Does Mild Renal Failure Affect Coronary Flow Reserve after Coronary Artery Bypass Graft Surgery?

2014 ◽  
Vol 17 (1) ◽  
pp. 18 ◽  
Author(s):  
Murat Günday ◽  
Özgür Çiftçi ◽  
Mustafa Çalışkan ◽  
Mehmet Özülkü ◽  
Hakan Bingöl ◽  
...  
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Creatinine Clearance ◽  
Artery Bypass ◽  
Estimated Gfr ◽  
Flow Reserve ◽  
The Mean ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

<p><strong>Introduction</strong>: There are only a limited number of studies on the link between mild renal failure and coronary artery disease. The purpose of this study is to investigate the effects of mild renal failure on the distal vascular bed by measuring the coronary flow reserve (CFR) in transthoracic echocar-diography after coronary artery bypass grafting (CABG)</p><p><strong>Methods</strong>: The study included 52 consecutive patients (12 women and 40 men) who had undergone uncomplicated CABG. The patients were divided into 2 groups. Group 1 included patients with a preoperative glomerular filtra-tion rate (GFR) of 60-90 (mild renal failure), and group 2 included those with a GFR &gt;90. The CFR measurements were carried out through a second harmonic transthoracic Doppler echocardiography.</p><p><strong>Results</strong>: The mean age was 60.08 ± 1.56 years in group 1 and 60.33 ± 1.19 in group 2. The mean preoperative CFR was 1.79 ± 0.06 in group 1 and 2.05 ± 0.09 in group 2. The mean postoperative CFR was 2.09 ± 0.08 in group 1 and 2.37 ± 0.06 in group 2. There was a statistically significant difference between the 2 groups as to preoperative creatinine clearance, preopera-tive estimated GFR, postoperative day 7 creatinine clearance, postoperative month 6 creatinine clearance, postoperative day 7 estimated GFR, postoperative month 6 estimated GFR, pre-operative CFR, and postoperative CFR (P &lt; .05). After bypass surgery, there was a significant increase in the mean postopera-tive CFR, when compared with the mean preoperative CFR (P = .001).</p><p><strong>Conclusion</strong>: In our study, we detected a decrease in CFR in patients with mild renal failure. We believe that in patients undergoing CABG for coronary artery disease, mild renal failure can produce adverse effects due to deterioration of the microvascular bed.</p>

Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity

Angiology ◽  
2021 ◽  
pp. 000331972199141
Author(s):  
Arafat Yildirim ◽  
Mehmet Kucukosmanoglu ◽  
Fethi Yavuz ◽  
Nermin Yildiz Koyunsever ◽  
Yusuf Cekici ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vascular Disease ◽  
Operating Characteristics ◽  
Coronary Artery Disease Severity ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA2DS2-VASc, and CHA2DS2VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA ( r = 0.570), ATRIA-HSV ( r = 0.614), CHA2DS2-VASc ( r = 0.428), and CHA2DS2-VASc-HS ( r = 0.500) scores ( Ps < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA2DS2-VASc (>1, AUC: 0.746) and CHA2DS2-VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

scholarly journals Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study

2019 ◽  
Vol 20 (8) ◽  
pp. 875-882 ◽  
Author(s):  
Seong-Mi Park ◽  
Janet Wei ◽  
Galen Cook-Wiens ◽  
Michael D Nelson ◽  
Louise Thomson ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Flow Reserve ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = −0.296, P = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.

