scholarly journals Obstructive Sleep Apnea Increases the Risk of Perioperative Myocardial Infarction Following Off-Pump Coronary Artery Bypass Grafting

2021 ◽  
Vol 8 ◽  
Author(s):  
Kangjun Fan ◽  
Mingxin Gao ◽  
Wenyuan Yu ◽  
Hongli Liu ◽  
Liang Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Obstructive Sleep Apnea ◽  
Regression Analysis ◽  
Artery Bypass ◽  
Syntax Score ◽  
Bypass Grafting ◽  
Perioperative Myocardial Infarction ◽  
Off Pump ◽  
Obstructive Sleep ◽  
Hs Crp

Background and Aims: The impact of obstructive sleep apnea (OSA) on perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) remains unclear. Off-pump CABG (OPCABG) has become a common practice for CABG in China. The present study investigated mainly the correlation between OSA and PMI following OPCABG.Methods: In this prospective observational single-center study, consecutive eligible patients listed for elective OPCABG underwent cardiorespiratory polygraphy before surgery between January 2019 and June 2020. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. The primary end point was perioperative myocardial infarction (PMI) following OPCABG (type 5 MI).Results: Patients with OSA accounted for 42.2% (62/147) of the cohort. Twenty-four patients (16.3%) met the protocol criteria for PMI: 17 (27.4%) in the OSA group and 7 (8.2%) in the non-OSA group (P = 0.002). Multivariate logistic regression analysis revealed that AHI (OR = 1.115, 95% CI 1.066 to 1.166, P < 0.001), high-sensitivity c-reactive protein (hs-CRP) (OR = 1.080, 95% CI 1.025 to 1.138, P = 0.004), and SYNTAX score (OR = 1.098, 95% CI 1.056 to 1.141, P < 0.001) were associated with PMI incidence. Furthermore, ROC analysis revealed that the AHI (AUC = 0.766, 95% CI 0.689 to 0.832, P < 0.001) and SYNTAX score (AUC = 0.789, 95% CI 0.715 to 0.852, P < 0.001) had predictive value for PMI. In addition, multiple linear regression analysis showed that the AHI was an independent influencing factor of hs-CRP (B = 0.176, 95% CI 0.090 to 0.263, P < 0.001) and the SYNTAX score (B = 0.553, 95% CI 0.397 to 0.709, P < 0.001).Conclusions: OSA was independently associated with a higher incidence of PMI following OPCABG, and the formation of severe coronary atherosclerotic lesions aggravated by an enhanced inflammatory response might be the potential mechanism. The efficacy of CPAP treatment for improving prognosis after CABG remains to be further investigated.

scholarly journals Perioperative Outcomes after On- and Off-Pump Coronary Artery Bypass Grafting

2014 ◽  
Vol 41 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Faisal G. Bakaeen ◽  
Danny Chu ◽  
Rosemary F. Kelly ◽  
William L. Holman ◽  
Michael E. Jessen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Perioperative Myocardial Infarction ◽  
Off Pump ◽  
Intention To Treat ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward). The primary outcome was perioperative (30-day or in-hospital) death; the secondary outcomes were perioperative stroke, dialysis dependence, reoperation for bleeding, mechanical circulatory support, myocardial infarction, ventilator support ≥48 hr, and mediastinitis. Propensity scores calculated from age, 17 preoperative risk factors, and year of surgery were used to match 8,911 OFF with 26,733 ON patients. In the complete cohort, compared with the ON patients (n=53,468), the OFF patients (n=11,629) had less perioperative death (2.02% vs 2.53%, P=0.0012) and lower incidences of all morbidities except perioperative myocardial infarction. In the matched cohort, perioperative death did not differ significantly between OFF and ON patients (1.94% vs 2.28%, P=0.06), but the OFF group had lower incidences of all morbidities except for perioperative myocardial infarction and mediastinitis. A subgroup intention-to-treat analysis yielded similar but smaller outcome differences between the ON and OFF groups. Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG. Future studies should examine the effect of off-pump CABG on long-term outcomes.

