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Reynolds HR, Cyr DD, Merz CNB, Shaw LJ, Chaitman BR, Boden WE, Alexander KP, Rosenberg YD, Bangalore S, Stone GW, Held C, Spertus J, Goetschalckx K, Bockeria O, Newman JD, Berger JS, Elghamaz A, Lopes RD, Min JK, Berman DS, Picard MH, Kwong RY, Harrington RA, Thomas B, O'Brien SM, Maron DJ, Hochman JS. Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial. J Am Heart Assoc 2024; 13:e029850. [PMID: 38410945 PMCID: PMC10944079 DOI: 10.1161/jaha.122.029850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/09/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management. METHODS AND RESULTS The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; P=0.49), with no significant sex-by-treatment-group interactions. CONCLUSIONS Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial. REGISTRATION URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522.
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Affiliation(s)
| | | | | | - Leslee J. Shaw
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research FoundationNew YorkNYUSA
| | | | | | | | | | | | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research FoundationNew YorkNYUSA
| | - Claes Held
- Dept of Medical Sciences, CardiologyUppsala University and Uppsala Clinical Research CenterUppsalaSweden
| | - John Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri ‐ Kansas City (UMKC)Kansas CityMOUSA
| | | | - Olga Bockeria
- National Research Center for Cardiovascular SurgeryMoscowRussia
| | | | | | - Ahmed Elghamaz
- Northwick Park Hospital‐Royal Brompton HospitalLondonUnited Kingdom
| | | | | | | | - Michael H. Picard
- Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | | | | | | | | | - David J. Maron
- Department of MedicineStanford University School of MedicineStanfordCAUSA
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Penton A, Lin J, Kolde G, DeJong M, Blecha M. Investigation of Combined Carotid Endarterectomy and Coronary Artery Bypass Graft Surgery Outcomes and Adverse Event Risk Factors in the Vascular Quality Initiative. Vasc Endovascular Surg 2023; 57:884-900. [PMID: 37303074 PMCID: PMC10756645 DOI: 10.1177/15385744231183741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate outcomes of simultaneous CEA and CABG utilizing the Vascular Quality Initiative (VQI). Additionally, we seek to investigate risks for both perioperative and long-term mortality and adverse neurological outcomes. METHODS All carotid endarterectomies in the VQI between January 2003 and May 2022 were queried. We identified 171,816 CEA in the database. We extracted 2 cohorts from these CEA. The first group was patients who underwent simultaneous carotid endarterectomy (CEA) and coronary artery bypass (CABG) (N = 3137). The second group encompassed patients who underwent CABG or percutaneous coronary artery angioplasty/stent within 5 years of ultimately undergoing CEA (N = 27,387). We investigated the following outcomes in a multivariable fashion: 1. Risks for mortality in long term follow-up for both cohorts combined; 2. Risks for ischemic event in the cerebral hemisphere ipsilateral to the CEA site after index hospital admission in follow up for both cohorts combined. Tertiary outcomes are also investigated in the manuscript. RESULTS On multivariable analysis, patients undergoing simultaneous combined CEA and CABG had equivalent long-term survival to patients who underwent coronary revascularization within 5 years of ultimately undergoing CEA. Five-year survival is noted to be 84.5% vs 86% with a Cox regression non-significant P-value (.203). Significant multivariable risks for reduced long term survival (P < .03 for all) included: advancing age (HR 2.48/year); smoking history (HR 1.26); Diabetes (HR 1.33); history of CHF (HR 1.66); history of COPD (HR 1.54); baseline renal insufficiency at the time of surgery (HR 1.30); anemia (HR1.64); lack of preoperative aspirin (HR 1.12); and lack of preoperative statin (HR 1.32); lack of patch placement at CEA site (HR 1.16); perioperative MI (HR 2.04); perioperative CHF (1.66); perioperative dysrhythmia (HR 1.36); cerebral reperfusion injury (HR 2.23); perioperative ischemic neurological event (HR 2.48); and lack of statin at discharge (HR 2.04). Amongst patients with documented neurological status in follow up, combined CEA and CABG had over 99% freedom from ischemic cerebral event ipsilateral to the CEA site after discharge. CONCLUSIONS Combined CEA and CABG provides excellent long-term mortality prevention in patients with co-existing severe coronary and carotid atherosclerosis. Simultaneous CEA and CABG provides equivalent stroke prevention and long-term survival to both a cohort of patients undergoing coronary revascularization within 5 years of CEA and patients undergoing isolated CEA or CABG in the literature. The two most impactful modifiable risk factors towards long-term stroke and mortality prevention for patients undergoing simultaneous CEA-CABG are patch placement at CEA site and adherence to statin medication therapy.
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Affiliation(s)
- Ashley Penton
- Department of Sugery, Loyola University Medical Center, Maywood, IL, USA
| | - Jonathan Lin
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Grant Kolde
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Matthew DeJong
- Department of Sugery, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Maywood, IL, USA
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Gaudino M, Dangas GD, Angiolillo DJ, Brodt J, Chikwe J, DeAnda A, Hameed I, Rodgers ML, Sandner S, Sun LY, Yong CM. Considerations on the Management of Acute Postoperative Ischemia After Cardiac Surgery: A Scientific Statement From the American Heart Association. Circulation 2023; 148:442-454. [PMID: 37345559 DOI: 10.1161/cir.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Acute postoperative myocardial ischemia (PMI) after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for the diagnosis of acute PMI. In addition, current evidence on the management of acute PMI after cardiac surgery is sparse and generally of low methodological quality. Once acute PMI is suspected, prompt diagnosis and treatment are imperative, and options range from conservative strategies to percutaneous coronary intervention and redo coronary artery bypass grafting. In this document, a multidisciplinary group including experts in cardiac surgery, cardiology, anesthesiology, and postoperative care summarizes the existing evidence on diagnosis and treatment of acute PMI and provides clinical guidance.
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4
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Sajja LR, Mannam G, Kamtam DN, Balakrishna N. Female gender does not have any significant impact on the early postoperative outcomes after coronary artery bypass grafting: a propensity-matched analysis. Indian J Thorac Cardiovasc Surg 2023; 39:231-237. [PMID: 37124586 PMCID: PMC10140232 DOI: 10.1007/s12055-022-01465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023] Open
Abstract
Purpose Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure performed in India. There are fundamental differences between males and females in the incidence and responses of the body to various diseases. These differences are noticeable, more so in conditions relating to cardiovascular health, particularly coronary artery disease (CAD). This study aims to assess the gender differences in the early postoperative outcomes following CABG. Methods Between April 1999 through February 2018, 13,415 patients underwent isolated CABG in our practice. Propensity score matching was performed to yield 1825 well-matched pairs in each gender. These groups were compared in terms of various early postoperative outcomes. Results There were no significant differences between females and males in terms of early postoperative composite outcomes (4.2% vs. 5.2%) (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.60-1.12, p = 0.213) of 30-day mortality, non-fatal myocardial infarction (MI), non-fatal cerebrovascular accidents (CVA), and need for renal replacement therapy (RRT), 30-day mortality (0.7% vs. 0.7%) (OR 1.11; 95%CI 0.50-2.45, p = 0.796), MI (2.7% vs. 3.1%) (OR 0.93; 95%CI 0.63-1.37, p = 0.708), CVA (0.4% vs. 0.8%) (OR 0.46; 95%CI 0.19-1.14, p = 0.096), and need for RRT (0.7% vs. 0.7%) (OR 0.88; 95%CI 0.40-1.93, p = 0.753). Conclusion Females have similar early postoperative outcomes compared to males in terms of composite outcomes of 30-day mortality, non-fatal MI, non-fatal CVA, and RRT among patients undergoing CABG. The outcomes are also similar when individually assessed. The off-pump technique has no additional benefit compared to the on-pump technique in females undergoing CABG.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Hyderabad, 500034 India
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Hyderabad, 500073 India
| | - Gopichand Mannam
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Hyderabad, 500034 India
| | | | - Nagalla Balakrishna
- Department of Biostatistics, Sajja Heart Foundation, Hyderabad, 500073 India
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Alamri HM, Alotaibi TO, Alghatani AA, Alharthy TF, Sufyani AM, Alharthi AM, Mahmoud AA, Almahdi MK, Alama N, Al-Ebrahim KE. Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG). Cureus 2023; 15:e37717. [PMID: 37206527 PMCID: PMC10191450 DOI: 10.7759/cureus.37717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022. Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005). CONCLUSION This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.
