scholarly journals Long-term outcomes after coronary artery bypass surgery in patients with diabetes

2020 ◽  
Vol 30 (5) ◽  
pp. 685-690
Author(s):  
Tomas Andri Axelsson ◽  
Jonas A Adalsteinsson ◽  
Linda O Arnadottir ◽  
Dadi Helgason ◽  
Hera Johannesdottir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract OBJECTIVES Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications. METHODS This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes. RESULTS Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27–4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P < 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P < 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53–2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23–1.75). CONCLUSIONS Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

Abstract 2298: Impact of Preopeartive Anemia on Long-term Outcomes Following Isolated Coronary Artery Bypass Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yan Li ◽  
Zhe Zheng ◽  
Shiju Zhang ◽  
Xianqiang Wang ◽  
Huawei Gao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Total Mortality ◽  
Long Term Outcomes ◽  
Preoperative Anemia ◽  
Cabg Surgery ◽  
Repeated Revascularization

Background: The prognostic and clinical value of preopeartive anemia in patients undergoing cardiac surgery has recently been recognized. However, very limited information exists on the impact of preopeartive anemia on long-term outcomes following coronary artery bypass graft (CABG) surgery. This study aimed at examining the degree to which preopeartive anemia affects long-term outcomes after isolated CABG surgery. Methods: A unicenter study was conducted on 5488 consecutive survivors of isolated CABG between January 1999 and December 2005. Preopeartive anemia was defined according to the World Health Organization definition (hemoglobin < 13g/dL for male; hemoglobin < 12g/dL for female). Long-term outcomes of interest were total mortality, myocardial infarction (MI), repeated revascularization, and major adverse cardiac events (MACEs=total mortality or MI or repeated revascularization). These outcomes were compared after adjustment for differences in baseline risk factors among the patients. Results: 1437 (26.2%) patients had preoperative anemia. After a mean follow-up of 43.3±18.3 months, preoperative anemia was found to be an independent risk factor for total mortality (hazard ration [HR]: 1.490; 95% CI: 1.074 to 2.067; p=0.017), MI (HR: 1.595; 95% CI: 1.028 to 2.474; p=0.037) and MACEs (HR: 1.363; 95% CI: 1.059 to 1.755; p=0.016). We also found that aspirins and beta-blockers were underused in patients with anemia during follow-up. Conclusions: Preopeartive anemia has a strong negative impact on long-term outcomes following isolated CABG. Our data also suggest that the incorporation of preoperative anemia into the risk assessments of long-term outcomes after CABG is recommended. Future intense and systematic studies are needed to help ensure high-quality cardiac care of patients with anemia.

scholarly journals Risk-Adjusted Short- and Long-Term Outcomes for On-Pump Versus Off-Pump Coronary Artery Bypass Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Matthew L. Williams ◽  
Lawrence H. Muhlbaier ◽  
Jacob N. Schroder ◽  
Jonathan A. Hata ◽  
Eric D. Peterson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Short Term ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
To Receive

Background— Surgeons have adopted off-pump coronary artery bypass grafting (OPCAB) in an effort to reduce the morbidity of surgical revascularization. However, long-term outcome of OPCAB compared with conventional coronary artery bypass grafting (CABG) remains poorly defined. Methods and Results— Using logistic regression analysis and proportional hazards modeling, short-term and long-term outcomes (perioperative mortality and complications, risk-adjusted survival, and survival/freedom from revascularization) were investigated for patients who underwent OPCAB (641 patients) and CABG-cardiopulmonary bypass (5026 patients) from 1998 to 2003 at our institution. For these variables, follow-up was 98% complete. OPCAB patients were less likely to receive transfusion (odds ratio for OPCAB, 0.80; P =0.037), and there were trends toward improvement in other short-term outcomes compared with CABG-cardiopulmonary bypass. Long-term outcomes analysis demonstrated no difference in survival, but OPCAB patients were more likely to require repeat revascularization (OPCAB hazard ratio, 1.29; P =0.020). Conclusions— OPCAB patients were less likely to receive transfusion during their hospitalization for surgery but had higher risk for revascularization in follow-up. These results highlight the need for a large randomized, controlled trial to compare these 2 techniques.