scholarly journals Predictors of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Mohamed A. Amr ◽  
Elsayed Fayad
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Perioperative Myocardial Infarction ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Abstract Background Perioperative myocardial infarction (PMI) increases morbidity and mortality after off-pump coronary artery bypass grafting (CABG). The objective of the current study was to characterize patients with PMI after off-pump CABG and identify its predictors. Results We included 1181 patients who had off-pump CABG from 2010 to 2020; 59 patients (5%) had PMI. We compared patients with PMI to those without PMI. Patients with PMI were older (57 (25th–75th percentiles: 51–63) vs. 54 (48–60) years; P = 0.01) and had higher NYHA class (28 (47.46%) vs. 326 (29.06%): P = 0.01). The distal anastomosis time was longer in patients with PMI (28 (23–35) vs. 24 (16–30) min; P ˂ 0.001). Patients with PMI had higher postoperative low cardiac output (10 (18.18%) vs. 1 (0.1%): P ˂ 0.001), prolonged ventilation (12 (8–39) vs. 8 (6–10) h, P ˂ 0.001), ICU (71 (46–138) vs. 24 (23–42) h; P ˂ 0.001), and hospital stay (9 (6–15) vs. 7 (6–8) days; P ˂ 0.001). Mortality was significantly higher in patients with PMI (20 (33.9%) vs. 6 (0.53%); P ˂ 0.001). Older age (OR: 1.05 (95% CI: 1.01–1.1); P = 0.02), increased number of distal anastomoses (OR: 1.74 (95% CI: 1.20–2.50); P = 0.003), preoperative congestive heart failure (OR: 10.27 (95% CI: 2.58–40.95); P = 0.001), and thrombolysis within 24 h of surgery (OR: 15.34 (1.93–121.9); P = 0.01) were associated with increased PMI, while PMI was lower in male patients (OR: 0.42 (95% CI: 0.19–0.93); P = 0.03) and with higher body surface area (BSA) (OR: 0.08 (95% CI: 0.07–0.86); P = 0.04). Conclusions Post-off-pump CABG PMI was associated with increased morbidity and mortality. Risk factors for PMI were older age, lower BSA, females, increased distal anastomoses, preoperative heart failure, and thrombolysis.

scholarly journals The effects of high-sensitivity C-reactive protein on the clinical outcomes in obstructive sleep apnea patients undergoing off-pump coronary artery bypass grafting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mingxin Gao ◽  
Kangjun Fan ◽  
Wenyuan Yu ◽  
Hongli Liu ◽  
Yongxiang Wei ◽  
...  
Keyword(s):  
Artery Bypass ◽  
High Sensitivity ◽  
Bypass Grafting ◽  
C Reactive Protein ◽  
Off Pump ◽  
Reactive Protein ◽  
Obstructive Sleep ◽  
Duration Of Hospitalization ◽  
Hs Crp ◽  
The Relationship

Abstract Purpose To investigate the relationship between obstructive sleep apnea (OSA) severity and high-sensitivity C-reactive protein (Hs-CRP), and their respective impact on the clinical outcomes in patients undergoing off-pump cardiac artery bypass grafting (OPCABG). Methods We enrolled consecutive eligible patients listed for elective OPCABG who underwent cardiorespiratory polygraphy before surgery between January 2019 and December 2019 in this prospective observational single-center study. Baseline, intraoperative, and postoperative clinical data were compared between absent-mild and moderate-severe OSA groups. Regression analysis investigated the relationship between Hs-CRP level and severity of OSA, and further assessed the factors influencing postoperative atrial fibrillation, duration of hospitalization, and hospital cost. Results Patients with moderate-severe OSA accounted for 42.3% (52/123) of the cohort. Partial pressure of carbon dioxide (PCO2), Hs-CRP, apnea hypopnea index (AHI), mean apnea time, maximum apnea time, and oxygen desaturation index ODI ≥ 3% were significantly higher in the moderate-severe OSA group than in the absent-mild OSA group. Left ventricle ejection fraction (LVEF), lowest arterial oxygen saturation (SaO2), and mean SaO2 were significantly lower in the moderate-severe OSA group. Moderate-severe OSA was associated with elevated Hs-CRP level (OR = 2.356, 95% CI 1.101–5.041, P = 0.027). Hs-CRP was an independent risk factor for post-CABG atrial fibrillation (POAF) (OR = 1.212, P = 0.01). Hs-CRP level independently correlated with duration of hospitalization (B = 0.456, P = 0.001) and hospital cost (B = 1.111, P = 0.044). Conclusion Hs-CRP level was closely related to OSA severity and have potential utility in predicting POAF, duration of hospitalization, and hospital costs in patients undergoing OPCABG.