MO180CHRONIC KIDNEY DISEASE IN PATIENT WITH CHRONIC CORONARY DISEASE AFTER CORONARY REVASCULARIZATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Shavkat Muminov ◽  
Durdona Saipova
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Creatinine Concentration ◽  
Relative Dynamics ◽  
Second Year ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Background and Aims to study of renal function in patients with coronary artery disease, depending on the method of revascularization and the initial state of the kidneys. Method There were 160 patients with coronary artery disease under observation who underwent re-endovascular procedures (RE). The average age of the patients was 56.6 ± 1.27 years. Coronary artery bypass grafting (CABG group) was performed in 21 patients with coronary artery disease and percutaneous coronary intervention (PCI group) - in 139 patients. The study included patients with an eGFR of at least 60 ml / min, determined by the serum creatinine concentration. Patients received standard therapy: antiplatelet therapy (double therapy), bisoprolol, valsartan, atorvastatin. All patients underwent dynamic determination of serum creatinine concentration in terms of 3 months - 1 year -2 years. Results The CABG groups (21 patients) and the PTCA group (139 patients) who received standard therapy for coronary artery disease (group B). In the CABG and PCI groups, the eGFR was 105.66 ± 3.74 ml / min and 102.71 ± 1.59 ml / min, respectively. By the 3rd month of follow-up, the dynamics of eGFR in the groups, did not differ (-16.36 ± 3.30% and -17.55 ± 1.25%, respectively), by the 3rd month eGFR observation in the CABG and PTCA groups was also comparable, although it also differed in the baseline data (90.14 ± 6.05 ml / min and 86.46 ± 2.37 ml / min, respectively, the differences with the baseline data in both groups - p &lt; 0.001. By the end the 1st year the following pattern emerged: in patients who underwent surgical revascularization, the decrease in eGFR was more pronounced than in patients who underwent stenting of the coronary arteries (-51.80 ± 3.51% versus -42, 39 ± 1.35%, p &lt;0.05), and the differences increased even more during the second year of observation (-57.99 ± 4.75% versus -44.76 ± 1.89%, p &lt;0.05). The second year of observation, eGFR in the CABG group was lower than in the PTCA group (44.63 ± 5.37 ml / min versus 56.54 ± 2.01 ml / min, p &lt;0.05). This pattern can be explained that fact in the CABG group were more patients with diabetes - 80.95% (17 patients out of 21) compared with PTCA patients - 12.23% (17 patients out of 139, chi square 49.83, p &lt; 0.001). All patients divided into 2 subgroups depending on the degree of eGFR by the 3rd month of observation: patients with eGFR by the 3rd month of observation more than 20% (31 patients, group 1) and less than 20% (group 2 - 129 sick). Initially, eGFR in group 1 was lower than in group 2. The relative dynamics of eGFR during the entire observation period was greater in patients of group 1 compared with group 2 (-43.58 ± 1.72% versus -11.10 ± 0.58% by the end 3rd month of observation, -61.30 ± 1.44% versus -39.38 ± 1.29% by the end of the first year and -68.78 ± 2.56% versus -41.14 ± 1.85% by the end of the second year of observation, the reliability of the difference in the relative dynamics between the groups at all three observation points is p &lt;0.001). Conclusion. In patients with coronary artery disease who underwent coronary revascularization, there is a decrease in renal function after revascularization. The most significant decrease was observed in patients undergoing coronary artery bypass grafting, as well as in patients with initially low filtration function of the kidneys.

1273Efficacy and safety of prehabilitation before coronary artery bypass grafting

