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Huang C, Zhang W, Chen X, Xu X, Qiu J, Pan Z. Fibrinogen is an independent preoperative predictor of hospital length of stay among patients undergoing coronary artery bypass grafting. J Cardiothorac Surg 2023; 18:112. [PMID: 37029421 PMCID: PMC10082530 DOI: 10.1186/s13019-023-02238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/02/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE This study aims to examine the impact of preoperative fibrinogen concentration on the short-term outcomes and hospital length of stay (LOS) of patients undergoing Coronary Artery Bypass Grafting (CABG). METHODS Between January 2010 and June 2022, a retrospective analysis comprised 633 patients who sequentially received isolated, primary CABG. These patients were categorized into normal fibrinogen group (fibrinogen < 3.5 g/L) and high fibrinogen group (fibrinogen ≥ 3.5 g/L) according to preoperative fibrinogen concentration. The primary outcome was LOS. To correct for confounding and investigate the effect of preoperative fibrinogen concentration on the short-term outcomes and LOS, we employed propensity score matching (PSM). The correlation between fibriongen concentration and LOS in subgroups was examined using subgroup analysis. RESULTS We categorized 344 and 289 patients in the "normal fibrinogen group" and "high fibrinogen group", respectively. After PSM, compared to the normal fibrinogen group, the high fibrinogen group had a longer LOS [12.00 (9.00-15.00) vs. 13.00 (10.00-16.00), P = 0.028] and higher incidence of postoperative renal impairment [49 (22.1%) vs. 72 (32.4%), P = 0.014]. Cardiopulmonary bypass (CPB) or non-CPB CABG patients showed similar correlations between various fibrinogen concentrations and LOS, according to subgroup analyses. CONCLUSIONS Fibrinogen is an independent preoperative predictor of both the LOS and the postoperative renal impairment that occurs after CABG. Patients with high preoperative fibrinogen concentration had a higher incidence of postoperative renal impairment and a longer LOS, emphasizing the significance of preoperative fibrinogen management.
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Affiliation(s)
- Chunsheng Huang
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Zhejiang, 315040, China
| | - Wenyuan Zhang
- Department of Anesthesiology and Intensive Care, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xiaofei Chen
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Zhejiang, 315040, China
| | - Xia Xu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Zhejiang, 315040, China
| | - Jun Qiu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Zhejiang, 315040, China
| | - Zhihao Pan
- Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Medical School of Ningbo University, Zhejiang, 315040, China.
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Mankovskyi D. Quality of Life and Social Functioning of Patients After Cardiosurgical Interventions. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective: to study the quality of life (QOL) and social functioning of patients who underwent cardiosurgery intervention (CSI) with the use of artificial circulation (AR) in the postoperative period, to determine and improve the system for further medical, psychological and social rehabilitation.
Materials and methods. 700 patients who underwent CSI with the use of AR were treated at the Heart Institute of the Ministry of Health of Ukraine. 86 patients had cerebral infarction (CI), 217 patients with signs of postoperative encephalopathy, and 504 patients with signs of cognitive dysfunction. The level of QOL and social functioning in patients with this pathology was analyzed.
Statistical analysis of differences in the quantitative values of indicators was performed using the nonparametric Mann-Whitney test.
Results. It was found that patients after CSI had generally low levels of QOL in all fields, namely in the indicators of psychological (emotional) well-being, general perception of life, ability to work, physical well-being, personal realization, selfcare and independence; interpersonal interaction.
The presence of ischemic and neurological complications in patients after CSI significantly reduces the QOL indicators in all areas, with differences in the quantitative values of such patients statistically significant (p<0,01) compared to the groups of patients without such complications.
The most significant deterioration of QOL is found in patients with cerebral infarction in the postoperative period, slightly less significant – in patients with signs of postoperative encephalopathy, and the smallest changes – in patients with signs of cognitive dysfunction.
