المؤلفون: Sandner, Sigrid^1,2 (AUTHOR), Redfors, Björn^3,4,5 (AUTHOR), An, Kevin R.^1,6 (AUTHOR), Harik, Lamia¹ (AUTHOR), Heise, Rachel¹ (AUTHOR), Di Franco, Antonino¹ (AUTHOR), Fremes, Stephen E.⁷ (AUTHOR), Hare, David L.⁸ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Lamy, Andre¹⁰ (AUTHOR), Peper, Joyce¹¹ (AUTHOR), Ruel, Marc¹² (AUTHOR), ten Berg, Jurrien M.¹¹ (AUTHOR), Willemsen, Laura M.¹¹ (AUTHOR), Zhao, Qiang¹³ (AUTHOR), Zhu, Yunpeng¹³ (AUTHOR), Wojdyla, Daniel M.¹⁴ (AUTHOR), Bhatt, Deepak L.¹⁵ (AUTHOR), Alexander, John H.¹⁶ (AUTHOR), Gaudino, Mario¹ (AUTHOR) mfg9004@med.cornell.edu

المصدر: Journal of the American College of Cardiology (JACC). Jul2024, Vol. 84 Issue 2, p182-191. 10p.

مصطلحات موضوعية: *MYOCARDIAL infarction, *CORONARY artery bypass, *CORONARY artery surgery, *CLINICAL trials, *DRUG-eluting stents

مستخلص: Women have worse outcomes after coronary artery bypass surgery (CABG) than men. This study aimed to determine the incidence of CABG graft failure in women, its association with cardiac events, and whether it contributes to sex-related differences in outcomes. A pooled analysis of individual patient data from randomized clinical trials with systematic imaging follow-up was performed. Multivariable logistic regression models were used to assess the association of graft failure with myocardial infarction and repeat revascularization between CABG and imaging (primary outcome) and death after imaging (secondary outcome). Mediation analysis was performed to evaluate the effect of graft failure on the association between female sex and risk of death. Seven randomized clinical trials (N = 4,413, 777 women) were included. At a median imaging follow-up of 1.03 years, graft failure was significantly more frequent among women than men (37.3% vs 32.9% at the patient-level and 20.5% vs 15.8% at the graft level; P = 0.02 and P < 0.001, respectively). In women, graft failure was associated with an increased risk of myocardial infarction and repeat revascularization (OR: 3.94; 95% CI: 1.79-8.67) and death (OR: 3.18; 95% CI: 1.73-5.85). Female sex was independently associated with the risk of death (direct effect, HR: 1.84; 95% CI: 1.35-2.50) but the association was not mediated by graft failure (indirect effect, HR: 1.04; 95% CI: 0.86-1.26). Graft failure is more frequent in women and is associated with adverse cardiac events. The excess mortality risk associated with female sex among CABG patients is not mediated by graft failure. [ABSTRACT FROM AUTHOR]

المؤلفون: Gaudino, Mario, Lemma, Massimo, Sandner, Sigrid, Boening, Andreas, Harik, Lamia, Albert, Marc, Martin, Jose Albors, Alcocer, Jorge, Alexander, John H, Bhatt, Deepak L, Bonaros, Nikolaos, Borger, Michael, Danner, Bernhard C, Davierwala, Piroze, Deja, Marek A, Paulis, Ruggero De, Deutsch, Marcus-Andre, Flather, Marcus, Kappetein, Pieter, Kurlansky, Paul

المصدر: European Journal of Cardio-Thoracic Surgery; May2024, Vol. 65 Issue 5, p1-7, 7p

مصطلحات موضوعية: ARTERIAL grafts, MYOCARDIAL infarction, CORONARY artery bypass, COVID-19 pandemic

مستخلص: The ROMA trial is a large randomized clinical trial comparing single arterial grafting (SAG) and multiple arterial grafting (MAG) in coronary artery bypass surgery (CABG). The trial began in 2017 and is expected to conclude in 2023. It was initiated due to the inconclusive results of a previous trial. Challenges faced by the ROMA trial include high crossover rates and the impact of the COVID-19 pandemic. The trial's results are still pending but are anticipated to provide valuable insights into the effectiveness of MAG in CABG procedures. The success of the ROMA trial has led to the establishment of the ROMA network, which conducts other cardiac surgery trials. The trial involves multiple participating centers across different continents, including hospitals in Asia such as Jilin Heart Hospital, Fuwai Hospital, Teda Hospital, National Taiwan University Hospital, and Ruijin Hospital Shanghai Jiao Tong USM. The document also provides a list of hospitals and medical institutions from various countries involved in the trial. The ROMA trial is funded by the National Institutes of Health and the Canadian Institutes of Health and Research. [Extracted from the article]