scholarly journals The effects of obstructive sleep apnea and high-sensitivity C-reactive protein on clinical outcome in off-pump coronary artery bypass grafting

2021 ◽  
Author(s):  
Mingxin Gao ◽  
Kangjun Fan ◽  
Wenyuan Yu ◽  
Hongli Liu ◽  
Yongxiang Wei ◽  
...  
Keyword(s):  
Artery Bypass ◽  
High Sensitivity ◽  
Bypass Grafting ◽  
C Reactive Protein ◽  
Off Pump ◽  
Reactive Protein ◽  
Obstructive Sleep ◽  
Duration Of Hospitalization ◽  
Hs Crp ◽  
The Relationship

Abstract Purpose This study aimed to investigate the relationship between obstructive sleep apnea (OSA) and high-sensitivity C-reactive protein (hs-CRP) to determine their effects on postoperative complications and clinical outcomes during hospitalization in patients undergoing off-pump cardiac artery bypass grafting (OPCABG). Methods This prospective, single-center study enrolled patients who underwent OPCABG. OSA was evaluated using a portable sleep monitor before OPCABG. Spearman correlation was performed to investigate the relationship between hs-CRP and polygraphy test indicators; regression analysis was performed to determine whether hs-CRP is an independent influencing factor for postoperative atrial fibrillation, duration of hospitalization, and hospital cost. Results Partial pressure of carbon dioxide (P = 0.033), high-sensitivity C-reactive protein (hs-CRP) (P = 0.001), apnea hypopnea index (AHI) (P = 0.000), mean apnea time (P = 0.000), maximum apnea time (P = 0.000), and ODI ≥ 3% (P = 0.000) were significantly higher in the moderate–severe OSA group than in the absent–mild OSA group. LVEF (P = 0.034), lowest arterial oxygen saturation (SaO2) (P = 0.000), and mean SaO2 (P = 0.000) were significantly lower in the moderate–severe OSA group. Hs-CRP levels correlated with AHI (rs = 0.235, P = 0.009), ODI ≥ 3% (rs = 0.228, P = 0.011), lowest SaO2 (rs = 0.186, P = 0.040), and mean SaO2 (rs = 0.331, P = 0.000). AHI independently correlated with hs-CRP levels (P = 0.01); hs-CRP was an independent risk factor for post-CABG atrial fibrillation (POAF) (OR = 1.17, P = 0.006); and hs-CRP level independently correlated with duration of hospitalization (P = 0.002) and hospital cost (P = 0.040). Conclusion Hs-CRP levels are closely related to the degree of OSA and have potential utility in predicting POAF, duration of hospitalization, and hospital costs in patients undergoing OPCABG.

Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting: Apoptosis, Inflammation, and Oxidative Stress

2014 ◽  
Vol 17 (5) ◽  
pp. 271 ◽  
Author(s):  
Murat Bicer ◽  
Tunay Senturk ◽  
Murat Yanar ◽  
Ahmet Tutuncu ◽  
Arzu Yilmaztepe Oral ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Cabg Surgery ◽  
Off Pump ◽  
Pump Cabg ◽  
Hs Crp ◽  
And Oxidative Stress

