Abstract 3246: Skeletonization of Internal Thoracic Arteries: Is it Safe in Long-term?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Arnaud Mommerot ◽  
Raymond Cartier
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cox Regression ◽  
Wound Infection Rate ◽  
Cardiac Events ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Opcab Surgery

Background: Skeletonization of internal thoracic arteries (ITA) is a popular technique in OPCAB surgery to increase length of arterial conduit and feasibility of «No-touch» revascularization. Impact of skeletonized (SK) ITA on long-term survival and cardiac events is not clearly defined. Methods: We reviewed 1000 consecutive patients having undergone OPCAB surgery at the Montreal Heart Institute, between September 1996 and March 2004 that were prospectively recorded in an OPCAB database. Among them, 994 had at least one ITA bypass. Results: Skeletonized ITA was used in 558 patients (56.1%). SK patients were older (p=0.045), had significantly more risk factors [dyslipidemia (p<0.001), hypertension (p<0.001), obesity (p=0.002)]. Preoperative Parsonnet score was not different between SK and non-SK groups. Use of bilateral ITA (p<0.001) and sequential grafting (p<0.001) were more frequent in SK group (36.6% vs 25.7% and 29.9% vs 0.7%, respectively). Operative mortality was similar (SK: 1.8% vs non-SK: 1.6%; p=0.82). Sternal wound infection rate was similar, but dehiscence rate was higher in the PD group (p=0.03). Hospital (p=0.27) and ICU (p=0.09) length of stay were similar in both groups. Overall 7-year survival was 83±2% in SK group and 80±2% in non-SK group (p=0.84). Long-term freedom from major adverse cardiac events was also similar between SK and non-SK groups (83±2% and 82±2%, respectively, p=0.4). Late rate rehospitalization for heart failure or revascularization (CABG or PCI) was similar for both groups. However, 7-year freedom from myocardial infarction was significantly better for non-SK group (p=0.04). By Cox regression analysis, COPD, cardiac heart failure, peripheral vascular disease, emergency and completeness of revascularization were independent predictors of late mortality whereas diabetes, skeletonization and the number of grafts by territory of revascularization were independent predictors of late myocardial infarction. Conclusion: ITA has no influence in long-term survival or major cardiac events in an all comer OPCAB population. However, SK and diabetes were predictors of late incidence of myocardial infarction. Thus, a word of caution should be made about skeletonization of the ITA in diabetic population.

scholarly journals Long-term survival benefit of ramipril in patients with acute myocardial infarction complicated by heart failure

Heart ◽  
2021 ◽  
Vol 107 (5) ◽  
pp. 389-395
Author(s):  
Jianhua Wu ◽  
Alistair S Hall ◽  
Chris P Gale
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Life Expectancy ◽  
Survival Benefit ◽  
Ace Inhibition ◽  
Survival Times ◽  
Term Survival ◽  
Long Term Survival

AimsACE inhibition reduces mortality and morbidity in patients with heart failure after acute myocardial infarction (AMI). However, there are limited randomised data about the long-term survival benefits of ACE inhibition in this population.MethodsIn 1993, the Acute Infarction Ramipril Efficacy (AIRE) study randomly allocated patients with AMI and clinical heart failure to ramipril or placebo. The duration of masked trial therapy in the UK cohort (603 patients, mean age=64.7 years, 455 male patients) was 12.4 and 13.4 months for ramipril (n=302) and placebo (n=301), respectively. We estimated life expectancy and extensions of life (difference in median survival times) according to duration of follow-up (range 0–29.6 years).ResultsBy 9 April 2019, death from all causes occurred in 266 (88.4%) patients in placebo arm and 275 (91.1%) patients in ramipril arm. The extension of life between ramipril and placebo groups was 14.5 months (95% CI 13.2 to 15.8). Ramipril increased life expectancy more for patients with than without diabetes (life expectancy difference 32.1 vs 5.0 months), previous AMI (20.1 vs 4.9 months), previous heart failure (19.5 vs 4.9 months), hypertension (16.6 vs 8.3 months), angina (16.2 vs 5.0 months) and age >65 years (11.3 vs 5.7 months). Given potential treatment switching, the true absolute treatment effect could be underestimated by 28%.ConclusionFor patients with clinically defined heart failure following AMI, ramipril results in a sustained survival benefit, and is associated with an extension of life of up to 14.5 months for, on average, 13 months treatment duration.

