Impact of Modifiable Risk Factors on Long-Term Outcomes after Coronary Artery Bypass Surgery

2020 ◽  
Author(s):  
Dror B. Leviner ◽  
Barak Zafrir ◽  
Ronen Jaffe ◽  
Walid Saliba ◽  
Moshe Y. Flugelman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Modifiable Risk Factors ◽  
Cardiac Catheterization Laboratory ◽  
Coronary Syndrome ◽  
Coronary Events

Abstract Background Risk factors control and secondary prevention measures are often reported to be suboptimal in patients undergoing coronary artery bypass grafting (CABG) and may lead to worse clinical outcomes. We aimed to examine potentially modifiable risk factors in patients undergoing CABG and investigate their association with long-term coronary events. Methods Cardiovascular risk factors were recorded preoperatively in the setting of a cardiac catheterization laboratory and were analyzed in relation to long-term coronary events, defined as acute coronary syndrome (ACS) or revascularization after CABG. Results Study population included 1,125 patients undergoing CABG without previous revascularization. Modifiable risk factors included hypertension (71%), hyperlipidemia (67%), diabetes (42%), obesity (28%), and smoking (21%). Only 8% did not have any of the five risk factors. During the mean follow-up of 93 ± 52 months after CABG, 179 patients (16%) experienced a coronary event. Incidence rates were higher in patients with than without the presence of each of the modifiable risk factors, except obesity. Active smoking (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: (1.07–2.13); p = 0.020), presence of diabetes (HR: 1.61; 95% CI: 1.18–2.18; p = 0.002), and hyperlipidemia (HR: 2.13; 95% CI: 1.45–3.14; p < 0.001) were independent predictors of future coronary events after CABG; they also displayed a progressive stepwise increment in the risk of long-term coronary events when cumulatively present. Conclusions In patients undergoing CABG, diabetes, hyperlipidemia, and smoking, as documented preoperatively, were potentially modifiable risk factors that were independently and cumulatively associated with long-term risk of ACS or coronary revascularization, highlighting the importance of early identification and risk factors control for improving cardiovascular health after CABG.

Time-Varying Risk Factors for Long-Term Mortality After Coronary Artery Bypass Graft Surgery

2006 ◽  
Vol 81 (3) ◽  
pp. 793-799 ◽  
Author(s):  
Dexiang Gao ◽  
Gary K. Grunwald ◽  
John S. Rumsfeld ◽  
Lynn Schooley ◽  
Todd MacKenzie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Time Varying ◽  
Artery Bypass Graft ◽  
Long Term Mortality

scholarly journals The effect of coronary stent type on the long-term results of coronary artery bypass surgery after stenting clinically related artery in acute coronary syndrome in patients with multivessel coronary artery disease

2019 ◽  
Vol 34 (3) ◽  
pp. 144-152
Author(s):  
A. V. Bocharov ◽  
L. V. Popov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Stents ◽  
Long Term Results ◽  
Bare Metal ◽  
Coronary Syndrome

Justification. The results of endovascular revascularization are largely determined by the type of stents used. The use of baremetal coronary stents significantly worsens the long-term results of endovascular treatment of coronary artery disease. Given the widespread use of bare-metal coronary stents in the Russian Federation for the treatment of coronary artery disease and acute coronary syndrome, in particular, the issue of the impact of the above-mentioned endovascular interventions on the long-term results of coronary artery bypass grafting (CABG) performed after endovascular revascularization of the clinically related artery in patients with acute coronary syndrome and multivessel lesions does not lose relevance.Aim. To compare the long-term results of the staged strategies of revascularization of the coronary bed: CABG performed after stenting the clinically related artery with third-generation biodegradable polymer-based sirolimus-eluting stents for acute coronary syndrome and CABG performed after stenting the clinically related artery with bare-metal coronary stents for acute coronary syndrome.Material and Methods. The analysis used the data of two-year follow-up of patients who underwent two-stage revascularization: at the first stage, patients received stenting of the clinically related artery for acute coronary syndrome and, at the second stage, they received coronary artery bypass grafting no later than 90 days from the date of stenting. The study included 218 patients with multivessel lesions of the coronary bed, admitted with clinical manifestation of acute coronary syndrome. The long-term follow-up period was 24 months. The following end points were analyzed: cardiovascular mortality, myocardial infarction, re-revascularization, and combined MACCE end point (cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, and re-revascularization). The observation was carried out at the hospital stage and, then, on an outpatient basis once every three months.Results. There were no significant differences between the groups. The frequency of repeated revascularization, including repeated revascularization of the stented artery, and recurrence of angina were significantly higher in the group with baremetal coronary stents. There were no significant differences between the groups in regard to cardiovascular mortality, nonfatal myocardial infarction and acute cerebrovascular accidents. The frequency of MACCE events was significantly higher in the group of bare-metal coronary stents, mainly due to the frequency of repeated revascularizations.Conclusion. Coronary artery bypass grafting performed in the early period after stenting of the clinically related artery using bare-metal coronary stents in patients with acute coronary syndrome and multivessel lesions was associated with a significantly larger number of repeated coronary revascularizations and higher rate of recurrent angina compared to a similar strategy, but with the use of modern third-generation biodegradable polymer-based sirolimus-eluting stents.

