scholarly journals Effects of chronic kidney disease on mid- and long-term clinical outcomes after off-pump coronary artery bypass grafting-a retrospective study

2020 ◽  
Author(s):  
Xihui Li ◽  
Bo Song ◽  
Shiyong Dong ◽  
Siyu Zhang
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass ◽  
Fatal Myocardial Infarction

Abstract Backgroud: To investigate the effect of chronic kidney disease (CKD) on mid- and long-term clinical outcomes after off-pump coronary artery bypass grafting (CABG).Methods: This was a retrospective analysis of data of 1141 patients discharged from the Department of Cardiac Surgery, Peking University First Hospital from January 2010 to June 2018 after undergoing off-pump CABG. Preoperative baseline, operative, and follow-up data obtained at regular outpatient visits or by telephone calls were collected. Follow-up endpoints included stroke, nonfatal myocardial infarction, heart failure, revascularization, and all-cause death. Patients with preoperative estimated glomerular filtration rate calculated, using the Chronic Kidney Disease Epidemiology equation of≥ 60 mL/min/1.73 m2 and < 60 mL/min/1.73m2, were assigned to normal Group (1, 910 cases) and CKD group (231 cases), respectively. The effects of CKD on selected endpoint events were compared and analyzed.Results: There was a higher proportion of women, more preoperative complications, and a higher incidence of early postoperative complications in patients with CKD than in those with normal renal function. After 1–9 years of follow-up (mean5.0±2.2 years), the incidences of stroke, non-fatal myocardial infarction, and all-cause mortality were significantly higher in the CKD than in the normal renal function group, whereas incidences of revascularization and heart failure were not. Logistic regression analysis showed that preoperative CKD was a risk factor for stroke, non-fatal myocardial infarction, and all-cause death during follow-up. After correcting for common confounding factors, such as sex, age, and left ventricular ejection fraction, preoperative CKD was a risk factor for non-fatal myocardial infarction (OR 2.675, 95% CI 1.023–6.995, P=0.045) and all-cause death (OR 1.833, 95% CI 1.079–3.114, P=0.025).Conclusions: In patients undergoing off-pump CABG, preoperative CKD is associated with increases in the incidences of mid- and long-term non-fatal myocardial infarction and all-cause mortality.

scholarly journals Effects of Chronic Kidney Disease on 5-Year Follow-Up Clinical Outcomes After Off-pump Coronary Artery Bypass Grafting-A Retrospective Study

2021 ◽  
Author(s):  
Xihui Li ◽  
Siyu Zhang ◽  
Feng Xiao
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Abstract BackgroudTo investigate the effect of chronic kidney disease (CKD) on mid- and long-term clinical outcomes after off-pump coronary artery bypass grafting (CABG).MethodsThis was a retrospective analysis of data of1141 discharged patients from January 2010 to June 2018 after undergoing off-pump CABG. Follow-up endpoints included stroke, myocardial infarction, heart failure, revascularization, and all-cause death.Patients with preoperative estimated glomerular filtration rate calculated, using the Chronic Kidney Disease Epidemiology equation of≥ 60 mL/min/1.73 m2 and < 60 mL/min/1.73m2, were assigned tonormal Group (1, 910 cases) and CKD group (231 cases), respectively. The effects of CKD on selected endpoint events were compared and analyzed.ResultsThere was a higher proportion of women, more preoperative complications, and a higher incidence of early postoperative complications in patients with CKD than inthose with normal renal function.After 1–9 years of follow-up (mean5.0±2.2 years), the incidences of stroke, myocardial infarction, and all-cause mortality were significantly higher in the CKD than in the normal renal function group, whereas incidences of revascularization and heart failure were not.Logistic regression analysis showed that preoperative CKD was a risk factor for stroke, myocardial infarction, and all-cause death during follow-up. After correctingfor common confounding factors, such as sex, age, and left ventricular ejection fraction, preoperative CKD was a risk factor for myocardial infarction and all-cause death.ConclusionsIn patientsundergoing off-pump CABG, preoperative CKD is associated with increases in the incidences of myocardial infarction and all-cause mortality 5-year postoperation..

scholarly journals A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting

2021 ◽  
Vol 10 (14) ◽  
pp. 3032
Author(s):  
Tomasz Kamil Urbanowicz ◽  
Michał Michalak ◽  
Aleksandra Gąsecka ◽  
Anna Olasińska-Wiśniewska ◽  
Bartłomiej Perek ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Risk Score ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass ◽  
Long Term Mortality

Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7–10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment.

Abstract 15407: Comorbidities and the Associated Long-term Utilization of Transthoracic Echocardiography Among Medicare Beneficiaries at a Large Academic Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Patrick M Hyland ◽  
Jiaman Xu ◽  
Changyu Shen ◽  
Lawrence Markson ◽  
Warren J Manning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Transthoracic Echocardiography ◽  
Medicare Beneficiaries ◽  
Female Sex ◽  
History Of

Introduction: The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives. Methods: TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with < 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities. Results: Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia ( Figure ). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p < 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p > 0.05). Conclusions: Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.

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.

scholarly journals Elevated Levels of Renalase, the β-NAD(P)H Isomerase, Can Be Used as Risk Factors of Major Adverse Cardiovascular Events and All-Cause Death in Patients with Chronic Kidney Disease

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1514
Author(s):  
Wojciech Knop ◽  
Natalia Maria Serwin ◽  
Elżbieta Cecerska-Heryć ◽  
Bartłomiej Grygorcewicz ◽  
Barbara Dołęgowska ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Major Adverse Cardiovascular Events ◽  
Occurrence Probability ◽  
Future Studies ◽  
All Cause Mortality ◽  
Red Flag

Background: Renalase is an enzyme and a cytokine involved in cell survival. Since its discovery, associations between it and both cardiovascular and kidney disease have been noted. Recognizing this, we conducted a study in which we followed patients with chronic kidney disease. Material and methods: The study involved 90 CKD patients with varying stages of the disease and 30 healthy controls. Renalase was measured with an ELISA kit, and patients were followed-up after a median of 18 months. During the follow-up, we asked about the occurrence of MACE, all-cause mortality and the need for dialysis initiation. Results: In CKD subgroups, RNSL correlated with all-cause death only in the HD group (Rs = 0.49, p < 0.01). In the whole CKD population, we found a positive correlation of RNSL concentration and both MACE occurrence (Rs = 0.38, p < 0.001) and all-cause death (Rs = 0.34, p < 0.005). There was a significant increase in MACE occurrence probability in patients with elevated renalase levels (>25 μg/mL). Conclusions: Elevated renalase levels can be used as a risk factor of MACE in patients with CKD, but its long-term utility needs further research. High renalase levels are a risk factor of death among CKD patients. In HD patients, all deaths were observed among patients with >30 μg/mL; this level could be used as a “red flag” marker in future studies.

Sign in / Sign up

Export Citation Format

Share Document