المؤلفون: Harik, Lamia, Habib, Robert H, Dimagli, Arnaldo, Rahouma, Mohamed, Perezgrovas-Olaria, Roberto, Jr Soletti, Giovanni, Alzghari, Talal, An, Kevin R, Rong, Lisa Q, Sandner, Sigrid, Bairey-Merz, C Noel, Redfors, Björn, Girardi, Leonard, Gaudino, Mario

المصدر: Journal of the American College of Cardiology. 83(9):918-928

مصطلحات موضوعية: Cardiac and Cardiovascular Systems, Kardiologi, Adult, Humans, Female, Male, Cohort Studies, Coronary Artery Bypass, adverse effects, Anemia, epidemiology, Cardiac Surgical Procedures, Hematocrit, Risk Factors, Treatment Outcome, Retrospective Studies

الوصف: Women undergoing coronary artery bypass grafting (CABG) have higher operative mortality than men.The purpose of this study was to evaluate the relationship between intraoperative anemia (nadir intraoperative hematocrit), CABG operative mortality, and sex.This was a cohort study of 1,434,225 isolated primary CABG patients (344,357 women) from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2022). The primary outcome was operative mortality. The attributable risk (AR) (the risk-adjusted strength of the association of female sex with CABG outcomes) for the primary outcome was calculated. Causal mediation analysis derived the total effect of female sex on operative mortality risk and the proportion of that effect mediated by intraoperative anemia.Women had lower median nadir intraoperative hematocrit (22.0% [Q1-Q3: 20.0%-25.0%] vs 27.0% [Q1-Q3: 24.0%-30.0%], standardized mean difference 97.0%) than men. Women had higher operative mortality than men (2.8% vs 1.7%; P< 0.001; adjusted OR: 1.36; 95%CI: 1.30-1.41). The AR of female sex for operative mortality was 1.21 (95%CI: 1.17-1.24). After adjusting for nadir intraoperative hematocrit, AR was reduced by 43% (1.12; 95%CI: 1.09-1.16). Intraoperative anemia mediated 38.5% of the increased mortality risk associated with female sex (95%CI: 32.3%-44.7%). Spline regression showed a stronger association between operative mortality and nadir intraoperative hematocrit at hematocrit values <22.0% (P< 0.001).The association of female sex with increased CABG operative mortality is mediated to a large extent by intraoperative anemia. Avoiding nadir intraoperative hematocrit values below 22.0% may reduce sex differences in CABG operative mortality.

الوصول الحر: https://gup.ub.gu.se/publication/335377Test

المؤلفون: Sandner, Sigrid, Gaudino, Mario, Redfors, Björn, Angiolillo, Dominick J, Ben-Yehuda, Ori, Bhatt, Deepak L, Fremes, Stephen E, Lamy, Andre, Marano, Riccardo, Mehran, Roxana, Pocock, Stuart, Rao, Sunil V, Spertus, John A, Weinsaft, Jonathan W, Wells, George, Ruel, Marc

المصدر: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 20(5)

مصطلحات موضوعية: Cardiac and Cardiovascular Systems, Kardiologi, Humans, Ticagrelor, therapeutic use, Aspirin, Platelet Aggregation Inhibitors, adverse effects, Prospective Studies, Coronary Artery Bypass, Myocardial Infarction, Stroke, etiology, prevention & control

الوصف: The optimal antiplatelet strategy after coronary artery bypass graft (CABG) surgery in patients with chronic coronary syndromes (CCS) is unclear. Adding the P2Y12 inhibitor, ticagrelor, to low-dose aspirin for 1 year is associated with a reduction in graft failure, particularly saphenous vein grafts, at the expense of an increased risk of clinically important bleeding. As the risk of thrombotic graft failure and ischaemic events is highest early after CABG surgery, a better risk-to-benefit profile may be attained with short-term dual antiplatelet therapy followed by single antiplatelet therapy. The One Month Dual Antiplatelet Therapy With Ticagrelor in Coronary Artery Bypass Graft Patients (ODIN) trial is a prospective, randomised, double-blind, placebo-controlled, international, multicentre study of 700 subjects that will evaluate the effect of short-term dual antiplatelet therapy with ticagrelor plus low-dose aspirin after CABG in patients with CCS. Patients will be randomised 1:1 to ticagrelor 90 mg twice daily or matching placebo, in addition to aspirin 75-150 mg once daily for 1 month; after the first month, antiplatelet therapy will be continued with aspirin alone. The primary endpoint is a hierarchical composite of all-cause death, stroke, myocardial infarction, revascularisation and graft failure at 1 year. The key secondary endpoint is a hierarchical composite of all-cause death, stroke, myocardial infarction, Bleeding Academic Research Consortium (BARC) type 3 bleeding, revascularisation and graft failure at 1 year (net clinical benefit). ODIN will report whether the addition of ticagrelor to low-dose aspirin for 1 month after CABG reduces ischaemic events and provides a net clinical benefit in patients with CCS. (ClinicalTrials.gov: NCT05997693).

الوصول الحر: https://gup.ub.gu.se/publication/335663Test