scholarly journals NT-proBNP and postoperative heart failure in surgery for aortic stenosis

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001063 ◽  
Author(s):  
Huiqi Jiang ◽  
Farkas Vánky ◽  
Henrik Hultkvist ◽  
Jonas Holm ◽  
Yanqi Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Cox Regression ◽  
Preoperative Evaluation ◽  
Area Under The Curve ◽  
Term Survival ◽  
Long Term Survival ◽  
Clinical Endpoints ◽  
Long Term Consequences

ObjectivePostoperative heart failure (PHF) after aortic valve replacement (AVR) for aortic stenosis (AS) may initially appear mild and transient but has serious long-term consequences. Methods to assess PHF are not well documented. We studied the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and PHF after AVR for AS.MethodsThis is a prospective, observational, longitudinal study of 203 patients undergoing elective first-time AVR for AS. Plasma NT-proBNP was assessed at preoperative evaluation, the day before surgery, and the first (POD1) and third postoperative morning. A clinical endpoints committee, blinded to NT-proBNP results, used prespecified haemodynamic criteria to diagnose PHF. The mean follow-up was 8.6±1.1 years.ResultsNo patient with PHF (n=18) died within 30 days after surgery, but PHF was associated with poor long-term survival (HR 3.01, 95% CI 1.45 to 6.21, p=0.003). NT-proBNP was significantly higher in patients with PHF only on POD1 (6415 (3145–11 220) vs 2445 (1540–3855) ng/L, p<0.0001). NT-proBNP POD1 provided good discrimination of PHF (area under the curve=0.82, 95% CI 0.72 to 0.91, p<0.0001; best cut-off 5290 ng/L: sensitivity 63%, specificity 85%). NT-proBNP POD1 ≥5290 ng/L identified which patients with PHF carried a risk of poor long-term survival, and PHF with NT-proBNP POD1 ≥ 5290 ng/L emerged as a risk factor for long-term mortality in the multivariable Cox regression (HR 6.20, 95% CI 2.72 to 14.1, p<0.0001).ConclusionsThe serious long-term consequences associated with PHF after AVR for AS were confirmed. NT-proBNP level on POD1 aids in the assessment of PHF and identifies patients at particular risk of poor long-term survival.

scholarly journals Application value of nomogram and prognostic factors of gastric cancer patients who underwent D2 radical lymphadenectomy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Guang-Chuan Mu ◽  
Yuan Huang ◽  
Zhi-Ming Liu ◽  
Xiang-Hua Wu ◽  
Xin-Gan Qin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Cox Regression ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Gastric Cancer Patients

Abstract Background The aim of this study was to explore the prognostic factors and establish a nomogram to predict the long-term survival of gastric cancer patients. Methods The clinicopathological data of 421 gastric cancer patients, who were treated with radical D2 lymphadenectomy by the same surgical team between January 2009 and March 2017, were collected. The analysis of long-term survival was performed using Cox regression analysis. Based on the multivariate analysis results, a prognostic nomogram was formulated to predict the 5-year survival rate probability. Results In the present study, the total overall 3-year and 5-year survival rates were 58.7 and 45.8%, respectively. The results of the univariate Cox regression analysis revealed that tumor staging, tumor location, Borrmann type, the number of lymph nodes dissected, the number of lymph node metastases, positive lymph nodes ratio, lymphocyte count, serum albumin, CEA, CA153, CA199, BMI, tumor size, nerve invasion, and vascular invasion were prognostic factors for gastric cancer (all, P < 0.05). However, merely tumor staging, tumor location, positive lymph node ratio, CA199, BMI, tumor size, nerve invasion, and vascular invasion were independent risk factors, based on the results of the multivariate Cox regression analysis (all, P < 0.05). The nomogram based on eight independent prognostic factors revealed a well-degree of differentiation with a concordance index of 0.76 (95% CI: 0.72–0.79, P < 0.001), which was better than the AJCC-7 staging system (concordance index = 0.68). Conclusion The present study established a nomogram based on eight independent prognostic factors to predict long-term survival in gastric cancer patients. The nomogram would be beneficial for more accurately predicting the prognosis of gastric cancer, and provide important basis for making individualized treatment plans following surgery.

