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Golukhova E, Sigaev I, Keren M, Slivneva I, Berdibekov B, Sheikina N, Kozlova O, Arakelyan V, Volkovskaya I, Zavalikhina T, Avakova S. Early and Long-Term Results of Simultaneous and Staged Revascularization of Coronary and Carotid Arteries. PATHOPHYSIOLOGY 2024; 31:210-224. [PMID: 38651405 PMCID: PMC11036243 DOI: 10.3390/pathophysiology31020017] [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: 12/11/2023] [Revised: 02/15/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus on the optimal choice of surgical treatment tactics for patients with significant stenoses in both carotid and coronary arteries. The aim of the current study was to compare the 30-day and long-term outcomes of coronary and carotid artery revascularization surgery based on the simultaneous or staged surgical tactics. MATERIAL AND METHODS This single-center retrospective study involved 192 patients with concurrent coronary artery disease and carotid artery stenosis ≥ 70%, of whom 106 patients underwent simultaneous intervention (CABG + CEA) and 86 patients underwent staged CABG/CEA. The mean time between stages ranged from 1 to 4 months (mean 1.88 ± 0.9 months). The endpoints included death from any cause, non-fatal stroke, non-fatal myocardial infarction (MI), and major adverse cardiovascular events (MACEs) (death + non-fatal MI + non-fatal stroke) within 30 days after the last intervention and in the long-term follow-up period (median follow-up-6 years). RESULTS The 30-day all-cause mortality, incidence of postoperative non-fatal MI, non-fatal stroke, and MACEs did not exhibit differences between the groups after single-stage and staged interventions. However, the overall risk of postoperative complications (adjusted for the risk of any complication per patient) (OR 2.214, 95% CI 1.048-4.674, p = 0.035), as well as the duration of ventilatory support (p = 0.004), was elevated in the group after simultaneous interventions compared with the staged intervention group. This difference did not result in an increased incidence of death and MACEs in the group after simultaneous interventions. In the long-term follow-up period, there were no significant differences observed when comparing simultaneous or staged surgical tactics in terms of overall survival (54.9% and 62.6% in Groups 1 and 2, respectively, P log-rank = 0.068), non-fatal stroke-free survival (45.6% and 33.6% in Groups 1 and 2, respectively, P log-rank = 0.364), non-fatal MI-survival (57.6% and 73.5% in Groups 1 and 2, respectively, P log-rank = 0.169), and MACE-free survival (7.1% and 30.2% in Groups 1 and 2, respectively, P log-rank = 0.060). The risk factors associated with an unfavorable outcome included age, smoking, BMI, LV EF, and atherosclerosis of the lower extremity arteries. CONCLUSIONS This study revealed no significant difference in the impact of simultaneous CABG + CEA or staged CABG/CEA on the incidence of death, stroke, MI, and MACEs over a 30-day and long-term follow-up period. Although the immediate results indicated an increased risk of a complicated course (attributable to overall complications) and more prolonged ventilation after simultaneous CABG + CEA compared with staged CABG/CEA, this did not lead to an increase in fatal complications. Therefore, the implementation of either tactic is considered eligible and appropriate following a thorough operative risk assessment.
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Affiliation(s)
| | | | - Milena Keren
- A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (E.G.); (I.S.); (B.B.); (N.S.); (O.K.); (V.A.); (I.V.); (T.Z.); (S.A.)
| | - Inessa Slivneva
- A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia; (E.G.); (I.S.); (B.B.); (N.S.); (O.K.); (V.A.); (I.V.); (T.Z.); (S.A.)
