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: Stephan Jacobs, Ravi De Silva, Matthias Thielmann, Sunil K. Ohri, Mohamad N. Bittar, Rajesh K. Kharbanda, Ivar Friedrich, Amal Bose, George Krasopoulos, Alexandros Paraforos, Daniel Wendt, Marius Berman, Oliver J. Liakopoulos, Cha Rajakaruna, Thomas Schachner, Thomas R. Gehrig, Joseph Zacharias, Umberto Benedetto, Philipp Angleitner, Yulia Gavrilov, Nikolaos Bonaros, Yeong-Hoon Choi, Sigrid Sandner, Terrence John Donovan, David P. Taggart, Gil Bolotin, Keith M. Channon, Hunaid A. Vohra, Leonid Ladyshenskij, Alexander Lipey

المساهمون: InVESTigators, Benedetto, Umberto (Beitragende*r), Vohra, Hunaid (Beitragende*r), Bittar, Mohamad Nidal (Beitragende*r), Bose, Amal (Beitragende*r), Berman, Marius (Beitragende*r), Kharbanda, Rajesh (Beitragende*r), Paraforos, Alexandros (Beitragende*r), Ladyshenskij, Leonid (Beitragende*r), Bonaros, Nikolaos (Beitragende*r), Schachner, Thomas (Beitragende*r), Sandner, Sigrid (Beitragende*r), Angleitner, Philipp (Beitragende*r), Bolotin, Gil (Beitragende*r), Jacobs, Stephan (Beitragende*r), Thielmann, Matthias Klaus (Beitragende*r), Wendt, Daniel (Beitragende*r), Choi, Yeong-Hoon (Beitragende*r), Liakopoulos, Oliver (Beitragende*r), Ohri, Sunil (Beitragende*r), Lipey, Alexander (Beitragende*r)

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Intimal hyperplasia, medicine.medical_treatment, Medizin, Coronary Artery Disease, Internal thoracic artery, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine.artery, Intravascular ultrasound, Humans, Medicine, Saphenous Vein, Coronary Artery Bypass, Vascular Patency, Computed tomography angiography, Hyperplasia, medicine.diagnostic_test, business.industry, Stent, medicine.disease, Surgery, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, 030228 respiratory system, Angiography, Disease Progression, Stents, Cardiology and Cardiovascular Medicine, business, Artery

الوصف: Objectives Little data exist regarding the potential of external stents to mitigate long-term disease progression in saphenous vein grafts. We investigated the effect of external stents on the progression of saphenous vein graft disease. Methods A total of 184 patients undergoing isolated coronary artery bypass grafting, using an internal thoracic artery graft and at least 2 additional saphenous vein grafts, were enrolled in 14 European centers. One saphenous vein graft was randomized to an external stent, and 1 nonstented saphenous vein graft served as the control. The primary end point was the saphenous vein graft Fitzgibbon patency scale assessed by angiography, and the secondary end point was saphenous vein graft intimal hyperplasia assessed by intravascular ultrasound in a prespecified subgroup at 2 years. Results Angiography was completed in 128 patients and intravascular ultrasound in the entire prespecified cohort (n = 51) at 2 years. Overall patency rates were similar between stented and nonstented saphenous vein grafts (78.3% vs 82.2%, P = .43). However, the Fitzgibbon patency scale was significantly improved in stented versus nonstented saphenous vein grafts, with Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8% versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P = .03). Fitzgibbon patency scale was inversely related to saphenous vein graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III saphenous vein grafts having an average minimal lumen diameter of 2.62 mm, 1.98 mm, and 1.32 mm, respectively (P < .05). Externally stented saphenous vein grafts also showed significant reductions in mean intimal hyperplasia area (22.5%; P < .001) and thickness (23.5%; P < .001). Conclusions Two years after coronary artery bypass grafting, external stenting improves Fitzgibbon patency scales of saphenous vein grafts and significantly reduces intimal hyperplasia area and thickness. Whether this will eventually lead to improved long-term patency is still unknown.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::31d0f111006319341743575a0031db62Test
https://ora.ox.ac.uk/objects/uuid:cc37fff7-fb18-4677-9915-24e6ba021aafTest

المؤلفون: Thuijs, Daniel J. F. M., Kappetein, A. Pieter, Serruys, Patrick W., Mohr, Friedrich-Wilhelm, Morice, Marie-Claude, Mack, Michael J., Holmes, David R. Jr, Curzen, Nick, Davierwala, Piroze, Noack, Thilo, Milojevic, Milan, Dawkins, Keith D., da Costa, Bruno R., Juni, Peter, Head, Stuart J.

