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Wang C, Chen J, Gu C, Li J. Analysis of survival after coronary endarterectomy combined with coronary artery bypass grafting compared with isolated coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:393-401. [PMID: 31180487 DOI: 10.1093/icvts/ivz125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractOBJECTIVESThe aim of this analysis was to compare survival outcomes of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with those of conventional CABG.METHODSEight observational studies were included in this analysis, including 10 529 different patients in Asia, Europe and North America, from 1985 to 2012, among whom 1925 underwent CE + CAGB and 8604 underwent conventional CAGB. The follow-up period ranged from 4 to 14 years. This meta-analysis was performed with the fixed-effects model.RESULTSAfter rigorous assessment of the quality of the studies included, this analysis showed that CE + CABG had a statistically significant weaker short-term outcome, with a higher risk of mortality [odds ratio (OR)] 1.61; P = 0.002]. Further, this phenomenon was exacerbated in the midterm. One-year and 2-year results indicated that death was, respectively, 163% (OR 2.63; P < 0.001) and 133% (OR 2.60; P < 0.001) more likely to occur in the CE + CABG group. However, the long-term results indicated no difference between the 2 groups. The 4-year hazard ratio (1.13; P = 0.10) did not show significant differences between the groups, and the Kaplan–Meier survival curves had the same level and pattern.CONCLUSIONSCE + CABG had a significantly weaker short-term outcome than conventional CABG, and this trend continued in the midterm. The survival rate had the largest gap in the midterm. However, there was no significant difference between these 2 groups in the long run.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun Chen
- People’s Hospital of Deyang City, Sichuan, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Wang C, Chen J, Gu C, Qiao R, Li J. Impact of risk factors and surgical techniques in coronary endarterectomy: a network meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:355-364. [PMID: 30982903 DOI: 10.1093/icvts/ivz090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Summary
The goal of this network meta-analysis was to compare the early mortality rate of patients who underwent coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with different techniques and with isolated CABG. This analysis also evaluated potential risk factors in patients who undergo CE. Eighteen studies were included, covering 21 752 different patients, among whom 3352 underwent CE + CABG with either open or closed techniques and 18 400 underwent isolated CABG. Patients who had CE + CABG had a statistically significant higher mortality rate [odds ratio (OR) 1.76; P < 0.001]. Subgroup analyses showed that, with closed CE, mortality was 52% (OR 1.52, P = 0.001) more likely to occur, whereas with open CE, mortality was 279% (OR 3.79, P < 0.001) more likely to occur, when both were compared with isolated CABG. A network meta-analysis indicated that both the open and closed methods had poorer results than CABG alone and that the open method had a higher risk of mortality than the closed one. For risk factors, diabetes mellitus (DM), hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were significant contributors to inclusion in the CE group, whereas other risk factors showed no significant difference. However, none of these factors indicated significant correlations with the incidence of mortality between the groups. CE + CABG has a significantly higher risk of death than isolated CABG, and open CE is more risky than closed CE, even though most of the individual studies did not show that CE had a higher risk of mortality. Moreover, DM, hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were more common in the patients who had CE + CABG, but these factors may not necessarily increase the mortality risk of patients who have CE.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun Chen
- People’s Hospital of Deyang City, Sichuan, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruiguo Qiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hsieh TH, Chen LW. Cardiopulmonary bypass not induces dysrhythmia in elderly coronary artery bypass grafting patients. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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