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Ding CY, Qi WH, An YJ, Yuan X, Yao YT. The effect of body mass index on short-term outcomes in patients undergoing off-pump coronary artery bypass grafting surgery: a retrospective study from a single cardiovascular center. J Cardiothorac Surg 2024; 19:86. [PMID: 38342892 PMCID: PMC10860294 DOI: 10.1186/s13019-024-02586-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE This study is designed to investigate the impact of body mass index (BMI) on the short-term outcomes of patients undergoing off-pump coronary artery bypass graft (OPCAB) surgery. METHODS Data was obtained from 1006 Chinese patients who underwent isolated, primary OPCAB at a high-traffic cardiovascular center during 2020. Subjects were categorized, by BMI, into a low & normal weight (LN) group (BMI < 24 kg/m2), an overweight (OVW) group (24 ≤ BMI < 28 kg/m2), and an obese (OBS) group (BMI ≥ 28 kg/m2). Information pertaining to patients' short-term outcomes (including incidence of mortality and morbidities; duration of postoperative mechanical ventilation; length of stay in the ICU and hospital; postoperative bleeding; etc.) were extracted, and the data from each group were compared. RESULTS The incidences of in-hospital mortality and morbidities were similar for all three groups. The volume of fluid infusion, postoperative bleeding within 24 h and total bleeding in LN group were higher than those in the OBS group (P < 0.001). The hemoglobin level was lower in the LN group than that in the OBS group (P < 0.001). Duration of mechanical ventilation and length of stay in the ICU in the LN group were longer than those in the OBS group (P < 0.001). CONCLUSIONS Our results demonstrate that BMI is not significantly related with short-term outcomes in OPCAB patients. However, we suggest that OPCAB patients with low-normal BMI are more susceptible to post-operative blood loss.
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Affiliation(s)
- Chen-Ying Ding
- Department of Anesthesiology, Hohhot First Hospital, Hohhot, 010030, Inner Mongolia Autonomous Region, China
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wen-Hui Qi
- Department of Anesthesiology, Harrison International Peace Hospital, Hengshui, 053000, Hebei Province, China
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yu-Jie An
- Department of Anesthesiology, The Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, 835000, Xinjiang Uygur Autonomous Region, China
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xin Yuan
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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Abreu A, Máximo J, Saraiva F, Leite-Moreira A. Body mass index effect on long-term survival after coronary artery bypass surgery: a competing risk analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad161. [PMID: 37740299 PMCID: PMC10534054 DOI: 10.1093/icvts/ivad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES The aim of this sudy was to investigate the presence of an obesity paradox on the long-term mortality of patients undergoing primary isolated coronary artery bypass surgery and to uncover whether any discrepancy found could be attributable to cardiovascular or noncardiovascular causes. METHODS Retrospective analysis of 5242 consecutive patients with body mass index (BMI) over 18.5 kg/m2 undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall, and cause-specific hazard models, with BMI forced both as a categorical (using World Health Organization predefined cutoffs) and as a continuous variable. RESULTS Follow-up was 99.7% complete. The median follow-up time was 12.79 years (interquartile range, 9.51-16.61). The cumulative incidence functions failed to uncover any difference in 15-year all-cause (log-rank test, P = 0.400), cardiovascular (Gray's test, P = 0.996) and noncardiovascular mortality (Gray's test, P = 0.305) between BMI categories. Likewise, extensive multivariable-adjusted Cox regression and cause-specific hazards models failed to demonstrate in-between category differences, with BMI forced as a categorical variable. On the other hand, using BMI as a continuous variable, the model identified the optimal BMI as between 25.8 and 30.3 kg/m2 (nadir around 28.9 kg/m2), albeit this was dependent on the definition of the reference value. CONCLUSIONS In this longitudinal, population-level analysis of patients undergoing isolated primary coronary artery bypass grafting, we could not attest to any protective effect of obesity on long-term survival.