المساهمون: Casselman, Filip, de Bruyne, Bernard, Christiansen, Evald Hoj, Riuz-Nodar, Juan M, Vermeersch, Paul, Schultz, Werner, Sabate, Manel, Guagliumi, Giulio, Grubitzsch, Herko, Stangl, Karl, Darremont, Olivier, Bentala, M, den Heijer, Peter, Preda, Istvan, Stoler, Robert, Mack, Michael, Szerafin, Tamas, Buckner, John, Guber, Myles, Verberkmoes, Niels, Akca, ferdi, Feldman, Ted, Beyersdorf, Friedhelm, Drieghe, Benny, Oldroyd, Keith, Berg, Geoff, Jeppsson, Anders, Barber, Kimberly, Wolschleger, Kevin, Heiser, John, van der Harst, Pim, Mariani, Massimo, Reichenspurner, Hermann, Stark, Christoffer, Laine, Mika, Ho, Paul, Chen, John, Zelman, Richard, Horwitz, Phillip, Bochenek, Andrzef, Krauze, Agata, Grothusen, Christina, Dudek, Dariusz, Heyrich, George, Davierwala, Piroze, Noack, Thilo, Kolh, Philippe, Legrand, Victor, Coelho, Pedro, Ensminger, Stephan, Nasseri, Boris, Ingemansson, Richard, Olivecrona, Goran, Escaned, Javier, Guera, Reddy, Berti, Sergio, Morice, Marie-Claude, Chieffo, Alaide, Burke, Nicholas, Mooney, Michael, Spolaor, Alvise, Hagl, Christian, Näbauer, Michael, Suttorp, Maarten Jan, Stine, Ronald, McGarry, Thomas, Lucas, Scott, Endresen, Knut, Taussig, Andrew, Accola, Kevin, Canosi, Umberto, Horvath, Ivan, Cannon, Louis, Talbott, John, Akins, Chris, Kramer, Robert, Aschermann, Michael, Killinger, William, Narbute, Inga, Holmes, David, Burzotta, Francesco, Bogers, Ad, Zijstra, Felix, Eltchaninoff, Hélène, Berland, Jacques, Stefanini, Giulio, Gonzalez, Ignacio Cruz, Hoppe, Uta, Kiesz, Stefan, Gora, Bartlomiej, Ahlsson, Anders, Corbascio, Matthias, Bilfinger, Thomas, Carrie, Didier, Tchétché, Didier, Hauptman, Karl-Eugen, Stahle, Elisabeth, James, Stefan, Sandner, Sigrid, Laufer, Günther

المصدر: Lancet (London, England), 394 (10206), 1325-1334 (2019)

مصطلحات موضوعية: Aged, Coronary Artery Bypass, Coronary Artery Disease/mortality/pathology/surgery, Drug-Eluting Stents, Female, Follow-Up Studies, Humans, Male, Middle Aged, Percutaneous Coronary Intervention, Survival Rate, Treatment Outcome, Human health sciences, Cardiovascular & respiratory systems, Sciences de la santé humaine, Systèmes cardiovasculaire & respiratoire

الوصف: peer reviewed ; BACKGROUND: The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results. METHODS: The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to the PCI group or CABG group. Patients with a history of PCI or CABG, acute myocardial infarction, or an indication for concomitant cardiac surgery were excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause death, which was assessed according to the intention-to-treat principle. Prespecified subgroup analyses were performed according to the presence or absence of left main coronary artery disease and diabetes, and according to coronary complexity defined by core laboratory SYNTAX score tertiles. This study is registered with ClinicalTrials.gov, NCT03417050. FINDINGS: From March, 2005, to April, 2007, 1800 patients were randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status information at 10 years was complete for 841 (93%) patients in the PCI group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%) patients had died after PCI and 211 (24%) after CABG (hazard ratio 1.17 [95% CI 0.97-1.41], p=0.092). Among patients with three-vessel disease, 151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG (hazard ratio 1.41 [95% CI 1.10-1.80]), and among patients with left main coronary artery disease, 93 (26%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0.90 [0.68-1.20], pinteraction=0.019). ...

العلاقة: urn:issn:0140-6736; urn:issn:1474-547X; https://orbi.uliege.be/handle/2268/250399Test; info:hdl:2268/250399; scopus-id:2-s2.0-85073022337; info:pmid:31488373

الإتاحة: https://doi.org/10.1016/S0140-6736Test(19)31997-X
https://orbi.uliege.be/handle/2268/250399Test