Safety and Feasibility of Thoracoscopic Lung Resection for Non-Small-Cell Lung Cancer in Octogenarians

2020 ◽  
pp. 155698452097162
Author(s):  
Xiaoying Lou ◽  
Andrew Sanders ◽  
Kaustubh Wagh ◽  
Jose N. Binongo ◽  
Manu Sancheti ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cox Regression ◽  
Lung Resection ◽  
Small Cell ◽  
Small Cell Lung ◽  
Preoperative Risk ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis

Objective Octogenarians comprise an increasing proportion of patients presenting with non-small-cell lung cancer (NSCLC). This study examines postoperative morbidity and mortality, and long-term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC, compared with younger cohorts. Methods We conducted a retrospective review of our institutional Society of Thoracic Surgeons General Thoracic Surgery Database of all patients ≥60 years old undergoing elective lobectomy or segmentectomy for pathologic stage I, II, and IIIA NSCLC between 2009 and 2018. Results were compared between octogenarians ( n = 71) to 2 younger cohorts of 60- to 69-year-olds ( n = 359) and 70- to 79-year-olds ( n = 308). Long-term survival among octogenarians was graphically summarized using the Kaplan–Meier method. Cox regression analysis was used to identify preoperative risk factors for mortality. Results A greater proportion of octogenarians required intensive care unit admission and discharge to extended-care facilities; however, postoperative length of stay was similar between groups. Among postoperative complications, arrhythmia and renal failure were more likely in the older cohort. Compared to the youngest cohort, in-hospital and 30-day mortality were highest among octogenarians. Overall survival among octogenarians at 1, 3, and 5 years was 87.3%, 61.8%, and 50.5%, respectively. On multivariable Cox regression analysis of baseline demographic variables, presence of stroke (hazard ratio [HR] = 28.5, 95% confidence interval [CI]: 6.1 to 132.7, P < 0.001) and coronary artery disease (HR = 2.5, 95% CI: 1.2 to 5.3, P = 0.02) were significant predictors of overall mortality among octogenarians. Conclusions Thoracoscopic resection can be performed with favorable early postoperative outcomes among octogenarians. Long-term survival, although comparable to their healthy peers, is worse than those of younger cohorts. Further study into preoperative risk stratification and alternative therapies among octogenarians is needed.

scholarly journals Impact of aspirin and statins on long-term survival in patients hospitalized with acute myocardial infarction complicated by heart failure: an analysis of 1706 patients

2013 ◽  
Vol 16 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Christian Lewinter ◽  
John M. Bland ◽  
Simon Crouch ◽  
John G.F. Cleland ◽  
Patrick Doherty ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Term Survival ◽  
Long Term Survival

Histology, not Lymph Node Involvement, Predicts Long-Term Survival in Bronchopulmonary Carcinoids

2011 ◽  
Vol 77 (12) ◽  
pp. 1669-1674 ◽  
Author(s):  
Rebecca Johnson ◽  
Steven Trocha ◽  
Marc Mclawhorn ◽  
Mitchell Worley ◽  
Grace Wheeler ◽  
...  
Keyword(s):  
Lymph Node ◽  
Cox Regression ◽  
Lymph Node Involvement ◽  
Term Survival ◽  
Pulmonary Carcinoid ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Node Involvement ◽  
Bronchopulmonary Carcinoid

Recently, the incidence of bronchopulmonary carcinoid has increased substantially, whereas survival associated with both subtypes has declined. We reviewed our experience with bronchopulmonary carcinoid to identify factors associated with long-term survival. We reviewed our cancer registry from 1985 to 2009 for all patients undergoing surgical resection for bronchopulmonary carcinoid. Cox regression analysis was used to evaluate prognostic factors. Fifty-two patients met criteria for inclusion. Forty-three patients (82%) presented with typical histology. The likelihood of lymph node metastasis was similar for patients with typical histology and patients with atypical histology. For patients with typical histology, the 5-year survival rates with and without lymph node metastases were 100 per cent and 97 per cent, respectively ( P = 0.420). The overall survival rate for patients with typical histology (97% at 5 years; 72% at 10 years) was significantly better than for patients with atypical histology (35% at 5 years, 0% at 10 years) ( P < 0.001). Univariate and multivariate analyses demonstrated that long-term survival was associated with histology but not lymph node involvement (hazards ratio = 14.6, 95% confidence interval: 1.7, 125.2). Our data suggests that long-term survival is associated with histology, not lymph node involvement. We found tumor histology to be the strongest predictor of long-term survival in patients with pulmonary carcinoid tumors.

