Propensity-Score Analysis of Early Outcomes after Bilateral versus Single Internal Thoracic Artery Grafting

2008 ◽  
Vol 3 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Sorin V. Pusca ◽  
Patrick D. Kilgo ◽  
J. David Vega ◽  
William A. Cooper ◽  
Thomas A. Vassiliades ◽  
...  
Keyword(s):  
Propensity Score ◽  
Internal Thoracic Artery ◽  
Propensity Score Analysis ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Deep Sternal Wound Infection ◽  
Treatment Type ◽  
Increased Risk

Objective The use of bilateral internal thoracic arteries (BITAs) during coronary artery bypass grafting (CABG) improves long-term and event-free survival compared with single internal thoracic artery (SITA) grafting. It is controversial whether BITA grafting alters in-hospital adverse events after CABG. Methods Isolated CABG cases using BITA or SITA at a single US academic center between January 1, 1997 and June 30, 2006 were retrospectively reviewed. A propensity score was used as a covariate to balance the treatment groups (BITA and SITA) with respect to 44 preoperative risk factors. A multivariable logistic regression model tested whether treatment type was significantly associated with in-hospital death, deep sternal wound infection (DSWI), or hospital length of stay (LOS). Results There were 599 BITA and 10,212 SITA cases performed. Overall for all BITA versus SITA cases, adjusted mortality (0.8% vs. 1.7%, P = 0.85) was not different between the groups. However, adjusted incidence of DSWI (2.0% vs. 1.2%, P = 0.036) and LOS (6.7 vs. 6.1, P = 0.025) were significantly higher in BITA patients. Subsets analyses of obese patients and diabetic patients revealed no statistical differences for any of the outcomes between BITA and SITA. Conclusions The long-term benefits of BITA grafting do not come at the cost of increased adjusted risk of in-hospital death. BITA grafting was associated with an increased risk of DSWI and a longer adjusted LOS. Neither obesity, nor diabetes significantly increased the risk of poor outcomes after BITA.

14-Year Results of Bilateral versus Single Internal Thoracic Artery Grafts for Left-Sided Myocardial Revascularization in Young Diabetic Patients

2016 ◽  
Vol 65 (04) ◽  
pp. 272-277 ◽  
Author(s):  
Alem Delalic ◽  
Edgar Eszlari ◽  
Walter Eichinger ◽  
Brigitte Gansera
Keyword(s):  
Internal Thoracic Artery ◽  
Survival Rates ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Diabetic Patients ◽  
Deep Sternal Wound Infection ◽  
Term Survival ◽  
Increased Risk

Objectives Despite encouraging late outcomes, the use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization in diabetic patients remains controversial because of an increased risk of sternal wound complications. In the present study, early- and long-term outcomes of the use of left-sided BITA versus single internal thoracic artery (SITA) grafting in young (< 65 years of age) diabetic patients were reviewed retrospectively. Methods A total of 250 propensity score pair-matched diabetic patients, operated on between February 2000 and December 2011, receiving either BITA (n = 125) or SITA (n = 125) grafting were analyzed retrospectively. In each group, 104 patients were males, and mean age was 60.1 ± 5.3 years. Follow-up was 2.1 to 14.8 years (mean, 9.3 ± 3.5 years) and complete for 100%. Results Incidence of deep sternal wound infection was 2.4 versus 3.2% (p = 0.722). Rethoracotomy due to bleeding occurred in 4.8 versus 3.2% (p = 0.608). The 5-, 10-, and 14-year estimates of survival were 93.4, 76.6, and 67.5% (BITA) versus 89.5, 81.5, and 32.8% (SITA); p = 0.288. Freedom from reangiography/intervention (60.5 vs. 63.9%) during follow-up was comparable (p = 0.507) as well as infarction rate (93.8 vs. 95.1%, p = 0.833) and redoes (p = 0.672, exclusively valve surgery) were comparable. Freedom from thromboembolic or cerebrovascular events did not show any significant differences (94.0 vs. 94.0%, p = 0.78). Multivariate analysis identified poor ejection fraction as predictor for decreased long-term survival. Neither age nor gender or urgency had an influence on long-term mortality. Conclusion Left-sided BITA grafting may be performed routinely even in diabetic patients without increased incidence of postoperative wound-healing complications. Survival rates after 5, 10, and 14 years were comparable for BITA and SITA grafting.

scholarly journals Mortality in childhood-onset type 1 diabetes: Nationwide population based data from Norway