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Affiliation(s)
- Hassan M Alamri
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Turki O Alotaibi
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Tariq F Alharthy
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Albaraa M Sufyani
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | - Nabil Alama
- Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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Long-Term Patency of Venous Conduits Targeting the Right Coronary Artery System-Single Is Superior to Sequential bypass Grafting. J Cardiovasc Dev Dis 2022; 9:jcdd9090285. [PMID: 36135430 PMCID: PMC9506273 DOI: 10.3390/jcdd9090285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Little is known about the fate of bypass grafts to the right coronary system. To investigate the long-term patency of venous bypass grafts directed to the right coronary artery (RCA) based on postoperative angiograms and to identify predictors of graft occlusion. Methods: In this single-center study, all patients who underwent coronary angiography from 2005 to 2021 after previously undergoing isolated coronary artery bypass grafting (CABG) were included. The primary endpoint was graft occlusion over a median follow-up of 9.1 years. Results: Among a total of 1106 patients (17.0% women, 64 (57−71) years median age), 289 (26.1%) received a sequential vein graft and 798 (72.2%) a single graft. Multivariate regression revealed age (HR 1.019, CI 95% 1.007−1.032), the urgency of CABG (HR 1.355, CI 95% 1.108−1.656), and severely impaired left ventricular function (HR 1.883, CI 95% 1.290−2.748), but not gender and chronic total occlusion (CTO) as predictive factors for graft occlusion. Single conduits were found to be a predictor of graft patency (HR 0.575 CI 95% 0.449−0.737). The angiographic outcome showed an overall 10-year freedom from graft occlusion of 73.4% ± 1.6%. The 5-year (10-year) freedom from graft occlusion was 76.9% ± 2.8% (57.8% ± 4.0%) for sequential grafts and 90.4% ± 1.1% (77.8% ± 1.7%) for single grafts (log-rank p < 0.001). Conclusions: In symptomatic patients with renewed angiography, venous bypass grafting of the RCA showed acceptable long-term patency rates. Single bypass grafting of the RCA was superior to sequential grafting, which needs to be further investigated.
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Li XW, Cui Z, Xiao JY, Gao MD, Zhang M, Zhang WJ, Tian FS, Song Y, Liu YW, Yao ZH, Ma J, Liu Y, Gao J. A five-parameter score for predicting saphenous vein graft degenerative and/or occlusive disease in recurring ischemic symptoms after one year post coronary artery bypass grafting. Perfusion 2022; 38:843-852. [PMID: 35583035 DOI: 10.1177/02676591221090588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The recurrence rate of ischemic symptoms after coronary artery bypass grafting (CABG) is increasing in recent years. How to prevent and treat saphenous vein graft disease (SVGD [symptomatic ⩾50% stenosis in at least one Saphenous vein graft]) has been a clinical challenge to date. Different pathogenesis may exist in SVGD of different periods. There are currently few available scores for estimating the risk of SVGD after one year post CABG. OBJECTIVE We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG. METHODS AND RESULTS This was a cross-sectional study and the results were validated using bootstrap resampling on a separate cohort. A nomogram and risk scoring system were developed based on retrospective data from a training cohort of 606 consecutive patients with recurring ischemia >1 year after CABG. Logistic regression model was used to find the predictive factors and to build a nomogram. To assess the generalization, models were validated using bootstrap resampling and an external cross-sectional study of 187 consecutive patients in four other hospitals. In multivariable analysis of the primary cohort, native lesion vessel number, SVG age, recurring ischemia type, very low-density lipoprotein level, and left ventricular end-diastolic diameter were independent predictors. A summary risk score was derived from nomogram, with a cut-off value of 15. In internal and external validation, the C-index was 0.86 and 0.82, indicating good discrimination. The calibration curve for probability of SVGD showed optimal agreement between actual observations and risk score prediction. CONCLUSION A simple-to-use risk scoring system based on five easily variables was developed and validated to predict the risk of SVGD among patients who recurring ischemia after one year post CABG. This score may be useful for providing patients with individualized estimates of SVGD risk.
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Affiliation(s)
- Xiao-Wei Li
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Cardiovascular Institute, 499773Tianjin Chest Hospital, Tianjin, China
| | - Zhuang Cui
- Tianjin Medical University, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Mei Zhang
- Tianjin Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Wen-Juan Zhang
- Tianjin Medical University General Hospital, Tianjin, China
| | | | - Yu Song
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Ying-Wu Liu
- Tian Jin Third Center Hospital, Tianjin, China
| | | | - Jun Ma
- Tianjin Medical University, Tianjin, China
| | - Yin Liu
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Jing Gao
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Cardiovascular Institute, 499773Tianjin Chest Hospital, Tianjin, China
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Dixon LK, Di Tommaso E, Dimagli A, Sinha S, Sandhu M, Benedetto U, Angelini GD. Impact of sex on outcomes after cardiac surgery: A systematic review and meta-analysis. Int J Cardiol 2021; 343:27-34. [PMID: 34520795 DOI: 10.1016/j.ijcard.2021.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite advances in cardiac surgery, observational studies suggest that females have poorer post-operative outcomes than males. This study is the first to review sex related outcomes following both coronary artery bypass graft (CABG) and valve surgery with or without combined CABG. METHODS We identified 30 primary research articles reporting either short-term mortality (in-hospital/30 day), long-term mortality, and post-operative stroke, sternal wound infection and myocardial infarction (MI) in both sexes following CABG and valve surgery with or without combined CABG. Reported adjusted odds/hazard ratio were pooled using an inverse variance model. RESULTS Females undergoing CABG and combined valve and CABG surgery were at higher risk of short-term mortality (odds ratio (OR) 1.40; 95% confidence interval (CI) 1.32-1.49; I2 = 79%) and post-operative stroke (OR 1.2; CI 1.07-1.34; I2 = 90%) when compared to males. However, for isolated AVR, there was no difference found (OR 1.19; 95% CI 0.74-1.89). There was no increased risk in long-term mortality (OR 1.04; 95% CI: 0.93-1.16; I2 = 82%), post-operative MI (OR 1.22; 95%CI: 0.89-1.67; I2 = 60%) or deep sternal wound infection (OR 0.92; 95%CI: 0.65-1.03, I2 = 87%). No evidence of publication bias or small study effect was found. CONCLUSION Females are at a greater risk of short-term mortality and post-operative stroke than males following CABG and valve surgery combined with CABG. However, there is no difference for Isolated AVR. Long-term mortality is equivalent in both sexes. PROSPERO Registration: CRD42021244603.