: Copyright of European Journal of Cardio-Thoracic Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

المؤلفون: Gaudino, Mario¹ mfg9004@med.cornell.edu, Sandner, Sigrid², An, Kevin R.^1,3, Dimagli, Arnaldo¹, Di Franco, Antonino¹, Audisio, Katia¹, Harik, Lamia¹, Perezgrovas-Olaria, Roberto¹, Soletti, Giovanni¹, Fremes, Stephen E.⁴, Hare, David L.⁵, Kulik, Alexander⁶, Lamy, Andre⁷, Peper, Joyce⁸, Ruel, Marc⁹, ten Berg, Jurrien M.⁸, Willemsen, Laura M.⁸, Qiang Zhao¹⁰, Wojdyla, Daniel M.¹¹, Bhatt, Deepak L.¹²

المصدر: Circulation. 10/24/2023, Vol. 148 Issue 17, p1305-1315. 11p.

مصطلحات موضوعية: *CORONARY artery bypass, *MYOCARDIAL infarction, *DIAGNOSTIC imaging, *CLINICAL trials, *DATA analysis, *ARTERIAL grafts

مستخلص: BACKGROUND: Graft patency is the postulated mechanism for the benefits of coronary artery bypass grafting (CABG). However, systematic graft imaging assessment after CABG is rare, and there is a lack of contemporary data on the factors associated with graft failure and on the association between graft failure and clinical events after CABG. METHODS: We pooled individual patient data from randomized clinical trials with systematic CABG graft imaging to assess the incidence of graft failure and its association with clinical risk factors. The primary outcome was the composite of myocardial infarction or repeat revascularization occurring after CABG and before imaging. A 2-stage meta-analytic approach was used to evaluate the association between graft failure and the primary outcome. We also assessed the association between graft failure and myocardial infarction, repeat revascularization, or all-cause death occurring after imaging. RESULTS: Seven trials were included comprising 4413 patients (mean age, 64.4±9.1 years; 777 [17.6%] women; 3636 [82.4%] men) and 13 163 grafts (8740 saphenous vein grafts and 4423 arterial grafts). The median time to imaging was 1.02 years (interquartile range [IQR], 1.00-1.03). Graft failure occurred in 1487 (33.7%) patients and in 2190 (16.6%) grafts. Age (adjusted odds ratio [aOR], 1.08 [per 10-year increment] [95% CI, 1.01-1.15]; P=0.03), female sex (aOR, 1.27 [95% CI, 1.08-1.50]; P=0.004), and smoking (aOR, 1.20 [95% CI, 1.04-1.38]; P=0.01) were independently associated with graft failure, whereas statins were associated with a protective effect (aOR, 0.74 [95% CI, 0.63-0.88]; P<0.001). Graft failure was associated with an increased risk of myocardial infarction or repeat revascularization occurring between CABG and imaging assessment (8.0% in patients with graft failure versus 1.7% in patients without graft failure; aOR, 3.98 [95% CI, 3.54-4.47]; P<0.001). Graft failure was also associated with an increased risk of myocardial infarction or repeat revascularization occurring after imaging (7.8% versus 2.0%; aOR, 2.59 [95% CI, 1.86-3.62]; P<0.001). All-cause death after imaging occurred more frequently in patients with graft failure compared with patients without graft failure (11.0% versus 2.1%; aOR, 2.79 [95% CI, 2.01-3.89]; P<0.001). CONCLUSIONS: In contemporary practice, graft failure remains common among patients undergoing CABG and is strongly associated with adverse cardiac events. [ABSTRACT FROM AUTHOR]

المؤلفون: Sandner, Sigrid

المصدر: BMJ: British Medical Journal; 6/15/2024, Vol. 385 Issue 8432, pq1083-2, 2p

مصطلحات موضوعية: PREVENTION of surgical complications, COMBINATION drug therapy, VASCULAR grafts, MYOCARDIAL infarction, PATIENT safety, RESEARCH funding, MAJOR adverse cardiovascular events, TREATMENT effectiveness, CAUSES of death, TREATMENT duration, CORONARY artery bypass, PLATELET aggregation inhibitors

المؤلفون: Caliskan, Etem, Misfeld, Martin, Sandner, Sigrid, Böning, Andreas, Aramendi, Jose, Salzberg, Sacha P, Choi, Yeong-Hoon, Perrault, Louis P, Tekin, Ilker, Cuerpo, Gregorio P, Lopez-Menendez, Jose, Weltert, Luca P, Böhm, Johannes, Krane, Markus, González-Santos, José M, Tellez, Juan-Carlos, Holubec, Tomas, Ferrari, Enrico, Emmert, Maximilian Y, investigators, European DuraGraft Registry

