Long-term survival in patients who had CABG with or without prior coronary artery stenting

ObjectiveTo conduct a large-scale, single-centre retrospective cohort study to understand the impact of prior percutaneous coronary intervention (PCI) on long-term survival of patients who then undergo coronary artery bypass graft (CABG).MethodsBetween 1999 and 2017, a total of 11 332 patients underwent CABG at a hospital in the UK. The patients were stratified into those who received PCI (n=1090) or no PCI (n=10 242) prior to CABG. A total of 1058 patients from each group were matched using propensity score matching. Kaplan-Meier estimates were used to assess risk-adjusted survival in patients with prior PCI. Cox proportional hazards (CoxPH) model was then used to assess the effect of prior PCI and other variables in patients undergoing CABG.ResultsThe immediate postoperative outcome showed no difference in number of grafts per patients, blood transfusion, hospital stay or 30 days mortality between the groups. There was no significant difference in 5 years (90.8% vs 87.9), 10-year (76.5% vs 74.6%) and 15-year (64.4% vs 64.7%) survival between the non-PCI versus PCI groups. The Cox proportional hazards model further supports the null hypothesis as the PCI variable was found to be non-significant (CoxPH=1.03, p=0.75, CI=0.87–1.22) implying there was no difference in hazard of death for CABG patients with or without previous PCI. However, the model did yield information on the covariates that do affect the hazard of death.ConclusionThere is no difference in 5-year, 10-year and 15-year survival between patients undergoing CABG with or without prior PCI. However, certain patient, preoperative and intraoperative risk factors were identified with high hazard of death which needs to be investigated further.

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The long-term prognosis of pneumomediastinum associated with dermatomyositis: a two-centre retrospective cohort study

Rheumatology ◽

10.1093/rheumatology/keaa582 ◽

2020 ◽

Author(s):

Can Li ◽

Mei’e Liang ◽

Hui Jiang ◽

Jiuliang Zhao ◽

Chanyuan Wu ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Term Survival ◽

Long Term Survival ◽

Hazards Model ◽

Long Term Prognosis

Abstract Objectives Pneumomediastinum (PnM) is a rare but life-threatening complication of DM. The present study aims to characterize the long-term prognosis and prognostic factors of DM-associated PnM. Methods Inpatients with DM-associated PnM were retrospectively enrolled from two tertiary referral centres for rheumatic disease. The enrolled patients were divided into survivors or non-survivors. Information about the demographics, clinical manifestations, CT scan features, laboratory findings and outcomes were collected from their medical records. A least absolute shrinkage and selection operator regularized Cox regression model was used to select the most relevant factors. Prognosis was analysed using a Kaplan–Meier curve. A Cox proportional hazards model was used to identify independent predictive factors for long-term survival. Results A total of 62 patients (26 women) with DM-associated PnM were enrolled. The mean age was 44.3 years (s.d. 11.7). The median follow-up duration was 17 days (quartiles 7, 266.5). Thirty-five patients died during follow-up. The survival rates were 75.4% at 1 week, 46.2% at 3 months and 41.9% at 1 year. The Cox proportional hazards model identified the development of fever [hazard ratio (HR) 3.23 (95% CI 1.25, 8.35), P = 0.02] and a decrease in the number of lymphocytes [HR 2.19 (95% CI 1.10, 4.39), P = 0.03] as independent risk factors for death. Conclusion The results suggest poor overall survival among patients with DM-associated PnM. Survival during the first 3 months is crucial for long-term survival. Meanwhile, the development of fever and a decrease in the number of lymphocytes were associated with long-term mortality. Early recognition and prompt treatment of this high-risk group of DM patients is therefore important.

