 0.002), perfusion time (p = 0.017), postoperative use of inotropes (p < 0.001), postoperative renal failure (p = 0.001), and re-operation (p = 0.005). All studies included in the analysis were of good quality. Conclusions The risk factors identified in our review could be used to improve monitoring of at-risk patients for early detection and treatment of new-onset POAF after CABG, reducing the risk of other complications and negative clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02224-x.
Collapse
Affiliation(s)
- Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, 16499, Republic of Korea
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan, 48520, Republic of Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, Seoul, 06974, Republic of Korea.
| |
Collapse
|
8
|
Trivedi DP, Chigarapalli SR, Gangahar DM, Machiraju VR. The impact of advances in percutaneous catheter interventions on redo cardiac surgery. Indian J Thorac Cardiovasc Surg 2021; 37:61-69. [PMID: 33442208 PMCID: PMC7778657 DOI: 10.1007/s12055-020-01029-5] [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: 05/18/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
Toward the end of the twentieth century, redo cardiac surgery accounted for approximately 15-20% of total cardiac surgical volume. Major risk factors for redo cardiac surgery include young age at time of the first operation, progression of native coronary artery disease (CAD), vein graft atherosclerosis, bioprosthetic valve failure and endocarditis, and transplantation for end stage heart failure. Historically, redo coronary artery bypass grafting (CABG) alone carried a mortality risk of around 4%. Factors such as older age, female sex, comorbidities, combined procedures, hemodynamic instability, and emergency procedures contributed to even higher mortality and morbidity. These poor outcomes made it necessary to look for less invasive alternate methods of treatment. Advances in catheter-based interventions have made a major impact on redo cardiac surgeries, making it no longer the first option in a majority of cases. Percutaneous interventions for recurrence following CABG, transcutaneous aortic valve replacement (TAVR) for calcific aortic stenosis, valve in valve (VIV) implantations, device closure of paravalvular leaks (PVL), and thoracic endovascular aortic repair (TEVAR) for residual and recurrent aneurysms and mitral clip to correct mitral regurgitation (MR) in heart failure are rapidly developing or developed, obviating the need for redo cardiac surgery. Our intent is to review these advances and their impact on redo cardiac surgery.
Collapse
Affiliation(s)
- Dhaval Pravin Trivedi
- Department of Cardiothoracic Surgery, Los Angeles Medical Center, Kaiser Permanente, Los Angeles, CA USA
| | - SukeshKumar Reddy Chigarapalli
- Department of Cardiothoracic Surgery, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, TG 500031 India
| | - Deepak Mohan Gangahar
- Department of Thoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | | |
Collapse
|
9
|
Ozen G, Aljesri K, Celik Z, Turkyılmaz G, Turkyılmaz S, Teskin O, Norel X, Topal G. Mechanism of thromboxane receptor-induced vasoconstriction in human saphenous vein. Prostaglandins Other Lipid Mediat 2020; 151:106476. [PMID: 32721526 DOI: 10.1016/j.prostaglandins.2020.106476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
Saphenous vein (SV) is one of the most widely used graft material in patients undergoing coronary artery bypass graft surgery (CABG). Thromboxane A2 (TXA2) is implicated in graft failure by inducing vasoconstriction and platelet aggregation. The aim of this study is to investigate the mechanism involved in TXA2-induced vasoconstriction in human SV. The role of different inhibitors and blockers on U46619 (TXA2-mimetic)-induced vasoconstriction is investigated by using an isolated organ bath system. Relaxation responses to several mediators are evaluated in SV pre-contracted with U46619 and compared with those pre-contracted with phenylephrine. Our results demonstrate that U46619-induced contraction is completely blocked by myosin light chain kinase inhibitor ML-9 or TP receptor antagonist BAY u3405. Furthermore, U46619-induced contraction is partially inhibited by phospholipase C inhibitor U73122, protein kinase C inhibitor calphostin C, Rho-kinase inhibitor Y-27632, L-type calcium channel blocker nifedipine, store-operated channel inhibitor SKF96365 or removal of extracellular calcium. Relaxation responses to NO donor (sodium nitroprusside), guanylate cyclase (GC) stimulator (riociguat), phosphodiesterase (PDE) inhibitors (sildenafil, IBMX), adenylate cyclase (AC) activator (forskolin) and acetylcholine (ACh) are markedly reduced when U46619 is used as a pre-contraction agent. Our results demonstrate that influx of extracellular Ca2+ (through L-type calcium channels and store-operated calcium channels) and intracellular Ca2+ release together with Ca2+ sensitization (through Rho-kinase activation) are necessary components for TXA2-induced vasoconstriction in SV. Moreover, more pronounced decrease in vasorelaxation induced by several mediators (SNP, riociguat, sildenafil, IBMX, forskolin, and ACh) in the presence of U46619 when compared with phenylephrine suggests that there is a crosstalk between the TP receptor signaling pathway and PDE, AC, GC enzymes. We believe that the investigation of mechanism of the TXA2-induced vasoconstriction in SV will provide additional information for the prevention of SV graft failure.