المصدر: European Journal of Cardio-Thoracic Surgery; Oct2022, Vol. 62 Issue 4, p1-9, 9p

مصطلحات موضوعية: CORONARY artery bypass, MYOCARDIAL infarction, MAJOR adverse cardiovascular events, PROPENSITY score matching, CORONARY artery disease

مستخلص: Open in new tab Download slide OBJECTIVES Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft Registry to investigate clinical event rates at 1 year in patients with and without LMCAD undergoing isolated CABG in contemporary practice. METHODS Patients undergoing isolated CABG were selected. The primary end point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1 year. The secondary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching was performed to balance for differences in baseline characteristics. RESULTS LMCAD was present in 1033 (41.2%) and absent in 1477 (58.8%) patients. At 1 year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, P  = 0.002) driven by higher rates of death (5.4% vs 3.4%, P  = 0.016), MI (3.0% vs 1.3%, P  = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, P  = 0.13). The incidence of MACCE was 8.8% vs 6.6%, P  = 0.043, with a stroke rate of 1.0% and 2.4%, P  = 0.011, for the LMCAD and non-LMCAD groups, respectively. After propensity score matching, the MACE rate was 8.0% vs 5.2%, P  = 0.015. The incidence of death was 5.1% vs 3.7%, P  = 0.10, MI 3.0% vs 1.4%, P  = 0.020, and RR was 2.7% vs 1.6%, P  = 0.090, for the LMCAD and non-LMCAD groups, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, P  = 0.017). The MACCE rate was not different, 8.5% vs 6.7%, P  = 0.12. CONCLUSIONS In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients. Clinical trial registration number ClinicalTrials.gov NCT02922088. [ABSTRACT FROM AUTHOR]

: Copyright of European Journal of Cardio-Thoracic Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Wollner, Gregor, Zimpfer, Daniel, Manduric, Marina, Laufer, Günther, Rieger, Armin, Sandner, Sigrid E.

المصدر: Journal of Cardiac Surgery; Oct2020, Vol. 35 Issue 10, p2543-2549, 7p, 5 Charts, 3 Graphs

مصطلحات موضوعية: HIV infections, CORONARY artery bypass, HIGHLY active antiretroviral therapy, HIV infection complications, STROKE, SURGICAL complications, CARDIOVASCULAR diseases, RETROSPECTIVE studies, MYOCARDIAL infarction, TREATMENT effectiveness, CORONARY artery disease, DISEASE complications

الشركة/الكيان: MEDIZINISCHE Universitat Wien

مستخلص: Background: With early and effective antiretroviral therapy and improved survival for persons living with human immunodeficiency virus infection (PLHIV), this patient population now faces an increasingly elevated risk of cardiovascular disease. However, the data on outcomes after coronary artery bypass grafting (CABG) for revascularization of coronary artery disease (CAD) in HIV+ patients is limited.Methods: We conducted a retrospective analysis of 16 patients undergoing isolated CABG at the Medical University of Vienna from 2005 to 2018, who were HIV+ on admission. The primary endpoint of the study was survival. Secondary endpoints included the components of major adverse cardiac and cerebrovascular events (MACCE): cardiovascular death, stroke, myocardial infarction (MI), and repeat revascularization.Results: Patients were followed for a median of 49 months (range, 7-142 months). Survival was 100% and 90% at 1 and 3 years after CABG, respectively. There were no strokes. MI and subsequent repeat revascularization were observed in two patients.Conclusion: CABG provides excellent short- and midterm survival and freedom from MACCE in HIV+ patients with CAD requiring revascularization. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Cardiac Surgery is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Sandner, Sigrid¹ (AUTHOR), Gaudino, Mario² (AUTHOR) mfg9004@med.cornell.edu

المصدر: Journal of Cardiac Surgery. Aug2021, Vol. 36 Issue 8, p2802-2804. 3p.