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Affiliation(s)
- Lauren Kari Dixon
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Ettorino Di Tommaso
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Manraj Sandhu
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
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Hosseini K, Yavari N, Pashang M, Jalali A, Nalini M, Majdi Nassab F, Sadeghian S, Salehi Omran A, Bagheri J, Poorhosseini H, Salarifar M, Ahmadi Tafti SH, Tajdini M. Sex difference in the risk factor distributions and outcomes after coronary artery bypass graft surgery in the young population. Eur J Cardiothorac Surg 2021; 62:6423098. [PMID: 34747461 DOI: 10.1093/ejcts/ezab475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Coronary artery disease is becoming a major health concern in the young population. Male and female patients may experience different journeys after coronary artery disease events. We aimed to evaluate risk factors and compare outcomes between young male and female patients undergoing coronary artery bypass graft surgery (CABG). METHODS In this registry-based large sample size study, patients undergoing isolated CABG at a young age (premature isolated CABG) between 2007 and 2016 were included and followed up until 2020. Premature was defined as women and men younger than 55 years old. The main end points of the study were 7-year all-cause mortality and 7-year major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS Of a total of 24 428 patients who underwent CABG, 7217 patients (men-to-women ratio ≈4:1) with premature isolated CABG were included. The median follow-up duration was 78.5 months (75.2-81.6 months). The prevalence rates of diabetes mellitus, hypertension, dyslipidaemia and obesity were significantly higher in women than in men (58.3% vs 28.6%, 64.2% vs 38.5%, 69.7% vs 55.3% and 44.7 vs 23.9, respectively; all Ps < 0.05). The risk factor burden (mean of the risk factor count per year) was also higher among the female population. Diabetes mellitus was the common mortality predictor between men and women. In the subgroup analysis (interaction analysis in the adjusted model), hypertensive females had a higher rate of MACCE and a higher rate of mortality than hypertensive males; however, this difference was not significant in the non-hypertensive population. Opium addiction was a strong predictor of MACCE and all-cause mortality among men. Female patients had a higher rate of 7-year MACCE (hazard ratio, 1.33; 95% confidence interval, 1.16-1.51) and a higher rate of 7-year all-cause mortality (hazard ratio, 1.23; 95% confidence interval, 0.98-1.53). CONCLUSIONS The risk factor profile and predictors of outcomes were different between our female and male patients. Women carried a higher risk of events and mortality after CABG at a young age.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Yavari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Saeed Sadeghian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Salehi Omran
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masih Tajdini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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10
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Attia RQ, Katumalla E, Cyclewala S, Rochon M, Marczin N, Raja SG. Do in-hospital outcomes of isolated coronary artery bypass grafting vary between male and female octogenarians? Interact Cardiovasc Thorac Surg 2021; 34:958-965. [PMID: 34718583 PMCID: PMC9159460 DOI: 10.1093/icvts/ivab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Female gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. We aimed to analyse in-hospital outcomes of isolated CABG in this cohort. METHODS All octogenarians that underwent isolated CABG, from January 2000 to October 2017, were included. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. A propensity score was generated for each patient from a multivariable logistic regression model based on 25 pre-treatment covariates. A total of 156 matching pairs were derived. RESULTS Five hundred and sixty-seven octogenarians underwent isolated CABG. This included 156 females (mean age 82.1 [SD: 0.9]) and 411 males (mean age 82.4 [SD: 2.1 years]). More males were current smokers (P = 0.002) with renal impairment (P = 0.041), chronic obstructive pulmonary disease (P = 0.048), history of cerebrovascular accident (P = 0.039) and peripheral vascular disease (P = 0.027) while more females had New York Heart Association class 4 (P = 0.02), left ventricular ejection fraction 30-49% (P = 0.038) and left ventricular ejection fraction <30% (P = 0.049). On-pump, CABG was performed in 140 males and 52 females (P = 0.921). There was no difference in in-hospital mortality (5.4% vs 6.4%; P = 0.840), stroke (0.9% vs 1.3%; P = 0.689), need for renal replacement therapy (17.0% vs 13.5%; P = 0.732), pulmonary complications (9.5% vs 8.3%; P = 0.746) and sternal wound infection (2.7% vs 2.6%; P = 0.882). The outcomes were comparable for the propensity-matched cohorts. CONCLUSIONS No gender difference in outcomes was seen in octogenarians undergoing isolated CABG.
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Affiliation(s)
- Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Eve Katumalla
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | | | - Melissa Rochon
- Department of Quality & Safety (Surveillance section), Harefield Hospital, London, UK
| | - Nandor Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Anaesthesia, Harefield Hospital, London, UK
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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11
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Anand PA, Keshavamurthy S, Shelley EM, Saha S. Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting? Int J Angiol 2021; 30:202-211. [PMID: 34776820 PMCID: PMC8580610 DOI: 10.1055/s-0041-1735221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The etiology of coronary artery disease (CAD) is multifactorial, stemming from both modifiable and nonmodifiable risk factors such as age. Several studies have reported the effects of age on various outcomes of coronary artery bypass grafting (CABG). This article reviews age-related outcomes of CABG and offers direction for further studies in the field to create comprehensive, evidence-based guidelines for the treatment of CAD. Ninety-two primary sources were analyzed for relevance to the subject matter, of which 17 were selected for further analysis: 14 retrospective cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our review revealed four broad age ranges into which patients can be grouped: those with CAD (1) below the age of 40 years, (2) between the ages of 40 and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above 80 years. Patients below the age of 40 years fare best overall with total arterial revascularization (TAR). Patients between the ages of 40 and 60 years also fare well with the use of multiarterial grafts (MAGs) whereas either MAGs or single-arterial grafts may be of significant benefit to patients at or above the age of 60 years, with younger and diabetic patients benefitting the most. Arterial grafting is superior to vein grafting until the age of 80 years, at which point there is promising evidence supporting the continued use of the saphenous vein as the favored graft substrate. Age is a factor affecting the outcomes of CABG but should not serve as a barrier to offering patients CABG at any age from either a cost or a health perspective. Operative intervention starts to show significant mortality consequences at the age of 80 years, but the increased risk is countered by maintenance or improvement to patients' quality of life.