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Affiliation(s)
- Armando Abreu
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
| | - José Máximo
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João University Hospital Center, Porto, Portugal
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Lebovitz S, Rozen G, Abu Ghosh Z, Korem M, Elinav H, Zayyad H, Carasso S, Planer D, Amir O, Elbaz-Greener G. The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis. J Clin Med 2023; 12:jcm12113848. [PMID: 37298043 DOI: 10.3390/jcm12113848] [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: 04/07/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The association between Body Mass Index (BMI) and clinical outcomes following sepsis continues to be debated. We aimed to investigate the relationship between BMI and in-hospital clinical course and mortality in patients hospitalized with bacteremic sepsis using real-world data. METHODS A sampled cohort of patients hospitalized with bacteremic sepsis between October 2015 and December 2016 was identified in the National Inpatient Sample (NIS) database. In-hospital mortality and length of stay were defined as the relevant outcomes. Patients were divided into 6 BMI (kg/m2) subgroups; (1) underweight ≤ 19, (2) normal-weight 20-25, (3) over-weight 26-30, (4) obese I 31-35, (5) obese II 36-39, and (6) obese stage III ≥ 40. A multivariable logistic regression model was used to find predictors of mortality, and a linear regression model was used to find predictors of an extended length of stay (LOS). RESULTS An estimated total of 90,760 hospitalizations for bacteremic sepsis across the U.S. were analyzed. The data showed a reverse-J-shaped relationship between BMI and study population outcomes, with the underweight patients (BMI ≤ 19 kg/m2) suffering from higher mortality and longer LOS as did the normal-weight patients (BMI 20-25 kg/m2) when compared to the higher BMI groups. The seemingly protective effect of a higher BMI diminished in the highest BMI group (BMI ≥ 40 kg/m2). In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 were found to be independent predictors of mortality. CONCLUSIONS A reverse-J-shaped relationship between BMI and mortality was documented, confirming the "obesity paradox" in the real-world setting in patients hospitalized for sepsis and bacteremia.
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Affiliation(s)
- Shalom Lebovitz
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical Center, Boston, MA 02111, USA
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Maya Korem
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Hila Elinav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Hiba Zayyad
- Infectious Diseases Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1528001, Israel
| | - Shemy Carasso
- The Jerusalem Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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Fan Y, Liu J, Jin L, Liu Z, Han L, Wang Y, Zhang Y, Shen P, Li Z. Impacts of metabolic disorders on short- and long-term mortality after coronary artery surgery in the elderly. BMC Cardiovasc Disord 2022; 22:504. [PMID: 36434496 PMCID: PMC9700925 DOI: 10.1186/s12872-022-02954-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Elderly patients undergoing cardiac operation often suffer various metabolic comorbidities, such as diabetes mellitus (DM) and obesity. The metabolic disorders in these individuals are widely considered to be possible predisposing factors for unfavourable prognosis. This retrospective study was aimed to determine the association of metabolic diseases with the mortality of elderly patients after coronary artery bypass grafting (CABG) and to identify the protective or risk factors related to their short- and long-term survival. METHODS Totally 684 patients aged 75 years or above undergoing isolated CABG were evaluated retrospectively. There were two groups depending on the body mass index (BMI): an overweight and obesity group (n = 354) and a normal weight and lean group (n = 330). Propensity score matching (PSM) was performed to adjust baseline clinical characteristics, which reduced confounding bias. The short-term postoperative mortality was tested via logistic regression. Kaplan-Meier and Cox regression analyses were done to compute the overall survival in each group and to identify relevant variables associated with all-cause mortality, respectively. RESULTS The prevalence rates of metabolic comorbidities in the total cohort were: diabetes mellitus (32.5%), overweight or obesity (51.8%) and hypertension (72.8%). The 30-day postoperative mortality was 5.1% and the long-term mortality was 15.25% at a median 46.2-month follow-up (1.0-178.6 months). The 30-day postoperative mortality was relevant to DM, diseased coronary arteries, New York Heart Association class, intra-aortic balloon pump and emergency surgery. The long-term mortality was negatively associated with overweight and obesity. Univariate and multivariate logistic regression recognized DM as an adverse factor related with 30-day postoperative mortality whether before or after PSM. The long-term mortality was not significantly relevant with DM (HR = 0.753, 95% CI 0.402-1.411). Overweight or obesity was not the risk factor of 30-day postoperative mortality (OR = 1.284, 95% CI 0.426-3.868), but was the protective factor of long-term survival (HR = 0.512, 95% CI 0.279-0.939). CONCLUSIONS The "obesity paradox" exists regarding the prognosis of individuals aged ≥ 75, which was presented as lower long-term mortality no matter from all cause or cardio-cerebrovascular cause in patients with BMI ≥ 24. Trial registration ChiCTR2200061869 (05/07/2022).
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Affiliation(s)
- Yuhong Fan
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200030, China
| | - Jingjing Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Lei Jin
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200030, China
| | - Zhonghe Liu
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200030, China
| | - Lixiang Han
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Wang
- Outpatient Clinic, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200030, China.
| | - Peiming Shen
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200030, China.
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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