scholarly journals Sex-specific outcome after minimally invasive direct coronary artery bypass for single-vessel disease

2019 ◽  
Vol 30 (3) ◽  
pp. 380-387
Author(s):  
Christine Friedrich ◽  
Rouven Berndt ◽  
Assad Haneya ◽  
René Rusch ◽  
Rainer Petzina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Survival Rates ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Abstract OBJECTIVES Female gender is reported as an independent risk factor for a poor outcome after coronary artery bypass grafting. We analysed the influence of gender on surgical outcome in patients with single-vessel disease undergoing minimally invasive direct coronary artery bypass (MIDCAB). METHODS From January 1998 to December 2016, a total of 607 consecutive patients with single-vessel disease (31.9% women) underwent MIDCAB at our institution. Major adverse cardiac and cerebrovascular events (MACCE) were recorded during a median follow-up period of 8.0 years. Survival time was estimated for all patients and after applying propensity score matching (138 women vs 138 men). Multivariable Cox regression analysis identified risk factors predicting a long-term mortality rate. RESULTS In women, a longer surgical time (125 vs 113 min; P &lt; 0.001) and a higher transfusion rate were recorded (13.0% vs 5.1%; P = 0.001) with similar rates of in-hospital deaths (1.0% vs 0.5%; P = 0.60) and MACCE (1.5% vs 0.7%; P = 0.39). Survival and MACCE-free survival during the follow-up period did not differ significantly between genders (P = 1.0, P = 0.36). Survival and MACCE-free survival rates after 5 years were 94% and 90% in women compared to 91% and 86% in men. Propensity score matching demonstrated improved long-term survival rates in women (P = 0.029). Insulin-dependent diabetes mellitus, postoperative atrial fibrillation and prolonged intensive care unit stay were associated with long-term deaths for both genders, whereas obesity, former myocardial infarction and preoperative atrial fibrillation were significant risk factors in men. CONCLUSIONS Female patients showed no adverse outcomes after MIDCAB, although risk factors were gender-specific. Overall, MIDCAB demonstrated excellent short- and long-term results as a treatment for single-vessel disease in both genders.

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation

2020 ◽  
Vol 27 (18) ◽  
pp. 1996-2003 ◽  
Author(s):  
Farzad Masoudkabir ◽  
Negin Yavari ◽  
Mina Pashang ◽  
Saeed Sadeghian ◽  
Arash Jalali ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome ◽  
Cerebrovascular Events

Background A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting. Methods The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers ( n = 23,619), persistent postoperative opium consumers ( n = 3636) and enduring postoperative opium withdrawal ( n = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation. Results After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06–1.54; P = 0.009) and 25% (HR 1.25, 95% CI 1.13–1.40; P < 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16–1.55; P < 0.0001). Conclusions The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.

Risk Factors for Respiratory Failure and Long-Term Survival Following Coronary Artery Bypass Grafting

CHEST Journal ◽  
2004 ◽  
Vol 126 (4) ◽  
pp. 855S ◽  
Author(s):  
Ioannis K. Toumpoulis ◽  
Constantine E. Anagnostopoulos ◽  
Robert C. Ashton ◽  
Cliff P. Connery ◽  
Joseph J. DeRose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Term Survival ◽  
Artery Bypass Grafting

Phẫu thuật cầu nối chủ vành ở bệnh nhân có tiền sử can thiệp mạch vành qua da tại Bệnh viện Trung ương Huế

2021 ◽  
Author(s):  
An Vinh Bui Duc
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Cabg Surgery ◽  
Percutaneous Coronary