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Affiliation(s)
- Pavan Ashwini Anand
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Suresh Keshavamurthy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Ellis M. Shelley
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Sibu Saha
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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12
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Barili F, D'Errigo P, Rosato S, Biancari F, Forti M, Pagano E, Parolari A, Gellini M, Badoni G, Seccareccia F. Impact of gender on 10-year outcome after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:510-517. [PMID: 34000041 DOI: 10.1093/icvts/ivab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the impact of gender on the 10-year outcome of patients after isolated coronary artery bypass grafting (CABG) included in the Italian nationwide PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery (PRIORITY) study. METHODS The PRIORITY project was designed to evaluate the long-term outcomes of patients who underwent CABG and were included in 2 prospective multicentre cohort studies. The primary end point of this analysis was major adverse cardiac and cerebrovascular events. Baseline differences between the study groups were balanced with propensity score matching and inverse probability of treatment. Time to events was analysed using Cox regression and competing risk analysis. RESULTS The study population comprised 10 989 patients who underwent isolated CABG (women 19.6%). Propensity score matching produced 1898 well-balanced pairs. The hazard of major adverse cardiac and cerebrovascular event was higher in women compared to men [adjusted hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.03-1.23; P = 0.009]. The incidence of major adverse cardiac and cerebrovascular event in women was significantly higher at 1 year (HR 1.31, 95% CI 1.11-1.55; P < 0.001) and after 1 year (HR 1.11, 95% CI 1.00-1.24; P = 0.05). Mortality at 10 years in the matched groups was comparable (HR 1.04, 95% CI 0.93-1.16; P = 0.531). Women have significantly a higher 10-year risk of myocardial infarction (adjusted HR 1.40, 95% CI 1.17-1.68; P = 0.002) and percutaneous coronary intervention (adjusted HR 1.32, 95% CI 1.10-1.59; P = 0.003). CONCLUSIONS The present study documented an excess of non-fatal cardiac events after CABG among women despite comparable 10-year survival with men. These findings suggest that studies investigating measures of tertiary prevention are needed to decrease the risk of adverse cardiovascular events among women.
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Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Marco Forti
- Agenzia Regionale per i Servizi Sanitari Regionali, Rome, Italy
| | - Eva Pagano
- Department of Epidemiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Parolari
- Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, S. Donato Milanese, Italy
| | - Mara Gellini
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian Health Institute, Rome, Italy
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13
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Miñana G, Núñez J, Monmeneu JV, López-Lereu MP, Gavara J, Marcos-Garcés V, Ríos-Navarro C, Pérez N, de Dios E, Fernández-Cisnal A, Núñez E, Chorro FJ, Sanchis J, Bodi V. Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance. Open Heart 2021; 8:openhrt-2021-001619. [PMID: 34001655 PMCID: PMC8130753 DOI: 10.1136/openhrt-2021-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We assessed the influence of the ischaemic burden (IB) as derived from vasodilator stress cardiovascular magnetic resonance (CMR) on the risk of death and the effect of revascularisation across sex. METHODS We evaluated 6237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischaemia was defined as >5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used. RESULTS A total of 2371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularisation. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived IB across sex (p value for interaction=0.039). Women exhibited an adjusted lower risk of death and only equaled men's risk when extensive ischaemia was present. Likewise, CMR-related revascularisation was shown to be differentially associated with the risk of mortality across sex (p value for interaction=0.025). In patients with non-extensive ischaemia, revascularisation was associated with a higher risk of death, with a greater extent in women. At higher IB, revascularisation was associated with a lower risk in men, with more uncertain results in women. CONCLUSIONS CMR-derived IB allows predicting the risk of death and gives insight into the potential effect of revascularisation in men and women with CCS. Compared with men, women with non-extensive ischaemia displayed a lower risk and a similar risk with a higher IB. The impact of CMR-related revascularisation on mortality risk was also significantly different according to IB and sex. Further research will be needed to confirm these hypothesis-generating findings.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Jose V Monmeneu
- Cardiac Imaging Unit, ERESA, Unidad de Imagen Cardiaca Valencia, ES, Valencia, Spain
| | - Maria P López-Lereu
- Cardiac Imaging Unit, ERESA, Unidad de Imagen Cardiaca Valencia, ES, Valencia, Spain
| | - Jose Gavara
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | | | - Nerea Pérez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Elena de Dios
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Eduardo Núñez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Juan Sanchis
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Vicente Bodi
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
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14
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Ripoll JG, Smith MM, Hanson AC, Schulte PJ, Portner ER, Kor DJ, Warner MA. Sex-Specific Associations Between Preoperative Anemia and Postoperative Clinical Outcomes in Patients Undergoing Cardiac Surgery. Anesth Analg 2021; 132:1101-1111. [PMID: 33543869 DOI: 10.1213/ane.0000000000005392] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preoperative anemia is common in cardiac surgery, yet there were limited data describing the role of sex in the associations between anemia and clinical outcomes. Understanding these relationships may guide preoperative optimization efforts. METHODS This is an observational cohort study of adults undergoing isolated coronary artery bypass grafting or single- or double-valve surgery from 2008 to 2018 at a large tertiary medical center. Multivariable regression assessed the associations between preoperative hemoglobin concentrations and a primary outcome of postoperative acute kidney injury (AKI) and secondary outcomes of perioperative red blood cell (RBC) transfusion, reoperation, vascular complications (ie, stroke, pulmonary embolism, and myocardial infarction), and hospital length of stay (LOS). Each outcome was a single regression model, using interaction terms to assess sex-specific associations between hemoglobin and outcome. RESULTS A total of 4117 patients were included (57% men). Linear splines with sex-specific knots (13 g/dL in women and 14 g/dL in men) provided the best overall fit for preoperative hemoglobin and outcome relationships. In women, each 1 g/dL decrease in hemoglobin <13 g/dL was associated with increased odds of AKI (odds ratio = 1.49; 95% confidence interval [CI], [1.23-1.81]; P < .001), and there was no significant association between hemoglobin per 1 g/dL >13 g/dL and AKI (0.90 [0.56-1.45]; P = .67). The association between hemoglobin and AKI in men did not meet statistical significance (1.10 [0.99-1.22]; P = .076, per 1 g/dL decrease <14 g/dL; 1.00 [0.79-1.26]; P = .98 for hemoglobin per 1 g/dL >14 g/dL). In women, lower preoperative hemoglobin (per 1 g/dL decrease <13 g/dL) was associated with increased odds of RBC transfusion (2.90 [2.33-3.60]; P < .001), reoperation (1.27 [1.11-1.45]; P < .001) and a longer hospital LOS (multiplicative increase in geometric mean 1.05 [1.03-1.07]; P < .001). In men, preoperative hemoglobin (per 1 g/dL decrease <14 g/dL) was associated with increased odds of perioperative RBCs (2.56 [2.27-2.88]; P < .001) and longer hospital LOS (multiplicative increase in geometric mean 1.02 [1.01-1.04] days; P < .001) but not reoperation (0.94 [0.85-1.04]; P = .256). Preoperative hemoglobin per 1 g/dL >13 g/dL in women and 14 g/dL in men were associated with lower odds of RBCs transfusion (0.57 [0.47-0.69]; P < .001 and 0.74 [0.60-0.91]; P = .005, respectively). CONCLUSIONS Preoperative anemia was associated with inferior clinical outcomes after cardiac surgery. The associations between hemoglobin and outcomes were distinct for women and men, with different spline knot points identified (13 and 14 g/dL, respectively). Clinicians should consider data-driven approaches to determine preoperative hemoglobin values associated with increasing risk for adverse perioperative outcomes across sexes.