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Argunova ◽  
A Korotkevich ◽  
E Belik ◽  
S Pomeshkina ◽  
O Barbarash
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
High Intensity ◽  
Troponin I ◽  
Artery Bypass ◽  
Study Groups ◽  
Preoperative Management ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Purpose To evaluate the effectiveness and safety of high intensity prehabilitation included in the routine preoperative management of patients with coronary artery disease (CAD) for elective on-pump coronary artery bypass grafting (CABG). Methods 38 male patients with stable CAD referred to on-pump CABG who either underwent prehabilitation or not were assigned into two study groups. Group 1 patients (n=20, the mean age 61.5 years [55; 64] underwent high intensity treadmill exercises. Group 2 patients (n=18, the mean age 62.0 years [56; 65]) underwent routine preoperative management without prehabilitation. Treadmill exercises in Group 1 patients were performed under hemodynamic control and ECG monitoring. The training power of a workout was calculated based on cardiopulmonary exercise test (CPET) performed before preoperative exercises, and was estimated as 80% of the maximal power obtained during the exercise test. Adenosine loading single-photon emission computed tomography (SPECT) was used to measure the parameters of myocardial perfusion before preoperative exercises and on days 5–7 after CABG in both study groups. Biochemical markers of myocardial damage (troponin I, NT-proBNP) were measured before the training session, after it and then in the postoperative period to assess the safety of the prehabilitation program. In-hospital postoperative complications were recorded and analyzed. Results Both study groups were comparable in the main clinical and demographic parameters, intraoperative clinical parameters as well as in preoperative CPET and SPECT results. There were no cases of complications during prehabilitation. The analysis of myocardial perfusion parameters demonstrated that patients who had undergone prehabilitation had significantly higher accumulation of radiopharmaceuticals than those in the control group in basal segments (74.9±3.98% vs. 70.3±7.40% p=0.04), middle (86.7±5.24% vs. 79.6±10.43%, p=0.03) and apical (85.8±5.03% vs. 79.0±8,67%, p=0.02) myocardium. The stress-induced ischemia (SDS) was less pronounced in Group 1 compared to Group 2 (0 scores and 0.9±0.53 scores, respectively, p=0.04). Myocardial perfusion defect significantly decreased during the infusion of adenosine (SSS) (p=0.013), as well as the SDS index (p=0.018) in the prehabilitation group after CABG compared with the baseline. Both groups had similar serum troponin I levels within the normal range before and after CABG. NT-pro BNP levels significantly increased in the postoperative period in patients who did not undergo prehabilitation (p=0.003). Patients who underwent prehabilitation had a significantly lower incidence of the in-hospital postoperative complications compared to patients without exercise trainings (p=0.002). Conclusion The inclusion of high intensity preoperative exercises in the routine preoperative management of patients referred to elective CABG is safe and effective method of cardioprotection improving surgical outcomes.

scholarly journals Incresed inflammatory response in patients with the first myocardial infarction and nonsignificant stenosis of infarct-related artery

2012 ◽  
Vol 69 (9) ◽  
pp. 787-793
Author(s):  
Nenad Ratkovic ◽  
Dragan Dincic ◽  
Branko Gligic ◽  
Snjezana Vukotic ◽  
Aleksandra Jovelic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Inflammatory Diseases ◽  
Mean Value ◽  
Significant Stenosis ◽  
Infarct Related Artery ◽  
The Mean ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Introduction/Aim. Atherosclerosis presents a serial of highly specific cellular and molecular responses, and could be described as inflammatory diseases. Accordingly, for development of acute myocardial infarction (AMI), structure and vulnerability of atherosclerotic plaque are more important than the extent of stenosis of infarct-related artery. Consequently, inflammation and atherosclerosis and its complications are in good correlation. C-reactive protein (CRP) as nonspecific inflammatory marker, has prognostic significance in coronary artery diseases. The aim of this study was to establish the correlation between inflammatory response expressed as levels of CRP and fibrinogen in serum and extent of coronary artery stenosis. Methods. Study included 35 patients with acute myocardial infarction, as the first manifestation of coronary artery disease, which were treated with thrombolytic therapy according to the guidelines. All the patient had a reperfusion. The patients with acute or chronic inflammatory diseases, an increased value of sedimentation, fibrinogen, CK ?190 U/L, early and late complications of AMI were excluded. CRP was measured on admission, after 24, 48 and 72 hrs, and 21 days latter, while fibriogen only on admission. Results. All the patients underwent coronary angiography, and were divided into two groups: the group 1 (23 patients), with significant stenosis of infarct-related artery (stenosis ? 75%), and the group 2 (13 patients) without significant stenosis (< 75%). Mean value of CRP serum level on admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p < 0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L, and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the group 2 (p < 0.001). There was no significant difference between the groups 1 and 2 related to gender, age, localization of AMI, CK, EF value, and risk factors for coronary artery disease. Conclusion. The patients with nonsignificant stenosis of infarct-related artery had increased inflammtory responses according to the CRP value, as a result of inflammatory process in atherosclerotic plaque and/or enhanced individual reactivity.