2013 ◽  
Vol 23 (1) ◽  
Author(s):  
Torild Skrivarhaug
Keyword(s):  
Type 1 Diabetes ◽  
Premature Mortality ◽  
Diabetic Coma ◽  
Diabetic Patients ◽  
Childhood Onset ◽  
Onset Type ◽  
Treatment Type ◽  
Increased Risk

Type 1 diabetes with onset in childhood (0-14.9 years) represents one of the most frequent chronic diseases in children and young adults. Norway has one of the highest incidences of childhood onset type 1 diabetes in the world. Before introduction of insulin therapy in 1922, few children survived more than one to two years after clinical onset. When insulin came available, a major shift occurred in the distribution of causes of death in type 1 diabetic patients away from diabetic coma, which dominated the pre-insulin era, to renal and cardiac diseases. The disease is related to a significant burden to society and patients because most cases require lifelong treatment with insulin as well as day-to-day monitoring. Type 1 diabetes also confers increased risk of severe late complications such as renal failure, blindness, amputations, heart disease and stroke. Despite advances in diabetes treatment, type 1 diabetes is still associated with considerable premature mortality resulting from acute and chronic complications of diabetes and an increase in mortality at every age. Although the main cause of death in type 1 diabetes is long-term complications, an excess death rate has also been reported in subjects with short duration without signs of long-term complications.

Preoperative Hemoglobin A1c Predicts Sternal Wound Infection after Coronary Artery Bypass Surgery with Bilateral versus Single Internal Thoracic Artery Grafts

2008 ◽  
Vol 3 (3) ◽  
pp. 131-138 ◽  
Author(s):  
Michael E. Halkos ◽  
Vinod H. Thourani ◽  
Omar M. Lattouf ◽  
Patrick Kilgo ◽  
Robert A. Guyton ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Propensity Score ◽  
Wound Infection ◽  
Hemoglobin A1c ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Sternal Wound Infection ◽  
Preoperative Hemoglobin ◽  
Increased Risk

Objective Bilateral internal thoracic artery (BITA) grafting during coronary artery bypass (CABG) improves long-term and event-free survival but may carry a higher risk of wound complications. It is unknown whether preoperative hemoglobin A1c (HbA1c), a measure of long-term glucose control, predicts deep sternal wound infection (DSWI) after BITA grafting. Methods Of 6356 consecutive patients who underwent isolated CABG between January 1, 2002 and March 30, 2007 and received at least one internal thoracic artery graft, 5199 (81.8%) had preoperative HbA1c levels obtained. BITA grafting was performed in 622 (9.8%) patients. A propensity score measured each patient's probability of having BITA versus single ITA based on 52 risk factors. The primary endpoint was DSWI. Multivariable logistic models with adjusted odds ratios (AOR) examined the effect of HbA1c, BITA grafting, and their interaction on outcomes, adjusted for the propensity score and postoperative glucose levels. Results Patients undergoing BITA grafting with HbA1c ≥7% had a higher incidence of DSWI compared with patients with HbA1c <7% (5.0% vs. 1.4%, P = 0.014). After multivariable adjustment, BITA was associated with an increased risk of DSWI (AOR = 2.84, 95% confidence interval 1.41–5.74) in all patients (P = 0.004). For each unit increase in HbA1c, there was a 31% increased risk of DSWI (AOR = 1.31, 95% CI 1.16–1.49, P < 0.001). Patients with HbA1c ≥7% had 2.88-fold increase in DSWI compared with patients with HbA1c <7%. Conclusions Elevated preoperative HbA1c and BITA grafting were significant predictors of DSWI after CABG. Elevated HbA1c level should be considered in the risk/benefit analysis when selecting patients for BITA grafting.

scholarly journals Bilateral internal thoracic artery versus single internal thoracic artery: a meta-analysis of propensity score-matched observational studies

2019 ◽  
Vol 29 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Stefano Urso ◽  
Eliú Nogales ◽  
Jesús María González ◽  
Rafael Sadaba ◽  
María Ángeles Tena ◽  
...  
Keyword(s):  
Propensity Score ◽  
Wound Infection ◽  
Risk Ratio ◽  
Internal Thoracic Artery ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Deep Sternal Wound Infection ◽  
Term Survival ◽  
Long Term Survival