Collapse
Affiliation(s)
- Gulsev Ozen
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Turkey.
| | - Khadija Aljesri
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Turkey
| | - Zeynep Celik
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Turkey
| | - Gulsum Turkyılmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Education and Research Hospital Bakırkoy, Istanbul, Turkey
| | - Saygın Turkyılmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Education and Research Hospital Bakırkoy, Istanbul, Turkey
| | - Onder Teskin
- Department of Cardiovascular Surgery, Biruni University, Istanbul, Turkey
| | - Xavier Norel
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France
| | - Gokce Topal
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul 34116, Turkey
| |
Collapse
|
10
|
Kulik A, Abreu AM, Boronat V, Ruel M. Impact of lipid levels and high-intensity statins on vein graft patency after CABG: Midterm results of the ACTIVE trial. J Card Surg 2020; 35:3286-3293. [PMID: 33025656 DOI: 10.1111/jocs.15014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/31/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND High-dose atorvastatin did not improve 1-year vein graft patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft Events trial. However, it remains unknown whether high-intensity statins may impact graft disease in the years that follow. METHODS In the trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80 mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the choice of statin was left to the patient's physician. In this study of participants who agreed to follow-up (N = 76), low-density lipoprotein (LDL) levels were measured and graft patency was assessed 3 years after surgery. RESULTS The rate of vein graft disease 3 years after surgery was not significantly reduced with atorvastatin 80 mg during the first postoperative year or the use of open-label high-intensity statin thereafter (p = NS). However, a trend was observed between higher LDL levels during the first postoperative year and a greater incidence of vein graft disease at 3 years (p = .12). Among patients who had LDL levels more than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl (p = .15). Higher mean LDL levels during the first postoperative year were associated with a higher rate of vein disease 3 years after surgery both at the graft level (p = .03) and at the patient level (p = .03) in multivariate analysis. CONCLUSIONS Higher LDL levels during the first postoperative year were associated with significantly greater vein graft disease 3 years after CABG.
Collapse
Affiliation(s)
- Alexander Kulik
- Division of Cardiac Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA
| | - Amy M Abreu
- Division of Cardiac Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA
| | - Viviana Boronat
- Division of Cardiac Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA
| | - Marc Ruel
- Division of Cardiac Surgery, The University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Kulik A. Commentary: Yin and Yang: Antiplatelet and lipid-lowering therapies to prevent vein graft thrombosis and atherosclerosis after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2020; 163:1042-1043. [PMID: 32381333 DOI: 10.1016/j.jtcvs.2020.03.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander Kulik
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Boca Raton, Fla.
| |
Collapse
|
12
|
Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery. Sci Rep 2020; 10:3831. [PMID: 32123285 PMCID: PMC7052208 DOI: 10.1038/s41598-020-60854-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/03/2020] [Indexed: 11/16/2022] Open
Abstract
Only sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.