Long-term survival outcomes of intravenous versus intraperitoneal chemotherapy in the treatment of advanced ovarian cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6046-6046 ◽  
Author(s):  
Rachel Soyoun Kim ◽  
Manjula Maganti ◽  
Marcus Bernardini ◽  
Stephane Laframboise ◽  
Sarah E. Ferguson ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cox Regression ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis

6046 Background: The role of intraperitoneal (IP) chemotherapy in the management of advanced ovarian cancer has been questioned given emerging evidence showing lack of survival benefits. The objective of this study was to compare the long-term survival associated with IP chemotherapy at a tertiary cancer center. Methods: We reviewed the long-term survival records of 271 women with stage IIIC or IV high-grade serous ovarian cancer treated with primary cytoreductive surgery (PCS) followed by IP or intravenous (IV) chemotherapy between 2001-2015 with a minimum follow-up of 4 years. 5-year progression free (PFS) and overall survival (OS) rates were compared using Kaplan-Meier survival analysis and covariates were evaluated using Cox regression analysis. Results: Women who received IP chemotherapy after PCS (n = 91) were more likely to have undergone aggressive surgery (p < 0.001), longer surgery (p < 0.001), and had no residual disease (p < 0.001) compared to the IV arm (n = 180). Median follow-up was 51.6 months. Five-year PFS was 19% vs. 18% (p = 0.63) and OS was 73% vs. 44% (p = 0.00016) in the IP vs. IV arms, respectively. After controlling for covariates in a multivariable model, the use of IP was no longer a significant predictor of OS in the entire cohort (p = 0.12). In patients with 0mm residual disease, PFS was 28% vs. 26% (p = 0.67) and OS was 81% vs. 60% (p = 0.059) in IP (n = 61) vs. IV (n = 69), respectively. In patients with residual of 1-9mm, PFS was 30% vs. 48% (p = 0.076) and OS was 60% vs. 43% (p = 0.74) in IP (n = 29) vs. IV (n = 31), respectively. Conclusions: IP chemotherapy showed a trend towards improved survival over conventional IV chemotherapy, especially in patients with no residual disease. Given the retrospective nature and small numbers in this study, prospective non-randomized cohort studies are warranted to evaluate the role of IP chemotherapy in advanced ovarian cancer.

Abstract 1144: Complete Revascularization of Patients Undergoing Multivessel PCI is an Independent Predictor of Improved Long-Term Survival

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ralf Lehmann ◽  
Laura Held ◽  
Carola Hobler ◽  
Gregor Baier ◽  
Stephan Fichtlscherer ◽  
...  
Keyword(s):  
Cox Regression ◽  
Treatment Strategies ◽  
Female Gender ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
Prognostic Impact ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis

The prognostic relevance of completeness of revascularization (CR) in patients with coronary multivessel disease (MV-CAD) has so far only been established for surgical treatment strategies. Therefore we investigated the prognostic impact of CR in patients with CAD undergoing multivessel PCI (MV-PCI). Long-term survival was assesed in 679 consecutive patients (pts), who underwent MV-PCI. 47% were treated for acute myocardial infarction. We adapted two common definitions of CR from the CABG trials for our study population: ARTS -successful treatment of all relevant lesions; BARI - no residual stenosis in the LAD. CR according to the ARTS definition was achieved in 73% of the stable patients as compared to only 61% in acute pts. CR (BARI) was achieved in 95% of all pts. Patients with CR demonstrated a better long-term survival (see figure ). Using a multivariable cox regression analysis, procedural factors such as left main PCI, number of diseased vessels, number of treated lesions, number of stents, total stent length, and acuity of underlying CAD did not predict survival. Independent predictors (p<0.05) of long-term mortality were age (> 60y HR 2.36), reduced LVEF (LVEF<40% HR 3.44), female gender (HR 1.67), chronic renal failure (creatinine > 200 mmol/l HR 2.68), elevated CRP (HR 2.09) as well as CR (ARTS; HR 0.46). An open LAD after procedure and PCI on at least one additional vessel (BARI) did not independently predict improved survival. Achievement of CR of all segments is associated with improved survival after PCI in pts with multivessel disease, regardless of the indication for PCI (acute MI or stable CAD).

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