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Affiliation(s)
- Juan G Ripoll
- From the Department of Anesthesiology and Perioperative Medicine
| | - Mark M Smith
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology and Perioperative Medicine
| | | | | | - Erica R Portner
- Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew A Warner
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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15
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DeFilippis EM, Wu WY, Lau ES, Blankstein R, Divakaran S. Sex Differences in Young Adults Who Experience Myocardial Infarction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Neointimal Hyperplasia after Carotid Transection and Anastomosis Surgery is Associated with Degradation of Decorin and Platelet Derived Growth Factor Signaling. JVS Vasc Sci 2020; 2:2-12. [PMID: 33842897 PMCID: PMC8034587 DOI: 10.1016/j.jvssci.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective Intimal hyperplasia (IH) is the expansion of the vascular intimal region after intervention, which can lead to stenosis and eventual failure of vascular grafts or interventional procedures such as angioplasty or stent placement. Our goals were to investigate the development of IH in a rabbit open surgical model and to evaluate the associated pathophysiologic processes involving decorin and the platelet-derived growth factor-BB/platelet-derived growth factor receptor-β/mitogen-activated protein kinase (PDGF-BB/PDGFR-β/MAPK) pathway. Methods We conducted carotid transection and primary anastomosis on five New Zealand white rabbits to induce IH and examined the associated pathophysiologic changes. Tissue was obtained for histological and protein analysis on postoperative day 21 using the contralateral vessel as a control. Intimal medial thickness (IMT) was calculated to measure IH and compared with the unoperated side. Western blot analysis was performed on tissue lysates to determine the expression of decorin core protein, PDGF-BB, PDGFR-β, and phosphorylated-MAPK (ph-MAPK). Immunofluorescence microscopy was used to assess tissue distribution of matrix metalloproteinase-2 (MMP-2) and ph-PDGFR-β. Results Bilateral carotid arteries were harvested on postoperative day 21. We compared the IMT in operated with unoperated specimens. IMT was significantly elevated in operated arteries vs unoperated arteries in all five animals (148.6 μm ± 9.09 vs 103.40 μm ± 7.08; 135.2 μm ± 8.30 vs 92.40 μm ± 2.35; 203.1 μm ± 30.23 vs 104.00 μm ± 4.52; 236.2 μm ± 27.22 vs 141.50 μm ± 9.95; 226.9 μm ± 11.12 vs 98.8 μm ± 3.78). Western blot analysis revealed degradation of decorin protein in the operated tissue, including loss of a 50 kDa band and the appearance of a cleaved fragment at 10 kDa. Decorin and MMP-2 were observed, via immunofluorescence microscopy, in the neointima of the operated vessels. Western blot analysis also revealed increased PDGF-BB, PDGFR-β, and ph-MAPK levels in operated tissue. Immunofluorescent staining for ph-PDGFR-β primarily localized to the neointima, indicating increased signaling through PDGF in this region. Conclusions Carotid transection and primary reanastomosis in rabbits induced IH that was associated with MMP-2 activation, degradation of decorin, and activation of the PDGF/PDGFR-β/MAPK pathway. The findings in this study should lead to further mechanistic evaluation of these pathways to better understand the potential to modify the intimal hyperplastic response to surgery. (JVS–Vascular Science 2020;2:2-12.) Clinical Relevance Intimal hyperplasia remains a significant challenge to the vascular surgeon in open and interventional procedures. Basic science studies have made headway into understanding the process, but this has not translated into many therapeutic options particularly for primary prevention after a procedure. Decorin is gaining popularity as an important mediator of various pathophysiologic processes involving the extracellular matrix. We sought to determine the possible role of decorin in the development of neointimal hyperplasia in an open surgical model. This study provides a replicable model for the development of intimal hyperplasia and potential therapeutic targets going forward.
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17
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Mahowald MK, Alqahtani F, Alkhouli M. Comparison of Outcomes of Coronary Revascularization for Acute Myocardial Infarction in Men Versus Women. Am J Cardiol 2020; 132:1-7. [PMID: 32773227 DOI: 10.1016/j.amjcard.2020.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Abstract
This study sought to examine the differences in the characteristics and outcomes between men and women who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) in contemporary US practice. The Nationwide Inpatient Sample was used to identify patients who underwent revascularization for AMI between January 1, 2003 and December 31, 2016. The primary outcome was in-hospital mortality. Propensity score matching was utilized to account for differences in baseline characteristics. In total, 3,603,142 patients were included, of whom only 1,180,436 (33%) were women. Compared with men, women were older and had higher prevalence of key co-morbidities including diabetes, hypertension, congestive heart failure, and chronic kidney and lung disease (p <0.001). In the PCI cohort, women were significantly less likely to undergo multivessel PCI, to receive mechanical circulatory support, or to undergo atherectomy. In the CABG group, women were more likely to have concomitant valve surgery. In the propensity-matched cohorts, in-hospital mortality was higher for women than men regardless of revascularization strategy: 7.6% versus 6.6% for PCI in ST-elevation myocardial infarction, 2.0% versus 1.9% for PCI in non-ST-elevation myocardial infarction, and 5.7% versus 4.3% for CABG in any AMI (p <0.001). Women also had higher rates of major complications, longer hospitalizations, higher costs, and were less likely to be discharged home (vs nursing facility). These sex-based differences persisted over the study 14-year period. In conclusion, in a contemporary nationwide analysis of propensity score-matched patients, women who undergo revascularization for AMI have worse in-hospital outcomes than men regardless of revascularization mode.
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18
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Kusu‐Orkar T, Kermali M, Oguamanam N, Bithas C, Harky A. Coronary artery bypass grafting: Factors affecting outcomes. J Card Surg 2020; 35:3503-3511. [DOI: 10.1111/jocs.15013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Nina Oguamanam
- Department of Emergency Medicine East Sussex Healthcare NHS Trust Seaford UK
| | | | - Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Hospital Liverpool UK
- Liverpool Center for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK
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19
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3605] [Impact Index Per Article: 901.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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20
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Sex Difference and Outcome after Percutaneous Intervention in Patients with Chronic Total Occlusion: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:25-31. [DOI: 10.1016/j.carrev.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/28/2019] [Accepted: 03/07/2019] [Indexed: 01/11/2023]
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21
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Friedrich C, Freundt M, Salem MA, Panholzer B, Huenges K, Puehler T, Cremer J, Haneya A. Sex-Specific Outcome after Ascending Aortic Surgery in Moderate Hypothermic Circulatory Arrest. Thorac Cardiovasc Surg 2019; 69:314-321. [PMID: 31604355 DOI: 10.1055/s-0039-1698409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. METHODS We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. RESULTS Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p < 0.001), and significantly shorter cardiopulmonary bypass (CPB) time (132 [105; 175] vs. 150 [118; 192] minutes; p < 0.001), while mean MHCA time was longer (15 [13; 19] vs. 14 [12; 17] minutes; p = 0.003). Surgical procedures were less complex in women and they were treated more frequently by isolated supracoronary ascending aorta replacement (61 vs. 54%; p = 0.046). Postoperatively, men showed a higher incidence of neurologic complications (7.0 vs. 3.3%; p = 0.03). The 30-day mortality (women 4.9% vs. men 3.9%; p = 0.48) did not differ significantly, likewise after statistical matching (4.7 vs. 2.3%; p = 0.120). Age, CPB time, and blood transfusion, but not female gender, were risk factors for mortality in multivariable regression analysis. CONCLUSION This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA.