Conclusions. The main task of modern cardiac surgery is not only to save the patient from death, but also to improve the quality of life (QOL). At the same time, patients after cardiac surgery are at risk of developing ischemic, neurological complications that significantly reduce QOL in all areas of life. That is why it is necessary to take into account the findings of the study in the development of treatment and rehabilitation programs and preventive measures for such patients.
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da Silveira LMV, Almeida AS, Fuchs FC, Silva AG, Lucca MB, Scopel S, Fuchs SC, Fuchs FD. Quality of life in patients with stable coronary artery disease submitted to percutaneous, surgical, and medical therapies: a cohort study. Health Qual Life Outcomes 2021; 19:261. [PMID: 34819096 PMCID: PMC8611891 DOI: 10.1186/s12955-021-01886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Clinical, surgical, and percutaneous strategies similarly prevent major cardiovascular events in patients with stable coronary artery disease (CAD). The possibility that these strategies have differential effects on health-related quality of life (HRQoL) has been debated, particularly in patients treated outside clinical trials.
Methods We assigned 454 patients diagnosed with CAD during an elective diagnostic coronary angiography to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical treatment (OMT), and followed them for an average of 5.2 ± 1.5 years. HRQoL was assessed using a validated Brazilian version of the 12-Item Short-Form Health Survey questionnaire. The association between therapeutic strategies and quality of life scores was tested using variance analysis and adjusted for confounders in a general linear model. Results There were no differences in the mental component summary scores in the follow-up evaluation by therapeutic strategies: 51.4, 53.7, and 52.3 for OMT, PCI, and CABG, respectively. Physical component summary scores were higher in the PCI group than the CABG and OMT groups (46.4 vs. 42.9 and 43.8, respectively); however, these differences were no longer different after adjustment for confounding variables. Conclusion In a long-term follow-up of patients with stable CAD, HRQoL did not differ in patients treated by medical, percutaneous, or surgical treatments.
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Affiliation(s)
- Lucas Molinari Veloso da Silveira
- Postgraduate Studies Program in Cardiology, School of Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil.,Division of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), SP, São Paulo, Brazil
| | - Adriana Silveira Almeida
- Postgraduate Studies Program in Cardiology, School of Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil
| | - Felipe C Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil.,Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Gonçalves Silva
- Hospital de Clínicas de Porto Alegre, INCT PREVER, CPC, 5º. and., Ramiro Barcelos, Porto Alegre, RS, 2350, 90035-903, Brazil
| | - Marcelo Balbinot Lucca
- Postgraduate Studies Program in Cardiology, School of Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, INCT PREVER, CPC, 5º. and., Ramiro Barcelos, Porto Alegre, RS, 2350, 90035-903, Brazil
| | - Samuel Scopel
- Hospital de Clínicas de Porto Alegre, INCT PREVER, CPC, 5º. and., Ramiro Barcelos, Porto Alegre, RS, 2350, 90035-903, Brazil
| | - Sandra C Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil. .,Hospital de Clínicas de Porto Alegre, INCT PREVER, CPC, 5º. and., Ramiro Barcelos, Porto Alegre, RS, 2350, 90035-903, Brazil.
| | - Flávio D Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil.,Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
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Krackhardt F, Kočka V, Waliszewski M, Toušek P, Janek B, Trenčan M, Krajči P, Lozano F, Roman KGS, Otaegui I, del Blanco BG, del Olmo VV, Nofrerías EF, Wachowiak L, Heang TM, Ahn TH, Jeong MH, Jung BC, Han KR, Piot C, Sebagh L, Rischner J, Pansieri M, Leschke M. Unrestricted use of polymer-free sirolimus eluting stents in routine clinical practice. Medicine (Baltimore) 2020; 99:e19119. [PMID: 32080086 PMCID: PMC7034709 DOI: 10.1097/md.0000000000019119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Viktor Kočka
- University Hospital Královské Vinohrady Prague, Czech Republic
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | - Petr Toušek
- University Hospital Královské Vinohrady Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | | - Lucie Wachowiak
- Medical Scientific Affairs, B.Braun France, Saint Cloud, France
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