Collapse
|
13
|
Taggart DP, Gaudino MF, Gerry S, Gray A, Lees B, Dimagli A, Puskas JD, Zamvar V, Pawlaczyk R, Royse AG, Flather M, Benedetto U. Effect of total arterial grafting in the Arterial Revascularization Trial. J Thorac Cardiovasc Surg 2020; 163:1002-1009.e6. [DOI: 10.1016/j.jtcvs.2020.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/03/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
|
14
|
Beller JP, Chancellor WZ, Mehaffey JH, Hawkins RB, Byler MR, Speir AM, Quader MA, Kiser AC, Yarboro LT, Ailawadi G, Teman NR. Hospital Variability Drives Inconsistency in Antiplatelet Use After Coronary Bypass. Ann Thorac Surg 2020; 110:13-19. [PMID: 32057813 DOI: 10.1016/j.athoracsur.2019.12.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/16/2019] [Accepted: 12/23/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Continuation of dual antiplatelet therapy (DAPT) after coronary artery bypass grafting (CABG) after acute myocardial infarction is recommended by current guidelines. We sought to evaluate guideline adherence over time and factors associated with postoperative DAPT within a regional consortium. METHODS Isolated CABG patients from 2011 to 2017 who had a myocardial infarction within 21 days prior to surgery were included. Patients were stratified by DAPT prescription at discharge and by time period, early (2011-2014) vs late (2015-2017). Hierarchical regressions were then performed to evaluate factors influencing DAPT use after CABG. RESULTS A total of 7314 patients were included with an overall rate of DAPT utilization of 31.2% that increased from 29.6% in the early to 33.4% in the late era (P < .01). There was considerable variability in hospital rates of DAPT (range 9.5%-92.1%) and hospital level changes over time (26% increased, 11% decreased, and 63% remained stable). After adjustment for clinical factors, era was not associated with DAPT use but treating hospital remained significantly associated with DAPT use. Other clinical factors associated with increased DAPT utilization included off-pump surgery (odds ratio [OR] 4.48, P < .01) and prior percutaneous coronary intervention (OR 2.02, P < .01), and atrial fibrillation (OR 0.39, P < .01) was associated with decreased utilization. CONCLUSIONS Dual antiplatelet use has increased between 2011 and 2017, driven primarily by evolving patient demographics. Significant hospital-level variability drives inconsistency in DAPT utilization. Efforts to promote DAPT use for patients treated with CABG after myocardial infarction in concordance with current guidelines should be targeted at the hospital level.
Collapse
Affiliation(s)
- Jared P Beller
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - William Z Chancellor
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Matthew R Byler
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Andy C Kiser
- Division of Cardiothoracic Surgery, East Carolina Heart Institute at ECU, Greenville, North Carolina
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
| |
Collapse
|
15
|
Xenogiannis I, Tajti P, Hall AB, Alaswad K, Rinfret S, Nicholson W, Karmpaliotis D, Mashayekhi K, Furkalo S, Cavalcante JL, Burke MN, Brilakis ES. Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery. JACC Cardiovasc Interv 2019; 12:1635-1649. [DOI: 10.1016/j.jcin.2019.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
|
16
|
Ruel M, Kulik A. Suboptimal Medical Therapy After Coronary Revascularization: A Missed Opportunity. J Am Coll Cardiol 2019; 71:603-605. [PMID: 29420955 DOI: 10.1016/j.jacc.2017.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Alexander Kulik
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| |
Collapse
|
17
|
Kulik A, Abreu AM, Boronat V, Ruel M. Intensive versus moderate statin therapy and early graft occlusion after coronary bypass surgery: The Aggressive Cholesterol Therapy to Inhibit Vein Graft Events randomized clinical trial. J Thorac Cardiovasc Surg 2019; 157:151-161.e1. [DOI: 10.1016/j.jtcvs.2018.05.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 01/21/2023]
|
18
|