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Affiliation(s)
- Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Miriam Freundt
- Department of Hospital Medicine and Critical Care, St. Bernards Medical Center, Jonesboro, Arkansas, United States
| | - Mohamed Ahmed Salem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Johnston A, Mesana TG, Lee DS, Eddeen AB, Sun LY. Sex Differences in Long-Term Survival After Major Cardiac Surgery: A Population-Based Cohort Study. J Am Heart Assoc 2019; 8:e013260. [PMID: 31438770 PMCID: PMC6755832 DOI: 10.1161/jaha.119.013260] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Little attention has been paid to the importance of sex in the long‐term prognosis of patients undergoing cardiac surgery. Methods and Results We conducted a retrospective cohort study of Ontario residents, aged ≥40 years, who underwent coronary artery bypass grafting (CABG) and/or aortic, mitral, or tricuspid valve surgery between October 1, 2008, and December 31, 2016. The primary outcome was all‐cause mortality. The mortality rate in each surgical group was calculated using the Kaplan‐Meier method. The risk of death was assessed using multivariable Cox proportional hazard models. Sex‐specific mortality risk factors were identified using multiplicative interaction terms. A total of 72 824 patients were included in the study (25% women). The median follow‐up period was 5 (interquartile range, 3–7) years. The long‐term age‐standardized mortality rate was lowest in patients who underwent isolated CABG and highest among those who underwent combined CABG/multiple valve surgery. Women had significantly higher age‐standardized mortality rate than men after CABG and combined CABG/mitral valve surgery. Men had lower rates of long‐term mortality than women after isolated mitral valve repair, whereas women had lower rates of long‐term mortality than men after isolated mitral valve replacement. We observed a statistically significant association between female sex and long‐term mortality after adjustment for key risk factors. Conclusions Female sex was associated with long‐term mortality after cardiac surgery. Perioperative optimization and long‐term follow‐up should be tailored to younger women with a history of myocardial infarction and percutaneous coronary intervention and older men with a history of chronic obstructive pulmonary disease and depression.
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Affiliation(s)
- Amy Johnston
- Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Thierry G Mesana
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences Ontario Canada.,Peter Munk Cardiac Centre University Health Network University of Toronto Toronto Ontario Canada
| | | | - Louise Y Sun
- Institute for Clinical Evaluative Sciences Ontario Canada.,Division of Cardiac Anesthesiology University of Ottawa Heart Institute and School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
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Nuru A, Weltzien JAH, Sandvik L, Tønnessen T, Bjørnstad JL. Short- and long-term survival after isolated coronary artery bypass grafting, the impact of gender and age. SCAND CARDIOVASC J 2019; 53:342-347. [PMID: 31321989 DOI: 10.1080/14017431.2019.1646430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Assess the short- and long-term survival for patients who underwent isolated coronary artery bypass grafting (CABG) and evaluate the impact of gender and age. Furthermore to assess the long-term survival in the CABG group compared to the general population. Design. This study included 4044 consecutive patients who underwent isolated CABG at Oslo University Hospital, Ullevål, in Oslo, Norway in the time period from 01 January 2003 to 31 December 2015. Patient data was collected retrospectively from the quality register at the department. Information on survival status was obtained from the Norwegian National Registry. Life expectancy data for the general population was gained from Statistics Norway. Results. Female patients were significantly older than male patients at the time of surgery (mean age 67.0 and 63.9 years, respectively, p < .001), and had significantly lower 30-day survival (mortality was 1.4% and 0.6%, respectively, p = .017). Male gender was independently associated with lower long-term survival (p = .0037) in a multivariate analysis. Male patients aged less than 60 years also showed significantly lower long-term survival (SMR = 1.84, 95% CI = 1.49-2.25) compared to the age-matched general population. Among patients older than 60 years, survival was similar to survival in the age-matched general population. Conclusions. Survival was excellent for patients undergoing surgery. Despite increased age and operative mortality, female patients had better adjusted long-time survival than male patients. There was lower long-term survival among male patients aged less than 60 compared to the general population. Our findings may help clinicians in selecting appropriate patients for surgery.
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Affiliation(s)
- A Nuru
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J A H Weltzien
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - T Tønnessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - J L Bjørnstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
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24
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Elbatarny M, Tam DY, Fremes SE. Commentary: Nuisance or nemesis? Postoperative atrial fibrillation increases long-term mortality regardless of sex. J Thorac Cardiovasc Surg 2019; 159:1426-1427. [PMID: 31262541 DOI: 10.1016/j.jtcvs.2019.05.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Malak Elbatarny
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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25
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Wagner AH, Zaradzki M, Arif R, Remes A, Müller OJ, Kallenbach K. Marfan syndrome: A therapeutic challenge for long-term care. Biochem Pharmacol 2019; 164:53-63. [PMID: 30926475 DOI: 10.1016/j.bcp.2019.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
Marfan syndrome (MFS) is an autosomal dominant genetic disorder caused by mutations in the fibrillin-1 gene. Acute aortic dissection is the leading cause of death in patients suffering from MFS and consequence of medial degeneration and aneurysm formation. In addition to its structural function in the formation of elastic fibers, fibrillin has a major role in keeping maintaining transforming growth factor β (TGF-β) in an inactive form. Dysfunctional fibrillin increases TGF-β bioavailability and concentration in the extracellular matrix, leading to activation of proinflammatory transcription factors. In turn, these events cause increased expression of matrix metalloproteinases and cytokines that control the migration and infiltration of inflammatory cells into the aorta. Moreover, TGF-β causes accumulation of reactive oxygen species leading to further degradation of elastin fibers. All these processes result in medial elastolysis, which increases the risk of vascular complications. Although MFS is a hereditary disease, symptoms and traits are usually not noticeable at birth. During childhood or adolescence affected individuals present with severe tissue weaknesses, especially in the aorta, heart, eyes, and skeleton. Considering this, even young patients should avoid activities that exert additional stress and pressure on the aorta and the cardiovascular system. Thus, if the diagnosis is made and prophylactic treatment is initiated in a timely fashion, MFS and its preliminary pathophysiologic vascular remodeling can be successfully ameliorated reducing the risk of life-threatening complications. This commentary focuses on new research opportunities and molecular findings on MFS, discusses future challenges and possible long-term therapies.