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Abstract 15567: Residual Cholesterol and Cardiovascular Events in Patients With Coronary Artery Disease Under Different Glucose Metabolism Status

Circulation ◽

10.1161/circ.142.suppl_3.15567 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jian-jun Li ◽

Yexuan Cao ◽

Hui-Wen Zhang ◽

Jing-Lu Jin ◽

Yan Zhang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Glucose Metabolism ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Significant Difference ◽

Artery Disease

Introduction: The atherogenicity of residual cholesterol (RC) has been underlined by recent guidelines, which was linked to coronary artery disease (CAD), especially for patients with diabetes mellitus (DM). Hypothesis: This study aimed to examine the prognostic value of plasma RC, clinically presented as triglyceride-rich lipoprotein-cholesterol (TRL-C) or remnant-like lipoprotein particles-cholesterol (RLP-C), in CAD patients with different glucose metabolism status. Methods: Fasting plasma TRL-C and RLP-C levels were directly calculated or measured in 4331 patients with CAD. Patients were followed for incident MACEs for up to 8.6 years and categorized according to both glucose metabolism status [DM, pre-DM, normal glycaemia regulation (NGR)] and RC levels. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals. Results: During a mean follow-up of 5.1 years, 541 (12.5%) MACEs occurred. The risk for MACEs was significantly higher in patients with elevated RC levels after adjustment for potential confounders. No significant difference in MACEs was observed between pre-DM and NGR groups (p>0.05). When stratified by status of glucose metabolism and RC levels, highest levels of RLP-C, calculated and measured TRL-C were significant and independent predictors of developing MACEs in pre-DM (HR: 2.10, 1.98, 1.92, respectively; all p<0.05) and DM (HR: 2.25, 2.00, 2.16, respectively; all p<0.05). Conclusions: In this large cohort study with long-term follow-up, data firstly demonstrated that higher RC levels were significantly associated with the worse prognosis in DM and pre-DM patients with CAD, suggesting RC might be a target for patients with impaired glucose metabolism.

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O193 ROLE OF MALNUTRITION IN 0ESOPHAGEAL SURGERY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doz092.193 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Alfieri ◽

M Nardi ◽

V Moretto ◽

E Pinto ◽

M Briarava ◽

...

Keyword(s):

Weight Loss ◽

Postoperative Complications ◽

Nutritional Status ◽

Term Survival ◽

Long Term Outcome ◽

Long Term Survival ◽

Oesophagogastric Junction ◽

Significant Difference ◽

The Impact

Abstract Aim To investigate whether preoperative malnutrition is associated with long term outcome and survival in patients undergoing radical oesophagectomy for oesophageal or oesophagogastric junction cancer. Background & Methods Dysphagia, weight loss, chemo-radiationtherapy frequently lead to malnutrition in patients with oesophageal or oesophagogastric junction cancer. Severe malnutrition is associated with higher risk of postoperative complications but little is known on the correlation with long term survival. We conducted a single center retrospective study on a prospectively collected database of patients undergoing oesophagectomy from 2008 and 2012 in order to evaluate the impact of preoperative malnutrition with postoperative outcome and long term survival. Preoperative malnutrition was classified as: prealbumin level less than 220 mg/dL (PL), MUST index (Malnutrition Universal Screeening Tool) >2 and weight loss >10%. Results 177 consecutive patients were considered: due to incomplete data 60 were excluded from the analysis that was performed on 117 patients. PL was reported in 52 (44%) patients, MUST index was recorded in 62 (53%), 58 (49%) patients presented more than 10% weight loss at the preoperative evaluation. PL was associated with more postoperative Clavien-Dindo 1-2 complications (p=0.048, OR 2.35 95%IC 1.001-5.50), no differences were observed in mortality, anastomotic leak, major pulmonary complications. MUST index was not correlated with postoperative complications nor mortality but resulted worse in patients treated with chemo-radiotherapy (p=0.046, OR 1.92 95%CI 1.011-3.64). Weight loss >10% was not associated with postoperative complications or mortality. Overall 7 years survival rate was 69%. and DFS was 68%. Malnourished patients did not differ from non-malnourished regarding age, sex, tumor site, tumor stage and histology. No significant difference in 7 years survival rates was observed in patients with PL <220 mg/dL ( 55 % vs 67%), neither in patients with MUST score>2 (58% vs 72%), nor in patients with weight loss >10% (53% vs 70%). Conclusions Malnutrition is more common in patients treated with chemoradiation therapy and it is associated with postoperative complications. However, both long term and disease free survival are not affected by preoperative nutritional status. Larger patient population and data on long term postoperative nutritional status will be analyzed in further studies.