مصطلحات موضوعية: *ACUTE coronary syndrome, *TICAGRELOR, *CORONARY artery bypass, *MYOCARDIAL infarction, *ATHEROSCLEROSIS, *REOPERATION, *CORONARY artery disease

مستخلص: Given the lack of established benefit, routine P2Y12 receptor inhibitor pretreatment in NSTE-ACS is not recommended in patients in whom the coronary anatomy is not known and early invasive management is planned, although it may be considered for patients with delayed invasive management.3 However, P2Y12 receptor inhibitor pretreatment may increase bleeding risk and delay surgery after diagnostic angiography in patients for whom CABG is indicated. In addition, in studies investigating the association of P2Y12 receptor inhibitors and perioperative bleeding risk a surgical bleeding site was identified in up to 55% of patients undergoing reoperation for bleeding,5,14 potentially confounding reports of increased bleeding with ticagrelor. Hansson et al.10 studied the incidence of CABG-related bleeding using the Bleeding Academic Research Consortium (BARC) classification11 in relation to P2Y12 receptor inhibitor discontinuation periods in a retrospective analysis of 2244 ACS patients referred for CABG on DAPT with either ticagrelor or clopidogrel. [Extracted from the article]

المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Schunkert, Heribert^1,2 (AUTHOR), Kastrati, Adnan^2,3 (AUTHOR), Wiedemann, Dominik¹ (AUTHOR), Misfeld, Martin⁴ (AUTHOR), Böning, Andreas⁵ (AUTHOR), Tebbe, Ulrich⁶ (AUTHOR), Nowak, Bernd⁷ (AUTHOR), Stritzke, Jan⁸ (AUTHOR), Laufer, Günther¹ (AUTHOR), Scheidt, Moritz von^2,3 (AUTHOR), Investigators, for the TiCAB (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Apr2020, Vol. 57 Issue 4, p732-739. 8p.

مصطلحات موضوعية: *CORONARY artery bypass, *ASPIRIN, *ARTERIAL grafts, *MYOCARDIAL infarction, *CEREBRAL revascularization, *TICAGRELOR

مستخلص: Open in new tab Download slide Open in new tab Download slide OBJECTIVES We evaluated the effect of ticagrelor monotherapy on outcomes after multiple arterial grafting (MAG) or single arterial grafting (SAG) in coronary artery bypass grafting (CABG). METHODS In a post hoc , non-randomized analysis of the TiCAB (Ticagrelor in CABG; ClinicalTrials.gov NCT01755520) trial, we compared event rates for ticagrelor versus aspirin in patients undergoing MAG and SAG. Primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction (MI), stroke or repeat revascularization 1 year after CABG. Secondary outcomes included individual components of the primary end point, all-cause death and bleeding. RESULTS Among 1753 patients, 998 patients underwent MAG and 755 patients underwent SAG. There was no significant difference in the 1-year primary composite outcome for ticagrelor versus aspirin with MAG [7.2% vs 7.9%; hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.57–1.43; P  = 0.66] or SAG (12.3% vs 8.6%; HR 1.47, 95% CI 0.93–2.31; P  = 0.10). Event rates for cardiovascular death, MI, stroke, repeat revascularization and all-cause death were similar for both treatment groups with MAG and SAG. No significant difference in major bleeding was observed for ticagrelor versus aspirin with MAG (2.6% vs 2.7%; HR 0.95, 95% CI 0.44–2.05; P  = 0.90) or SAG (5.8% vs 4.0%; HR 1.49, 95% CI 0.77–2.89; P  = 0.24). CONCLUSIONS In patients undergoing either MAG or SAG in the TiCAB trial, ticagrelor monotherapy compared with aspirin did not affect the rate of cardiovascular death, non-fatal MI, stroke or repeat revascularization, or the rate of bleeding, at 1 year after CABG. [ABSTRACT FROM AUTHOR]

المؤلفون: Caliskan, Etem^1,2 (AUTHOR), Sandner, Sigrid³ (AUTHOR), Misfeld, Martin⁴ (AUTHOR), Aramendi, Jose⁵ (AUTHOR), Salzberg, Sacha P.⁶ (AUTHOR), Choi, Yeong-Hoon⁷ (AUTHOR), Satishchandran, Vilas⁸ (AUTHOR), Iyer, Geeta⁸ (AUTHOR), Perrault, Louis P.⁹ (AUTHOR), Böning, Andreas¹⁰ (AUTHOR), Emmert, Maximilian Y.^1,2 (AUTHOR) emmert@dhzb.de

المصدر: Journal of Cardiothoracic Surgery. 10/15/2019, Vol. 14 Issue 1, pN.PAG-N.PAG. 1p.

مصطلحات موضوعية: *CORONARY artery bypass, *SAPHENOUS vein, *ARTERIAL grafts, *RADIAL artery, *VASCULAR endothelium

مستخلص: Background: Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures.Methods: This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft.Discussion: This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level).Trial Registration: ClinicalTrials.gov NCT02922088 . Registered October 3, 2016.Ethics and Dissemination: The regional ethics committees have approved the registry. Results will be submitted for publication. [ABSTRACT FROM AUTHOR]