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Affiliation(s)
- A H Wagner
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Germany.
| | - M Zaradzki
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - R Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - A Remes
- Department of Internal Medicine III, University Hospital Kiel, Kiel, Germany
| | - O J Müller
- Department of Internal Medicine III, University Hospital Kiel, Kiel, Germany
| | - K Kallenbach
- INCCI HaerzZenter, Department of Cardiac Surgery, Luxembourg, Luxembourg
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26
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Piątek J, Kędziora A, Konstanty-Kalandyk J, Kiełbasa G, Olszewska M, Wróbel K, Song BH, Darocha T, Wróżek M, Kapelak B. Minimally invasive coronary artery bypass as a safe method of surgical revascularization. The step towards hybrid procedures. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:320-325. [PMID: 29362575 PMCID: PMC5770863 DOI: 10.5114/aic.2017.71614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Coronary artery disease is nowadays responsible for approximately 15% of hospitalizations in Poland. Minimally invasive coronary artery bypass (MIDCAB) represents an attractive alternative to a sternotomy, and at the same time provides better life quality and facilitates quick rehabilitation. AIM To evaluate whether MIDCAB can be performed with similar early and mid-term results as off-pump coronary artery bypass (OPCAB) and therefore can be considered as a safe stage in hybrid revascularization. MATERIAL AND METHODS In a retrospective cohort study, we analyzed 73 consecutive patients who underwent coronary artery bypass grafting (left internal mammary artery to left anterior descending artery) between 2013 and 2016 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. Thirty-eight (52.1%) MIDCAB and 35 (47.9%) OPCAB patients were enrolled. RESULTS Short-term results did not significantly differ between groups and similar 30-day mortality was observed (MIDCAB 2.6% vs. OPCAB 2.9%, p = 1). The median follow-up period was 21 months. There were no statistical differences in terms of overall survival or cardiac mortality between groups (94.7% vs. 88.6%, p = 0.42; 2.6% vs. 2.9%, p = 1, respectively). The rate of hospitalization due to cardiac causes was similar in both groups (7.9% vs. 5.1%, p = 1) and there were no differences in current exacerbation of angina or heart failure, with median NYHA class I and CCS class I in both groups. CONCLUSIONS Despite higher technical difficulty, MIDCAB procedures can be performed with similar safety results as OPCAB procedures. No differences in terms of mortality, repeat revascularization or recurrent angina are observed.
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Affiliation(s)
- Jacek Piątek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, University Hospital, Krakow, Poland
| | - Marta Olszewska
- Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Wróbel
- Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland
| | - Bryan HyoChan Song
- Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Darocha
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland
| | - Marcin Wróżek
- Cardiosurgical Students’ Scientific Group, Jagiellonian University Medical College, Krakow, Poland
| | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
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Yüksel A, Kan II, Yolgösteren A, Velioğlu Y, Çayır MÇ, Gürbüz O, Kumtepe G, Akarsu S, Biçer M, Tok M, Şenkaya I. Are the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men's? Braz J Cardiovasc Surg 2017; 32:191-196. [PMID: 28832797 PMCID: PMC5570389 DOI: 10.21470/1678-9741-2016-0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 04/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the impact of gender difference in early postoperative
outcomes in elderly patients (aged 70 or older) undergoing coronary artery
bypass grafting surgery. Methods Between October 2009 and December 2013, a total of 223 elderly patients (aged
70 or older) undergoing isolated primary coronary artery bypass grafting
surgery were included in this retrospective observational cohort study.
Patients were divided into two groups according to their gender. The
patients' medical records were collected, their baseline preoperative
characteristics, operative data, and postoperative outcomes were
retrospectively reviewed, and the effect of gender difference in the early
postoperative outcomes was analyzed. Results Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152
patients, respectively. Mean age of patients was 74.4±3.6 years
(range: 70-84 years). The level of EuroSCORE I, the incidence of
hypertension and hyperlipidemia were significantly higher in Group 1, while
the rate of smoking was significantly higher in Group 2. Mean postoperative
intubation time, length of intensive care unit and hospital stay were longer
in female patients than in male patients, but these differences were not
statistically significant. No statistically significant difference between
two groups in terms of the transfusion of blood products was observed. The
rates of in-hospital mortality and major postoperative complications were
statistically similar between the two groups. Conclusion In conclusion, the female gender was not associated with worse early
postoperative outcomes in elderly patients undergoing coronary artery bypass
grafting surgery.
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Affiliation(s)
- Ahmet Yüksel
- Department of Cardiovascular Surgery of Bursa State Hospital, Bursa, Turkey
| | - Irem Iris Kan
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Atıf Yolgösteren
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Yusuf Velioğlu
- Department of Cardiovascular Surgery of Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | | | - Orçun Gürbüz
- Department of Cardiovascular Surgery of Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Gencehan Kumtepe
- Department of Cardiovascular Surgery of Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Serkan Akarsu
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Murat Biçer
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mustafa Tok
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
| | - Işık Şenkaya
- Department of Cardiovascular Surgery of Uludag University Faculty of Medicine, Bursa, Turkey
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De Rosa S, Polimeni A, Sabatino J, Indolfi C. Long-term outcomes of coronary artery bypass grafting versus stent-PCI for unprotected left main disease: a meta-analysis. BMC Cardiovasc Disord 2017; 17:240. [PMID: 28877676 PMCID: PMC5588710 DOI: 10.1186/s12872-017-0664-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/16/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronary artery bypass graft (CABG) surgery has traditionally represented the standard of care for left main coronary artery (LMCA) disease. However, percutaneous coronary intervention with stent implantation (PCI) has more recently emerged as a valuable alternative. The long-time awaited results of the largest randomized trials on the long-term impact of PCI versus CABG in LMCA disease, the newly published NOBLE and EXCEL studies, revealed contrasting results. Thus, aim of the present meta-analysis was to review the most robust evidence from randomized comparisons of CABG versus PCI for revascularization of LMCA. METHODS Randomized studies comparing long-term clinical outcomes of CABG or Stent-PCI for the treatment of LMCA disease were searched for in PubMed, the Chochrane Library and Scopus electronic databases. A total of 5 randomized studies were selected, including 4499 patients. RESULTS No significant difference between CABG and PCI was found in the primary analysis on the composite endpoint of death, stroke and myocardial infarction (OR = 1·06 95% CI 0·80-1·40; p = 0·70). Similarly, no differences were observed between CABG and PCI for all-cause death (OR = 1·03 95% CI 0·81-1·32; p = 0·81). Although not statistically significant, a lower rate of stroke was registered in the PCI arm (OR = 0·86; p = 0·67), while a lower rate of myocardial infarction was found in the CABG arm (OR = 1·43; p = 0·17). On the contrary, a significantly higher rate of repeat revascularization was registered in the PCI arm (OR = 1·76 95% CI 1·45-2·13; p < 0·001). CONCLUSIONS The present meta-analysis, the most comprehensive and updated to date, including 5 randomized studies and 4499 patients, demonstrates no difference between Stent-PCI and CABG for the treatment of LMCA disease in the composite endpoint of death, stroke and myocardial infarction. Hence, a large part of patients with unprotected left main coronary artery disease can be managed equally well by means of both these revascularization strategies.