Do Flow and Pulsatility Index within the Accepted Ranges Predict Long-Term Outcomes after Coronary Artery Bypass Grafting?

2017 ◽  
Vol 68 (02) ◽  
pp. 162-168 ◽  
Author(s):  
Maximiliano De Leon ◽  
Roberto Stanham ◽  
Gerardo Soca ◽  
Victor Dayan
Keyword(s):  
Overall Survival ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Pulsatility Index ◽  
Graft Failure ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Long Term Outcomes

Abstract Background Transit-time flow measurement (TTFM) is the gold standard for intraoperative detection of graft failure. Several reports show that TTFM and distal coronary bed quality (DCBQ) may also be useful for midterm detection of graft failure. Nonetheless, there are no data regarding their predictive role on long-term outcomes. Methods Patients with three-vessel disease who underwent isolated coronary artery bypass grafting (CABG) in 2006 and received at least one graft to the left anterior descending artery (LAD) or to the first obtuse marginal (OM1) or posterior descending artery (PDA) were included. Baseline characteristics, mean graft flow, pulsatility index, and subjective impression of DCBQ for each coronary territory were collected. Long-term cardiovascular (CV) and overall survival, operative mortality, and new percutaneous coronary intervention (PCI) were evaluated. Results A total of 177 patients underwent isolated CABG. The OM1 was grafted in 131 patients, the LAD in 169 patients, and the PDA in 100 patients. Neither DQCB nor TTFM were predictors for new PCI. Independent predictors for overall survival were age, previous acute myocardial infarction (AMI), and DQCB of OM1 (odds ratio [OR] = 2.97; 95% confidence interval [CI]: 1.15–7.71). Age, previous AMI, and DCBQ of OM1 (OR = 2.5; 95% CI: 1.39–4.81) were independent predictors for CV survival. Conclusions TTFM on patients with functioning grafts does not predict long-term survival or performance of new PCI. Subjective evaluation of distal coronary bed, especially of the OM1, has a strong impact on long-term outcomes.

Robotic versus Conventional Coronary Artery Bypass Grafting

2017 ◽  
Vol 12 (4) ◽  
pp. 239-246 ◽  
Author(s):  
Markus Kofler ◽  
Lukas Stastny ◽  
Sebastian Johannes Reinstadler ◽  
Julia Dumfarth ◽  
Juliane Kilo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Long Term Outcomes ◽  
Artery Disease

Objective Robotic coronary artery bypass grafting (CABG) was shown to be a safe and feasible method for the treatment of coronary artery disease in highly selected patients. However, long-term outcome data comparing robotic CABG with conventional CABG are still missing. Therefore, we aimed to compare robotic with conventional CABG in terms of perioperative and long-term outcomes. Methods Of 2947 consecutive elective patients with coronary artery disease operated at a single center between 2001 and 2013, 280 underwent robotic CABG. After propensity score matching, 134 pairs of robotic versus conventional CABG (age = 62 ± 10 years, log EuroScore = 2.4 ± 2.4% vs. mean ± SD age = 63 ± 10 years, log EuroScore 2.5 ± 1.7%, respectively; all P > 0.05) were formed. The mean ± SD follow-up was 6.6 ± 3.2 years. Results There was no difference in perioperative mortality (robotic = 0% vs. conventional = 1.5%, P = 0.154), myocardial infarction (robotic = 0% vs. conventional = 2.2%, P = 0.08), and stroke rate (robotic = 0% vs. conventional = 0.7%, P = 0.318) between the groups. Longer cardiopulmonary bypass (robotic = 112 ± 100 minutes vs. conventional = 67 ± 48 minutes, P < 0.0001) and cross-clamp times (robotic = 68 ± 54 minutes vs. conventional = 38 ± 27 minutes, P <0.0001) were observed in robotic patients. Long-term follow-up yielded equivalent results in terms of survival (1, 5, and 10 years: robotic = 99.3%, 96.9%, and 81.3% vs. conventional = 96.3%, 92.2%, and 82.6%, respectively; log-rank P = 0.187) and freedom from major adverse cardiac and cerebral events at 1, 5, and 10 years after procedure (robotic = 90.6%, 77.7%, 70.1% vs. conventional = 94.1%, 82.2%, 66.6%; log-rank P = 0.790). Conclusions Long-term outcomes of robotic CABG are comparable with conventional CABG for selected patients. Longer operative times of robotic CABG do not influence the excellent long-term outcomes.