scholarly journals COMPARISON OF THE EFFECT OF ANTEGRADE AND ANTEGRADE/RETROGRADE CARDIOPLEGIA ON THE OUTCOME OF CORONARY ARTERY BYPASS GRAFT SURGERY FOR SEVERE CORONARY ARTERY DISEASE

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S792-98
Author(s):  
Ali Gohar Zamir ◽  
Asif Mahmood Janjua ◽  
Musfireh Siddiqeh ◽  
Farrah Pervaiz ◽  
Noor Shah ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Vessel Coronary Artery Disease ◽  
Group 2 ◽  
Artery Disease ◽  
Vessel Coronary Artery ◽  
Group 1

Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019. Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital. Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1. Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,

scholarly journals The Importance of Prognostic Nutritional Index in Predicting Acute Renal Failure After On-Pump Coronary Artery Bypass Operations in Patients with Insulin-Dependent Diabetes Mellitus

2021 ◽  
Vol 24 (4) ◽  
pp. E651-E655
Author(s):  
Arif GUCU ◽  
Ozlem Arıcan Ozluk ◽  
Orhan Guvenc ◽  
Sadık AHmet Sunbul ◽  
Mesut Engin
Keyword(s):  
Diabetes Mellitus ◽  
Renal Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Prognostic Nutritional Index ◽  
Nutritional Index ◽  
Insulin Dependent ◽  
Pump Cabg ◽  
Group 2 ◽  
Group 1

Background: After coronary artery bypass graft (CABG) operations, acute kidney injury (AKI) appears at 5-30% rates, and this rate increases even more in patients with diabetes mellitus (DM). Prognostic nutritional index (PNI) is known as a valuable parameter that affects cardiovascular surgery outcomes. In this current study, we aimed to investigate the importance of PNI value in predicting AKI after on-pump CABG operations in insulin-dependent diabetic patients. Methods: A total of 254 consecutive patients with insulin-dependent diabetes who underwent on-pump CABG in our clinic between January 2016 and January 2020 retrospectively were included in this study. In the postoperative period, patients were registered as the renal failure group (Group 1), and those who did not develop renal failure were registered as Group 2. Results: A total of 255 patients with DM were included in the study. There were 82 patients in Group 1 and 173 patients in Group 2. There was no difference between the groups, in terms of age, gender, smoking, and hyperlipidemia rates. Hypertension rate significantly was higher in Group 2 (P = .001). In multivariate logistic regression analysis, hypertension (OR: 1.226, 95% CI: 1.114-2.459, P = .026), need for inotropic support (OR: 1.128, 95% CI: 1.070-1.784, P = .033), increased blood product use (OR: 1.291, 95% CI: 1.112-2.156, P = .021) preoperative high creatinine (OR: 3.563, 95% CI: 2.497-5.559, P < .001), and PNI (OR: 1.327, 95% CI: 1.118-2.785, P = .012) were independent predictors of AKI. Conclusion: In our study, we determined PNI value as an independent predictor in predicting acute renal injury occurring after on-pump CABG operations in patients with insulin-dependent DM.

Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

2015 ◽  
Vol 18 (6) ◽  
pp. 255 ◽  
Author(s):  
Hüseyin Şaşkın ◽  
Çagrı Düzyol ◽  
Kazım Serhan Özcan ◽  
Rezan Aksoy ◽  
Mustafa Idiz
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Platelet To Lymphocyte Ratio ◽  
Artery Bypass Grafting ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Group 1

<strong>Objective:</strong> To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation.<br /><strong>Methods:</strong> We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142.<br /><strong>Results:</strong> The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality.<br /><strong>Conclusion:</strong> In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

Age and Left Ventricular Impairment Predict Reopening for Bleeding

2003 ◽  
Vol 11 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Yongzhi Deng ◽  
Karen Byth ◽  
Hugh S Paterson
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Chronic Renal Failure ◽  
Multiple Logistic Regression Analysis ◽  
Left Ventricular ◽  
Older Age ◽  
Redo Surgery ◽  
Prophylactic Measures ◽  
Group 2 ◽  
Group 1

Statistical analysis of data collected prospectively from all patients undergoing surgery under cardiopulmonary bypass from September 1994 to November 1998 (group 1) was performed to identify preoperative risk factors for reopening for bleeding. Multiple logistic regression analysis of 19 preoperative variables was carried out with reoperation for bleeding as the endpoint. The protocol for intraoperative use of aprotinin was then changed to include high-risk patients. Data collected from all subsequent patients from May 1999 to March 2002 (group 2) were analyzed. Subgroup analyses on primary isolated coronary artery surgery were also performed. Data were obtained from 1,946 patients aged 22 to 88 years (mean, 62.5 years). Older age, severe left ventricular impairment, redo surgery, and chronic renal failure were the independent predictors of reopening for bleeding in group 1. There were no independent predictors of reopening in group 2. Older age and chronic renal failure were the predictors of reexploration for bleeding in patients undergoing primary isolated coronary artery grafting. Prophylactic measures to prevent excessive bleeding should be used in elderly patients and those with severe left ventricular impairment, redo surgery, and chronic renal failure.

scholarly journals Prognostic value of per-vessel treatment adherence in stable coronary artery disease based on novel computational pressure-flow dynamics derived fractional flow reserve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C K L Leung ◽  
L Y Lam ◽  
K Y Li ◽  
A S Y Yu ◽  
M Z Wu ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Fractional Flow Reserve ◽  
Coronary Vessels ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Adherence Group ◽  
Group 1

Abstract Background Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to evaluate the extent of myocardial ischemia in patients with coronary artery disease (CAD), which eliminates the need of invasive pressure guidewire and hyperaemic stimulus in conventional fractional flow reserve (FFR) measurement. Studies have shown improved clinical outcomes associated with adherence to functional myocardial ischemia assessment when deciding to perform percutaneous coronary intervention (PCI) at a per-patient level. However, the clinical significance of such treatment adherence at a per-vessel level remains uncertain. Methods A total of 928 patients (mean age 66.2±10.5, male 72.7%) with stable CAD were included in this study. The caFFR of all three major coronary vessels were obtained for every patient, and the FFR threshold of 0.8 was adopted as the threshold for caFFR to indicate functionally significant artery stenosis which warrants PCI, and vice versa. Based on the caFFR of each major coronary vessel and whether PCI was performed to the respective vessel, patients were stratified into 0–1 vessel with treatment adherence group (group 1) (n=105), 2 vessels with treatment adherence group (group 2) (n=338), and 3 vessels with treatment adherence group (group 3) (n=485). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and any subsequent revascularization. Results The severity of CAD based on SYNTAX score assessment was 18.6±10.2 in group 1, 14.6±8.9 in group 2, and 11.5±9.9 in group 3 (P&lt;0.001). The rates of MACE at 3 years were significantly different across groups 1, 2 and 3 (17.1% vs. 12.1% vs. 7.4%; P=0.004). With reference to group 3, the risk of MACE at 3 years was increased in group 2 (adjusted hazard ratio [HR]=1.597; 95% confidence interval [CI]=1.020–2.501; P=0.041), and further increased in group 1 (adjusted HR=1.933; 95% CI=1.081–3.457; P=0.026). Conclusion In stable CAD patients, the risk of MACE is incremental when fewer major coronary vessels are treated with adherence to caFFR threshold of 0.8. Per-vessel treatment adherence significantly affects clinical outcomes in terms of MACE. FUNDunding Acknowledgement Type of funding sources: None.

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