TÓM TẮT Đặt vấn đề: Can thiệp mạch vành qua da là lựa chọn điều trị đối với bệnh lý động mạch vành trong những trường hợp hẹp một hoặc hai nhánh động mạch vành, hội chứng vành cấp. Số lượng các trường hợp can thiệp mạch gia tăng dẫn đến ngày càng có nhiều bệnh nhân nhập viện phẫu thuật bắc cầu chủ vành đã có tiền sử can thiệp mạch vành. Nghiên cứu này nhằm mục tiêu 1) nhận diện các yếu tố nguy cơ phẫu thuật của các bệnh nhân có chỉ định tái tưới máu vào viện với tiền sử can thiệp mạch vành trước đó và 2) đánh giá kết quả phẫu thuật bắc cầu chủ vành ở nhóm bệnh nhân này. Đối tượng, phương pháp: Bệnh nhân có tiền sử can thiệp mạch vành qua da được phẫu thuật chương trình bắc cầu chủ vành tại Bệnh viện Trung Ương Huế. Nghiên cứu hồi cứu, mô tả. Kết quả: Trong giai đoạn từ 1/2012 - 1/2017, có 16 bệnh nhân được phẫu thuật. Tuổi trung bình là 64,6 ± 8,2, trung bình BMI - 24,7 ± 1,8, thời gian phẫu thuật sau can thiệp qua da trung bình 2 năm. Các yếu tố nguy cơ bao gồm: tăng huyết áp 87,5%, đái tháo đường 81,3%, rối loạn lipid máu 68,8%, hút thuốc lá 62,5%. Tất cả các bệnh nhân đều có triệu chứng của đau thắt ngực ổn định với 62,5% xếp loại CCS IV. Thời gian tuần hoàn ngoài cơ thể trung bình 125,3 ± 19,5 phút trong đó 37,5% không sử dụng tuần hoàn ngoài cơ thể. Phẫu thuật bắc cầu chủ vành ở nhiều vị trí chiếm đa số 87,5%. Quá trình hậu phẫu ghi nhận các biến chứng: chảy máu (43,8%), rung nhĩ (12,5%), tai biến mạch máu não (6,25%). 1 trường hợp đặt bóng đối xung trong thời gian hậu phẫu. Thời gian nằm viện trung bình 27,4 ± 8,5 ngày. Không ghi nhận tử vong trong quá trình nằm viện và sau 6 tháng theo dõi. Kết luận: Các yếu tố nguy cơ ảnh hưởng đến kết quả phẫu thuật đối với bệnh nhân có chỉ định tái tưới máu vào viện có tiền sử can thiệp mạch vành gồm hút thuốc lá, tăng huyết áp, đái tháo đường, thời gian phẫu thuật sau can thiệp mạch vành, số lượng mạch vành đã can thiệp, số mạch vành cần tái tưới máu và phân suất tống máu thất trái. Phẫu thuật bắc cầu chủ vành là phương pháp điều trị đem lại kết quả tốt ở các bệnh nhân này trong ngắn hạn. Từ khóa: Can thiệp mạch vành qua da, bắc cầu chủ vành, tái tưới máu ABSTRACT CORONARY ARTERY BYPASS GRAFTING AMONG PATIENTS WITH PRIOR PERCUTANEOUS CORONARY INTERVENTION AT HUE CENTRAL HOSPITAL Background: Percutaneous coronary intervention (PCI) is the preferred treatment modality for single and double vessel coronary artery disease and in the setting of acute coronary syndrome. The rising volume of PCI is directly proportional to the representation of patients hospitalized for coronary artery bypass graft (CABG) surgery who have a history of previous PCI procedures. This study aims to 1) identify the risk factors in patients requiring revascularization with prior PCI and 2) evaluate the surgical outcomes. Materials and method: This is a retrospective case series of patients with prior PCI undergoing elective CABG surgery at Hue Central Hospital. Results: From January 2012 and January 2017, 16 patients operated. The mean age was 64.6 ± 8.2. Mean Body Mass Index was 24.7 ± 1.8. The PCI and CABG gap was 2 years. Coronary risk factors including hypertension (87.5%), diabetes mellitus (81.3%), dyslipidemia (68.8%) and smoke (62.5%). All patients presented stable angina with 62.5% CCS class IV. Mean cardiopulmonary bypass time was 125.3 ± 19.5 minutes, 37.5% off - pump coronary surgery. Multi - bypass bypass grafting was performed in 87.5%. Surgical complications were recognized, including 43.8% bleeding, 12.5% atrial fibrillation, and 6.25% stroke. A case required an intra - aortic balloon pump during the postoperative period. Mean hospital stay was 27.4 ± 8.5 days. There was no mortality during hospitalization and 6 - month follow - up. Conclusion: Risk factors for surgical outcome in patients requiring coronary revascularization with prior PCI include diabetes mellitus, smoking, hypertension, time of CABG surgery after PCI, previously intervened vessels, coronary revascularization strategies, and left ventricular ejection fraction. CABG is an appropriate modality for reperfusion in these patients with positive early outcomes. Keywords: Percutaneous coronary intervention, coronary artery bypass grafting, revascularization.

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