scholarly journals Long-term outcome after off-pump coronary artery bypass grafting: implication for public health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Rosato ◽  
F Barili ◽  
P D'Errigo ◽  
F Biancari ◽  
M Forti ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Long Term Outcomes ◽  
Off Pump ◽  
Increased Risk ◽  
Pump Cabg

Abstract Background The debate on the benefits and limitations of off-pump (OPCAB) coronary artery bypass grafting (CABG) on long-term outcomes is not yet settled. This study aimed to compare the impact of OPCAB vs on-pump CABG on long-term outcomes and to evaluate possible public health implications linked to their use. Methods The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods. Results The study population consisted of 11 021 patients who underwent isolated CABG (27.2% OPCAB). The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). OPCAB had comparable late all-cause mortality to on-pump CABG (HR 0.94, 95%CI 0.85-1.03, p = 0.19), but it was associated to an increased risk of MACE (adjusted HR 1.14, 95%CI 1.06-1.23, p = 0.001). In particular, OPCAB had an increased risk of repeated revascularization with percutaneous cardiac intervention (PCI) (adjusted HR 1.33, 95%CI 1.16-1.53, p &lt; 0.001) compared to on-pump CABG. Conclusions OPCAB does not affect long-term mortality, but it significantly increases the risk of MACEs. In particular, OPCAB had an increased risk of repeated revascularization with PCI. These findings may have important implications towards health resources allocation. Key messages Off-pump coronary artery bypass grafting strategy is associated with an increased long-term risk of MACE and repeated PCI. Off-pump strategy is mainly based on operator preferences and can have important implications in terms of healthcare costs.

scholarly journals Hemoglobin A1c in Patients with Diabetes Predict Long-Term Mortality Following Coronary Artery Surgery

2021 ◽  
Vol 10 (12) ◽  
pp. 2739
Author(s):  
Muhammad Abu Tailakh ◽  
Shlomo-yaron Ishay ◽  
Jenan Awesat ◽  
Liat Poupko ◽  
Gidon Sahar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Hemoglobin A1c ◽  
Smoking Status ◽  
Artery Bypass ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Hba1c Levels

Objective: to estimate the association between preoperative hemoglobin A1c (HbA1c) levels below and above 7%, and the rate of all-cause mortality (ACM) in diabetes mellitus (DM) patients after coronary artery bypass grafting (CABG) within a ten-year follow-up period. Methods: we collected data on patient HbA1c levels that were measured up to 3 months prior to isolated CABG in consecutive patients with DM, and analyzed the rates of ACM over a median of a 5.9-year post-operative period. Results: preoperative HbA1c levels were collected in 579 DM patients. The mean HbA1c was 8.0 ± 1.7%, where 206 (35.6%) patients had an HbA1c ≤ 7% and 373 (64.4%) had an HbA1c > 7%. During the follow-up period, mortality rates were 20.4% and 28.7% in the HbA1c ≤ 7% and HbA1c > 7% groups, respectively (Kaplan-Meier estimates, log-rank p = 0.01). Multivariable Cox proportional hazards regression, adjusted for age, gender, smoking status, chronic obstructive pulmonary disease, hypertension, chronic renal failure, old myocardial infarction, number of coronary artery bypass surgeries, and post-operative glycemic control, showed a hazard ratio of 2.67 for long-term ACM (p = 0.001) in patients with HbA1c > 7%. Conclusions: DM patients with high HbA1c levels prior to CABG are at higher risk for long-term complications, especially late ACM.

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

Off-Pump Versus On-Pump: Long-Term Outcomes After Coronary Artery Bypass in a Veteran Population

2019 ◽  
Vol 33 (5) ◽  
pp. 1187-1194 ◽  
Author(s):  
Nisha Parmeshwar ◽  
Katherine E. Fero ◽  
Gerard Manecke ◽  
Joelle M. Coletta
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Off Pump
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