Stoičkov V, Šarić S, Andonov S, Kostić S, Lović M, Sekulović M. THE INFLUENCE OF EXERCISE TRAINING ON QT DISPERSION AND RISK FACTORS FOR CAR DIOVASCULAR DISEASES IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFT SURGE RY. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
19
|
Thaper A, Kulik A. Rationale for administering beta-blocker therapy to patients undergoing coronary artery bypass surgery: a systematic review. Expert Opin Drug Saf 2018; 17:805-813. [PMID: 30037300 DOI: 10.1080/14740338.2018.1504019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/20/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Secondary preventative therapies are essential for patients undergoing coronary artery bypass graft (CABG) surgery to optimize perioperative and long-term outcomes. Beta-blockers are commonly used to treat patients with coronary artery disease and congestive heart failure (CHF), but their role for CABG patients remains unclear. The goal of this systematic review was to evaluate the rationale for administering beta-blockers to the CABG population and to assess their efficacy before and after coronary surgical revascularization. AREAS COVERED A systematic literature review was performed to retrieve relevant articles from the PubMed database published between 1985 and 2017. EXPERT OPINION Outside of the surgical field, strong evidence supports the use of beta-blockers for patients with a history of previous myocardial infarction (MI) or CHF. For the CABG population, studies have suggested that perioperative beta-blocker therapy is beneficial, with an associated reduction in mortality, particularly among those with a history of previous MI or CHF. Beta-blocker administration has also clearly been shown to lower the rate of new-onset postoperative atrial fibrillation after CABG. Among the different types of beta-blockers, perioperative carvedilol appears to be the most beneficial. In the absence of contraindications, nearly all CABG patients are candidates for perioperative beta-blocker therapy.
Collapse
Affiliation(s)
- Arushi Thaper
- a Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA
| | - Alexander Kulik
- a Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA
| |
Collapse
|
20
|
Kulik A, Abreu AM, Boronat V, Kouchoukos NT, Ruel M. Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft events and thrombosis) randomized controlled trial (NCT02053909). Contemp Clin Trials 2018; 68:45-51. [PMID: 29551675 DOI: 10.1016/j.cct.2018.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 02/04/2023]
Abstract
RATIONALE Saphenous vein graft disease remains a major limitation of coronary artery bypass graft surgery (CABG). Up to 20% of vein grafts will occlude within the first year after CABG despite standard aspirin antiplatelet therapy. However, more potent postoperative platelet inhibition with ticagrelor may improve graft patency. The goal of this study will be to evaluate the efficacy of ticagrelor, as compared to aspirin, for the prevention of saphenous vein graft occlusion following CABG. STUDY DESIGN The Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET) study is a multi-center double-blind randomized controlled trial enrolling patients who have undergone multi-vessel CABG with at least one saphenous vein graft. Patients are being randomized to receive either aspirin 81 mg twice per day or ticagrelor 90 mg twice per day for 2 years starting within 7 days after surgery. The projected enrollment is 150 patients in each arm (300 total patients). Patients will undergo computed tomography (CT) coronary angiography at 1 and 2 years after surgery to assess the incidence of vein graft occlusion and stenosis. CONCLUSION To our knowledge, this trial is the first prospective study to evaluate the impact of early postoperative ticagrelor on 1- and 2-year graft patency after CABG. Furthermore, it is also the first trial to use a novel antiplatelet agent as a standalone, without aspirin, after CABG. Should ticagrelor reduce the incidence of postoperative graft occlusion, the results of this study will redefine modern antiplatelet management following coronary bypass surgery (ClinicalTrials.govNCT02053909).