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Predicting long-term survival after coronary artery bypass graft surgery

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx330 ◽

2017 ◽

Vol 26 (2) ◽

pp. 257-263 ◽

Cited By ~ 6

Author(s):

Md N Karim ◽

Christopher M Reid ◽

Molla Huq ◽

Samuel L Brilleman ◽

Andrew Cochrane ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Term Survival ◽

Long Term Survival

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Effects of Serum Albumin Levels on Antithrombin Supplementation Outcomes Among Patients With Sepsis-Associated Coagulopathy: A Retrospective Study

Clinical Medicine Insights: Blood Disorders ◽

10.1177/1179545x19858361 ◽

2019 ◽

Vol 12 ◽

pp. 1179545X1985836

Author(s):

Masatomo Ebina ◽

Kazunori Fujino ◽

Akira Inoue ◽

Koichi Ariyoshi ◽

Yutaka Eguchi

Keyword(s):

Retrospective Study ◽

Serum Albumin ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Term Survival ◽

Hazards Model ◽

The Relationship

Background:Severe sepsis is commonly associated with mortality among critically ill patients and is known to cause coagulopathy. While antithrombin is an anticoagulant used in this setting, serum albumin levels are known to influence serum antithrombin levels. Therefore, this study aimed to evaluate the outcomes of antithrombin supplementation in patients with sepsis-associated coagulopathy, as well as the relationship between serum albumin levels and the effects of antithrombin supplementation.Methods:This retrospective study evaluated patients who were >18 years of age and had been admitted to either of two intensive care units for sepsis-associated coagulopathy. The groups that did and did not receive antithrombin supplementation were compared for outcomes up to 1 year after admission. Subgroup analyses were performed for patients with serum albumin levels of <2.5 g/dL or ⩾2.5 g/dL.Results:Fifty-one patients received antithrombin supplementation and 163 patients did not. The Cox proportional hazards model revealed that antithrombin supplementation was independently associated with 28-day survival (hazard ratio [HR]: 0.374, P = 0.025) but not with 1 year survival (HR: 0.915, P = 0.752). In addition, among patients with serum albumin levels of <2.5 g/dL, antithrombin supplementation was associated with a significantly lower 28-day mortality rate (9.4% vs 36.8%, P = .009).Conclusion:Antithrombin supplementation may improve short-term survival, but not long-term survival, among patients with sepsis-associated coagulopathy.

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The impact of placing multiple grafts to each myocardial territory on long-term survival after coronary artery bypass grafting

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2008.09.018 ◽

2009 ◽

Vol 137 (1) ◽

pp. 60-64 ◽

Cited By ~ 5

Author(s):

Danny Chu ◽

Faisal G. Bakaeen ◽

Xing Li Wang ◽

Joseph S. Coselli ◽

Scott A. LeMaire ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Term Survival ◽

Long Term Survival ◽

Artery Bypass Grafting ◽

The Impact

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Long-term survival of the very elderly undergoing coronary artery bypass graft surgery

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(03)82840-1 ◽

2003 ◽

Vol 41 (6) ◽

pp. 529

Author(s):

Lawrence J. Dacey ◽

Frank W. Sellke ◽

Robert A. Clough ◽

Donato Sisto ◽

Reed D. Quinn ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Very Elderly ◽

Term Survival ◽

Long Term Survival

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P6355The behavior of atrial fibrillation in patients with heart failure hospitalization

European Heart Journal ◽

10.1093/eurheartj/ehz746.0951 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Fukunaga ◽