<strong>Background</strong>: It has been suggested that off-pump coronary<br />artery bypass grafting (CABG) surgery reduces myocardial<br />ischemia-reperfusion injury, postoperative systemic<br />inflammatory response, and oxidative stress. The aim of this<br />study was to measure serum malondialdehyde (MDA), highsensitivity<br />C-reactive protein (hs-CRP), M30, and M65 levels<br />and to investigate the relationship between M30 levels and<br />oxidative stress and inflammation in patients undergoing onand<br />off-pump CABG surgery.<br /><strong>Methods</strong>: Fifty patients were randomly assigned to onpump<br />or off-pump CABG surgery (25 patients off-pump and<br />25 on-pump CABG surgery), and blood samples were collected<br />prior to surgery, and 30 minutes, 60 minutes, 6 hours,<br />and 24 hours after CABG surgery.<br /><strong>Results</strong>: Compared to the on-pump group, serum MDA<br />levels at 30 minutes, 60 minutes, 6 hours, and 24 hours after<br />the CABG surgery were significantly lower in the off-pump<br />group (P = .001, P = .001, P = .001, and P = .001, respectively).<br />Serum M30 levels were found to be elevated in both groups,<br />returning to baseline at 24 hours. When compared to baseline,<br />the hs-CRP level reached its peak at 24 hours at 13.28 ±<br />5.32 mg/dL in the on-pump group, and 15.44 ± 4.02 mg/dL<br />in the off-pump group.<br /><strong>Conclusion</strong>: CABG surgery is associated with an increase<br />in inflammatory markers and serum M30 levels, indicating<br />epithelial/endothelial apoptosis in the early period.

Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring

2012 ◽  
Vol 23 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Naury de Jesus Danzi-Soares ◽  
Pedro Rodrigues Genta ◽  
Flávia Baggio Nerbass ◽  
Rodrigo Pinto Pedrosa ◽  
Flávia Souza Nunes Soares ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Coronary Artery ◽  
Sleep Apnea ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Portable Monitoring ◽  
Artery Bypass Grafting ◽  
Obstructive Sleep

scholarly journals Intraoperative Mild Hyperoxia May be Associated with Improved Survival After Off-Pump Coronary Artery Bypass Grafting: A Retrospective Observational Study

2021 ◽  
Author(s):  
Jae-Woo Ju ◽  
Hyun Woo Choe ◽  
Jinyoung Bae ◽  
Seohee Lee ◽  
Youn Joung Cho ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Lower Risk ◽  
Artery Bypass ◽  
Arterial Oxygen ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass

Abstract Background: The effect of hyperoxia due to supplemental oxygen administration on postoperative outcomes in patients undergoing cardiac surgery remains unclear. This retrospective study aimed to evaluate the relationship between intraoperative oxygen tension and mortality after off-pump coronary artery bypass grafting (OPCAB).Methods: The study included adult patients who underwent isolated OPCAB between July 2010 and June 2020. Patients were categorised into three groups based on their intraoperative time-weighted average arterial oxygen partial pressure (PaO2): normoxia/near-normoxia (<150 mmHg), mild hyperoxia (150–250 mmHg), and severe hyperoxia (>250 mmHg). The risk of in-hospital mortality was compared using weighted logistic regression analysis. Restricted cubic spline analysis was performed to analyse intraoperative PaO2 as a continuous variable. The risk of cumulative all-cause mortality was compared using Cox regression analysis.Results: The normoxia/near-normoxia, mild hyperoxia, and severe hyperoxia groups included 229, 991, and 173 patients (n=1,393), respectively. The mild hyperoxia group had a significantly lower risk of in-hospital mortality than the normoxia/near-normoxia (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.06–0.22) and severe hyperoxia groups (OR, 0.06; 95% CI, 0.03–0.14). Intraoperative PaO2 exhibited a U-shaped relationship with in-hospital mortality in the non-hypoxic range. The risk of cumulative all-cause mortality was significantly lower in the mild hyperoxia group (hazard ratio, 0.72; 95% CI, 0.52–0.99) than in the normoxia/near-normoxia group.Conclusions: Intraoperative mild hyperoxia was associated with a lower risk of mortality after OPCAB than normoxia, near-normoxia, or severe hyperoxia. Mildly increasing arterial oxygen tension during OPCAB may help to optimise postoperative outcomes.Trial registration: Not applicable.

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