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]

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المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Nolz, Richard² (AUTHOR), Loewe, Christian² (AUTHOR), Gregorich, Mariella³ (AUTHOR), Heinze, Georg³ (AUTHOR), Andreas, Martin¹ (AUTHOR), Kolh, Philippe⁴ (AUTHOR), Zimpfer, Daniel¹ (AUTHOR), Laufer, Guenther¹ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Apr2020, Vol. 57 Issue 4, p684-690. 7p.

مصطلحات موضوعية: *CORONARY artery bypass, *COMPUTED tomography, *PROPENSITY score matching, *STROKE, *ANGIOGRAPHY

مستخلص: Open in new tab Download slide Open in new tab Download slide OBJECTIVES The aim of this study was to determine stroke rates in patients who did or did not undergo routine computed tomography angiography (CTA) aortic imaging before isolated coronary artery bypass grafting (CABG). METHODS We conducted a retrospective analysis of a prospectively maintained single-centre registry. Between 2009 and 2016, a total of 2320 consecutive patients who underwent isolated CABG at our institution were identified. Propensity score matching was used to create a paired cohort of patients with similar baseline characteristics who did (CTA cohort) or did not (non-CTA cohort) undergo preoperative aortic CTA. The primary end point of the analysis was in-hospital stroke. RESULTS In 435 propensity score-matched pairs, stroke occurred in 4 patients (0.92%) in the CTA cohort and in 14 patients (3.22%) in the non-CTA cohort (P  = 0.017). Routine preoperative aortic CTA was associated with a significantly reduced risk of in-hospital stroke [relative risk 0.29, 95% confidence interval (CI) 0.09–0.86; P  = 0.026; absolute risk reduction 2.3%, 95% CI 0.4–4.2; P  = 0.017; number needed to treat = 44, 95% CI 24–242]. CONCLUSIONS A preoperative screening for atheromatous aortic disease using CTA is associated with reduced risk of stroke after CABG. The routine use of preoperative aortic CTA could be applied so that surgical manipulation of the ascending aorta can be selectively reduced or avoided in patients with atheromatous aortic disease. [ABSTRACT FROM AUTHOR]