K Hirose ◽

A Isotani ◽

T Morinaga ◽

K Ando

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Significant Difference ◽

The Impact

Abstract Background Relationship between atrial fibrillation (AF) and heart failure (HF) is often compared with proverbial question of which came first, the chicken or the egg. Some patients showing AF at the HF admission result in restoration of sinus rhythm (SR) at discharge. It is not well elucidated that the restoration into SR during hospitalization can render the preventive effect for rehospitalization. Purpose To investigate the impact of restoration into SR during hospitalization for readmission rate of the HF patients showing AF. Methods We enrolled consecutive 640 HF patients hospitalized from January 2015 to December 2015. Patients data were retrospectively investigated from medical record. Patients showing atrial fibrillation on admission but unrecognized ever were defined as “incident AF”; patients with AF diagnosed before admission were defined as “prevalent AF”. Primary endpoint was a composite of death from cardiovascular disease or hospitalization for worsening heart failure. Secondary endpoints were death from cardiovascular disease, unplanned hospitalization related to heart failure, and any hospitalization. Results During mean follow up of 19 months, 139 patients (22%) were categorized as incident AF and 145 patients (23%) were categorized as prevalent AF. Among 239 patients showing AF on admission, 44 patients were discharged in SR (39 patients in incident AF and 5 patients in prevalent AF). Among incident AF patients, the primary composite end point occurred in significantly fewer in those who discharged in SR (19% vs. 42% at 1-year; 23% vs. 53% at 2-year follow-up, p=0.005). To compare the risk factors related to readmission due to HF with the cox proportional-hazards model, AF only during hospitalization [Hazard Ratio (HR)=0.37, p<0.01] and prevalent AF (HR=1.67, p=0.04) was significantly associated. There was no significant difference depending on LVEF. Conclusion Newly diagnosed AF with restoration to SR during hospitalization was a good marker to forecast future prognosis.

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Diabetes mellitus and survival of esophageal cancer patients after esophagectomy: a systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/doz098 ◽

2020 ◽

Vol 33 (2) ◽

Author(s):

Xi Zheng ◽

Xingsheng Ma ◽

Han-Yu Deng ◽

Panpan Zha ◽

Jie Zhou ◽

...

Keyword(s):

Diabetes Mellitus ◽

Esophageal Cancer ◽

Cancer Patients ◽

Meta Analysis ◽

Outcome Data ◽

Term Survival ◽

Long Term Survival ◽

Significant Difference ◽

The Impact

SUMMARY Diabetes mellitus (DM) is one of the most common comorbidities in esophageal cancer patients who undergo esophagectomy. It is well established that DM has an unfavorable impact on short-term outcomes of patients with surgically treated esophageal cancer; however, whether DM has any impact on long-term survival of these patients remains unclear. We performed the first meta-analysis to investigate the impact of DM on survival of surgically treated esophageal cancer patients. We searched the following databases systematically to retrieve relevant studies on January 2, 2019: PubMed, Embase, and Web of Science. The main outcome data consisting of 3- and 5-year overall survival (OS) rates and hazard ratios (HRs) of OS were extracted to compare survival between patients with and without DM. We finally included for meta-analysis a total of eight cohort studies involving 5,044 esophageal cancer patients who underwent esophagectomy. We found no significant difference between 3-year (risk ratio [RR] = 0.94, 95% CI: 0.73–1.21; P = 0.65) and 5-year (RR = 0.92, 95% CI: 0.80–1.08; P = 0.31) OS rates between patients with and without DM after esophagectomy. Moreover, DM was not found to be an independent predictor of OS for these patients (HR = 1.10, 95% CI: 0.65–1.84; P = 0.72). Our study suggests that DM appears to have no significant impact on long-term survival of esophageal cancer patients who undergo esophagectomy. To improve the prognosis of these patients, it may be more important to control glycemic level in patients with DM who undergo esophagectomy. However, further high-quality studies with appropriate adjustment for confounding factors are needed to verify this conclusion.

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