Collapse
Affiliation(s)
- Alexander Kulik
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
| | - Amy M Abreu
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Viviana Boronat
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St. Louis, MO, United States
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
21
|
Verdoia M, Barbieri L, Kedhi E, Suryapranata H, De Luca G. Percutaneous Versus Surgical Revascularization for Left Main or Multivessel Coronary Artery Disease: Results From a Large-Scale Meta-Analysis in the Era of Drug-Eluting Stents. Angiology 2018; 69:812-824. [DOI: 10.1177/0003319718768656] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The best treatment options for left main (LM) or multivessel coronary disease (MVD) are still debated. We performed a meta-analysis of randomized trials comparing percutaneous versus surgical revascularization for LM or MVD. Primary end point was overall mortality. Secondary end points were major adverse cardiovascular events, recurrent myocardial infarction, repeated revascularization, or stroke. A total of 8 randomized trials were included, involving 8694 patients, 50% undergoing percutaneous coronary intervention (PCI). At a mean follow-up of 39.7 months, mortality was 8.2% with no difference for PCI versus coronary artery bypass grafting (CABG; odds ratio [OR] 95% confidence interval [CI] = 1.18 [0.90-1.55]; P = .24, P for heterogeneity [ Phet] = .01). However, CABG was slightly favored for MVD (OR [95% CI] = 1.54 [1.12-2.13]; P = .008, Phet = .14 for PCI) whereas noninferior for LM disease (OR [95% CI] = 0.88 [0.60-1.29]; P = .50, Phet = .10, P interaction = .03). A similar benefit with CABG was also observed in terms of repeated coronary revascularization, whereas PCI significantly reduced stroke. This meta-analysis shows that surgical coronary revascularization still offers advantages in survival and recurrent ischemic events compared to PCI using drug-eluting stents (DES) in MVD although burdened by an increased risk of stroke. In LM disease, CABG did not provide outcome benefits but was associated with a higher risk of stroke compared to PCI. Additional randomized trials are certainly needed with new-generation DES.
Collapse
Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| | - Lucia Barbieri
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
- Presidio Ospedaliero S. Andrea, Vercelli, Italy
| | - Elvin Kedhi
- Department of Cardiology, Isala Hospital, Zwolle, UMC St Radboud, Nijmegen, the Netherlands
| | | | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy
| |
Collapse
|
22
|
Kulik A, Abreu AM, Boronat V, Ruel M. Intensive versus moderate atorvastatin therapy and one-year graft patency after CABG: Rationale and design of the ACTIVE (Aggressive Cholesterol Therapy to Inhibit Vein Graft Events) randomized controlled trial (NCT01528709). Contemp Clin Trials 2017; 59:98-104. [DOI: 10.1016/j.cct.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/04/2017] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
|
23
|
Eraballi A, Pradhan B. Quality of life improvement with rehabilitation according to constitution of the World Health Organization for coronary artery bypass graft surgery patients: A descriptive review. Ayu 2017; 38:102-107. [PMID: 30254387 PMCID: PMC6153913 DOI: 10.4103/ayu.ayu_152_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This is a descriptive review focusing on trends of treatments required for postoperative coronary artery bypass graft surgery (CABG) patients to improve the quality of life (QOL). METHODOLOGY The sources of literary research to understand the concepts of coronary artery disease according to Indian scriptures are Ayurveda texts, Bhagavad Gita, Patanjali Yoga Sutra. The data was typed in Sanskrit using Devanagari script and explanation in English was given. As per new research techniques, surgery, physiotherapy rehabilitation and Yoga are serving CABG patient's medical and psychological health better. The World Health Organization (WHO) defines health as physical, mental and social well-being later redefined with additional terms like environmental and spiritual health. This definition is similar to the Panchakosha concept in Yoga and Pancha Mahabhutas in Ayurveda. In cases of emergency or passive treatment, medication serves as a better option for physical health. In circumstances where the person is able to move in daily activities (just after discharge), rehabilitation serves as a better option for physical, mental and social health. Travel and reactions to climatic change serve environmental health. Last strategy, belief, cultural and traditional methods with scientific background serves as the spiritual health. These step-wise treatments are required for CABG patients to get the overall health or QOL. However, surgery and physiotherapy rehabilitation are advanced as per modern era which serves physical, mental, and social health also, but environmental health and spiritual health have yet to be addressed. As an ancient system of medicine, Yoga combines physical, mental, social, environmental and spiritual practices and it should be added as treatment along with surgery and physiotherapy rehabilitation. If all of these therapies were in the treatment protocol for CABG surgery patients, we would observe the changes of QOL and fulfill the requirements of constitution of the WHO. Integrating concepts of Yoga, Ayurveda, modern rehabilitation, surgery and patient cooperation with lifestyle change are the key to QOL improvements after CABG.
Collapse
Affiliation(s)
- Amaravathi Eraballi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| | - Balaram Pradhan
- Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| |
Collapse
|