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Affiliation(s)
- Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
- URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche (CNR), 88100 Catanzaro, Italy
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29
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Carrel T, Winkler B. Current trends in selection of conduits for coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2017; 65:549-556. [DOI: 10.1007/s11748-017-0807-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/31/2017] [Indexed: 01/16/2023]
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30
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Chaudhry R, Zaki J, Wegner R, Pednekar G, Tse A, Sheinbaum R, Williams GW. Gastrointestinal Complications After Cardiac Surgery: A Nationwide Population-Based Analysis of Morbidity and Mortality Predictors. J Cardiothorac Vasc Anesth 2017; 31:1268-1274. [PMID: 28800983 DOI: 10.1053/j.jvca.2017.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The authors aimed to evaluate the incidence, risk factors, and outcomes of gastrointestinal (GI) complications in cardiac and aortic surgery using recent versions of the National (Nationwide) Inpatient Sample (NIS) to provide clinicians with a better understanding of these uncommon but potentially serious complications. DESIGN Population-based study. SETTING NIS database 2010-2012. PARTICIPANTS Patients undergoing cardiac and aortic aneurysm repair surgeries. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS The most common GI complication was postoperative ileus, which also had the lowest mortality, followed by GI hemorrhage. Mesenteric ischemia demonstrated the highest mortality, followed by intestinal perforation. Mortality was highest in those with infective endocarditis (16.02%), followed by myocardial infarction (12.48%). GI complications were highest in patients undergoing repair of abdominal aortic aneurysm, followed by off-pump coronary artery bypass grafting. CONCLUSION In conclusion, this study demonstrated that GI complications after cardiac surgery occurred at a rate of 4.17%, which is similar to that reported in the NIS database from 1998 to 2002 in coronary artery bypass grafting patients, but higher than that previously described in single-center studies. GI complications after cardiac surgery increased inpatient mortality 3-fold and more than doubled length of stay. Improved recognition and understanding of the predisposing risk factors and complications elucidated in this study could serve to increase the necessity for timely diagnosis and treatment of patients at high risk for GI complications after cardiac surgery.
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Affiliation(s)
- Rabail Chaudhry
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX
| | - John Zaki
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX
| | - Robert Wegner
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX
| | - Greesha Pednekar
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX
| | - Alex Tse
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX
| | - Roy Sheinbaum
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX
| | - George W Williams
- Department of Anesthesiology, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX; Department of Neurosurgery, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX.
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31
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Piątek J, Kędziora A, Konstanty-Kalandyk J, Kiełbasa G, Olszewska M, Song BH, Wierzbicki K, Milaniak I, Darocha T, Sobczyk D, Kapelak B. Risk factors for in-hospital mortality after coronary artery bypass grafting in patients 80 years old or older: a retrospective case-series study. PeerJ 2016; 4:e2667. [PMID: 27920951 PMCID: PMC5136134 DOI: 10.7717/peerj.2667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/08/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Age remains a significant and unmodifiable risk factor for cardiovascular diseases, and an increasing number of patients older than 80 years of age undergo Coronary Artery Bypass Grafting (CABG). Old age is also an independent risk factor for postoperative complications. The aim of this study is to describe the population of patients 80 years of age or older who underwent CABG procedure and to assess the mortality rate and risk factors for in-hospital mortality. METHODS A retrospective case-series study analyzing 388 consecutive patients aged 80 years of age or older who underwent isolated CABG procedure between 2010 and 2014 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. RESULTS In-hospital mortality stood at 7%, compared to 3.4% for all isolated CABG procedures at our Institution. In an univariate logistic regression analysis, risk factors for in-hospital mortality were as follows: NYHA class (p = 0.005, OR 1.95, 95% CI [1.23-3.1]), prolonged mechanical ventilation (p < 0.001, OR 7.08, 95% CI [2.47-20.3]), rethoracotomy (p = 0.04, OR 3.31, 95% CI [1.04-10.6]), duration of the procedure and ECC (for every 10 min p = 0.01, OR 1.01, 95% CI [1.0-1.01]; p = 0.03, OR 1.01, 95% CI [1.0-1.02], respectively), PRBC, FFP, and PLT transfusion (for every unit transfused p = 0.004, OR 1.42, 95% CI [1.12-1.8]; p = 0.002, OR 1.55, 95% CI [1.18-2.04]; p = 0.009, OR 1.93, 95% CI [1.18-3.14], respectively). Higher LVEF (p = 0.02, OR 0.97, 95% CI [0.94-0.99]) and LIMA graft implantation (p = 0.04, OR 0.36, 95% CI [0.13-0.98) decreased the in-hospital mortality. Death before discharge was more often observed in patients with multiple risk factors for cardiovascular diseases (0-2 -5.7%; 3-7.4%, 4-26.6%; p = 0.03). CONCLUSIONS Older age is associated with higher in-hospital mortality after isolated CABG at our Institution. Risk stratification scores and individualized risk evaluation, centered on comorbidities, NYHA class and left ventricular function, should be assessed in all cases. Whenever suitable, LIMA grafts should be used. Prolonged procedure and ECC time worsen the short-term outcome. Elderly individuals should be closely monitored postoperatively and the care should be focused on excessive blood loss and respiratory failure.
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Affiliation(s)
- Jacek Piątek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College , Krakow , Poland
| | - Janusz Konstanty-Kalandyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College , Krakow , Poland
| | - Marta Olszewska
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College , Krakow , Poland
| | - Bryan HyoChan Song
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College , Krakow , Poland
| | - Karol Wierzbicki
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Irena Milaniak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Tomasz Darocha
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland
| | - Dorota Sobczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Admission and Emergency Department, John Paul II Hospital, Krakow, Poland
| | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
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Petrie MC, Jhund PS, She L, Adlbrecht C, Doenst T, Panza JA, Hill JA, Lee KL, Rouleau JL, Prior DL, Ali IS, Maddury J, Golba KS, White HD, Carson P, Chrzanowski L, Romanov A, Miller AB, Velazquez EJ. Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation 2016; 134:1314-1324. [PMID: 27573034 DOI: 10.1161/circulationaha.116.024800] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown. METHODS A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure). RESULTS Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P=0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P<0.001). In contrast, cardiovascular mortality was not statistically significantly different across the spectrum of age in the MED group (53% versus 49% for quartiles 4 and 1, respectively; log-rank P=0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P=0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age (Pinteraction=0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages (Pinteraction=0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients (Pinteraction=0.004). In the CABG group, cardiopulmonary bypass time or days in intensive care did not differ for older versus younger patients. CONCLUSIONS CABG added to MED has a more substantial benefit on all-cause mortality and the combination of all-cause mortality and cardiovascular hospitalization in younger compared with older patients. CABG added to MED has a consistent beneficial effect on cardiovascular mortality regardless of age. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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Affiliation(s)
- Mark C Petrie
- BHF GCRC, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Pardeep S Jhund
- BHF GCRC, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lilin She
- Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher Adlbrecht
- Department of Medicine II, Division of Cardiology, Medical University of Vienna and 4 Medical Department, Hietzing Hospital, Vienna, Austria
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller University of Jena, Germany
| | - Julio A Panza
- Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Kerry L Lee
- Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA
| | - Jean L Rouleau
- University of Montreal, Montreal Heart Institute, Montreal, Canada
| | - David L Prior
- Department of Cardiology, St. Vincent's Hospital, University of Melbourne, Australia
| | - Imtiaz S Ali
- Libin Cardiovascular Institute of Alberta, University of Calgary, Canada
| | - Jyotsna Maddury
- Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Harvey D White
- Auckland City Hospital Greenlane Cardiovascular Services, Auckland, New Zealand
| | | | | | - Alexander Romanov
- Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Alan B Miller
- Department of Cardiology, University of Florida, Jacksonville, USA
| | - Eric J Velazquez
- Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA
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