Abstract The lack of benefit in terms of mid-term survival and the increase in the risk of sternal wound complications published in a recent randomized controlled trial have raised concerns about the use of bilateral internal thoracic artery (BITA) in myocardial revascularization surgery. For this reason, we decided to explore the current evidence available on the subject by carrying out a meta-analysis of propensity score-matched studies comparing BITA versus single internal thoracic artery (SITA). PubMed, EMBASE and Google Scholar were searched for propensity score-matched studies comparing BITA versus SITA. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The DerSimonian and Laird method was used to compute the combined risk ratio of 30-day mortality, deep sternal wound infection and reoperation for bleeding. Forty-five BITA versus SITA matched populations were included. Meta-analysis showed a significant benefit in terms of long-term survival in favour of the BITA group [HR 0.78; 95% confidence interval (CI) 0.71–0.86]. These results were consistent with those obtained by a pooled analysis of the matched populations comprising patients with diabetes (HR 0.65; 95% CI 0.43–0.99). When compared with the use of SITA plus radial artery, BITA did not show any significant benefit in terms of long-term survival (HR 0.86; 95% CI 0.69–1.07). No differences between BITA and SITA groups were detected in terms of 30-day mortality or in terms of reoperation for bleeding. Compared with the SITA group, patients in the BITA group had a significantly higher risk of deep sternal wound infection (risk ratio 1.66; 95% CI 1.41–1.95) even when the pooled analysis was limited to matched populations in which BITA was harvested according to the skeletonization technique (risk ratio 1.37; 95% CI 1.04–1.79). The use of BITA provided a long-term survival benefit compared with the use of SITA at the expense of a higher risk of sternal deep wound infection. The long-term survival advantage of BITA is undetectable when compared with SITA plus radial artery.

Effect of race/ethnicity and treatment delay on breast cancer survival

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6063-6063
Author(s):  
S. Sheinfeld Gorin ◽  
J. E. Heck ◽  
B. Cheng ◽  
S. Smith
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Cancer Treatment ◽  
Propensity Score Analysis ◽  
Large Population ◽  
Treatment Delay ◽  
Breast Cancer Treatment ◽  
Treatment Type ◽  
Increased Risk ◽  
Race Ethnicity

6063 Background: Several papers have examined the relationship between treatment delay and survival among patients who are diagnosed with cancer. None has yet relied on a large, population-based dataset to systematically examine survival among women within different ethnic/racial groups who delay breast cancer treatment. Methods: Subjects were 49,865 female Medicare enrollees age 65 and older who were diagnosed with breast cancer between 1992 and 1999 and identified by the Surveillance, Epidemiology, and End Results (SEER) program. Dates of their health care visits were identified through the linkage of SEER with Medicare claims data. Mortality from breast cancer was assessed through linkage with death certificates. Propensity score analyses that compared patients matched according to their propensity to receive treatment were used to balance patient characteristics between treatment groups, as would occur in a randomized clinical trial. Results: A propensity score analysis and a Cox proportional hazards model of survival (with adjustments for ER/PR status, treatment type, race/ethnicity, stage, age, comorbidities, marital status, poverty status, geographic location, and average number of service contacts) revealed that subjects with 1-month delay in the start of treatment had a reduced likelihood of survival (adjusted HR=1.17, 95% CI, 1.06–1.30) relative to those with less delay. Blacks had significantly lessened survival than women in other races/ethnicities (adjusted HR=1.23, 95% CI, 1.00–1.52). Receipt of radiation (adjusted HR=1.45, 95% CI, 1.24–1.69), chemotherapy (adjusted HR=1.73, 95% CI, 1.51–1.99), stage three diagnosis (adjusted HR=1.35, 95% CI, 1.08–1.70), being age 70 or older (adjusted HR=1.24, 95% CI, 1.09–1.41), or having 2 or more comorbidities (adjusted HR=1.47, 95% CI, 1.12–1.92) also predicted reduced survival from breast cancer. Conclusions: One month delay in accessing breast cancer treatment has a clear relationship to reduced survival, particularly among older, later-stage, comorbid black women who receive chemotherapy or radiation. Mechanisms for rapid access to treatment, using both provider- and system-based strategies, are recommended for these women who are at increased risk for breast cancer-related mortality. No significant financial relationships to disclose.

scholarly journals Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kawai ◽  
D Nakatani ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Plasma Volume ◽  
Cox Regression ◽  
Volume Status ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status. Methods To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years. Results During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247). Conclusion Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status. Funding Acknowledgement Type of funding source: None

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