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^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: An, Kevin R^1,2 (AUTHOR), Sandner, Sigrid³ (AUTHOR), Redfors, Björn^4,5,6 (AUTHOR), Alexander, John H⁷ (AUTHOR), Alzghari, Talal¹ (AUTHOR), Caldonazo, Tulio¹ (AUTHOR), Cancelli, Gianmarco¹ (AUTHOR), Dell'Aquila, Michele¹ (AUTHOR), Dimagli, Arnaldo¹ (AUTHOR), Gibson, C Michael⁸ (AUTHOR), Harik, Lamia¹ (AUTHOR), Heise, Rachel⁴ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Lamy, Andre¹⁰ (AUTHOR), Leith, Jordan¹ (AUTHOR), Peper, Joyce¹¹ (AUTHOR), Perezgrovas-Olaria, Roberto¹ (AUTHOR), Rossi, Camilla S¹ (AUTHOR), Ruel, Marc¹² (AUTHOR), Soletti, Giovanni Jr¹ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Jun2024, Vol. 65 Issue 6, p1-10. 10p.

مصطلحات موضوعية: *CORONARY artery bypass, *GASTRIC bypass, *OBESITY, *DATA analysis, *CLINICAL trials, *BODY mass index

مستخلص: OBJECTIVES The association between obesity and graft failure after coronary artery bypass grafting has not been previously investigated. METHODS We pooled individual patient data from randomized clinical trials with systematic postoperative coronary imaging to evaluate the association between obesity and graft failure at the individual graft and patient levels. Penalized cubic regression splines and mixed-effects multivariable logistic regression models were performed. RESULTS Six trials comprising 3928 patients and 12 048 grafts were included. The median time to imaging was 1.03 (interquartile range 1.00–1.09) years. By body mass index (BMI) category, 800 (20.4%) patients were normal weight (BMI 18.5–24.9), 1668 (42.5%) were overweight (BMI 25–29.9), 983 (25.0%) were obesity class 1 (BMI 30–34.9), 344 (8.8%) were obesity class 2 (BMI 35–39.9) and 116 (2.9%) were obesity class 3 (BMI 40+). As a continuous variable, BMI was associated with reduced graft failure [adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.97–0.99)] at the individual graft level. Compared to normal weight patients, graft failure at the individual graft level was reduced in overweight [aOR 0.79 (95% CI 0.64–0.96)], obesity class 1 [aOR 0.81 (95% CI 0.64–1.01)] and obesity class 2 [aOR 0.61 (95% CI 0.45–0.83)] patients, but not different compared to obesity class 3 [aOR 0.94 (95% CI 0.62–1.42)] patients. Findings were similar, but did not reach significance, at the patient level. CONCLUSIONS In a pooled individual patient data analysis of randomized clinical trials, BMI and obesity appear to be associated with reduced graft failure at 1 year after coronary artery bypass grafting. [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: Sandner, Sigrid, Redfors, Björn

مصطلحات موضوعية: coronary artery bypass, patency, saphenous vein graft, ticagrelor

جغرافية الموضوع: UMW:20942

وصف الملف: text/html

العلاقة: vignette : https://repositorium.meduniwien.ac.at/titlepage/urn/urn:nbn:at:at-ubmuw:3-58164/128Test; urn:nbn:at:at-ubmuw:3-58164; https://resolver.obvsg.at/urn:nbn:at:at-ubmuw:3-58164Test; local:99147048851603331; system:AC16688453

الإتاحة: https://doi.org/10.1111/jocs.16503Test
https://resolver.obvsg.at/urn:nbn:at:at-ubmuw:3-58164Test

المؤلفون: Alzghari, Talal¹ (AUTHOR), Sandner, Sigrid² (AUTHOR), Di Franco, Antonino¹ (AUTHOR), Harik, Lamia¹ (AUTHOR), Perezgorvas-Olaria, Roberto¹ (AUTHOR), Soletti, Giovanni¹ (AUTHOR), Dimagli, Arnaldo¹ (AUTHOR), Cancelli, Gianmarco¹ (AUTHOR), Demetres, Michelle³ (AUTHOR), Lau, Christopher¹ (AUTHOR), Girardi, Leonard N.¹ (AUTHOR), Gaudino, Mario¹ (AUTHOR) mfg9004@med.cornell.edu

المصدر: Heart, Lung & Circulation. Dec2023, Vol. 32 Issue 12, p1500-1511. 12p.

مصطلحات موضوعية: *CORONARY artery surgery, *CORONARY arteries, *CORONARY artery bypass, *INTERNAL thoracic artery, *RADIAL artery, *ILEAL conduit surgery

مستخلص: To review the available literature on the use of coronary artery bypass grafting (CABG) as a treatment option for anomalous origin of coronary artery in adults. A systematic literature search was performed in March 2023 (including Ovid MEDLINE, Ovid Embase, and the Cochrane Library databases) to identify studies reporting the use of CABG in adult patients with anomalous origin of coronary artery. A total of 31 studies and 62 patients were included, 32 patients (52%) were women, and the mean age was 45.1±16.1 years. The most common coronary anomaly was the right coronary artery arising from the left coronary sinus in 26 patients (42%), followed by an anomalous left coronary artery from the pulmonary artery in 23 patients (37%). A total of 65 conduits were used in 61 patients, and 1 case report did not report conduit type. Reported grafts included saphenous vein (23 of 65 [35.4%]), left internal thoracic artery (15 of 65 [23.1%]), right internal thoracic artery (23 of 65 [35.4%]), and radial artery (2 of 65 [3.1%]); right gastroepiploic artery and basilic vein were used once (1.5%) each. Ligation of the native coronary artery was performed in 42 (67.7%) patients. Patient follow-up was available in 19 studies with a mean of 31.2 months. Only 1 operative mortality was reported. Based on the limited available data, CABG can be performed with good early results. Use of arterial conduits and ligation of the native coronary artery may improve long-term graft patency. [Display omitted] [ABSTRACT FROM AUTHOR]

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: Gaudino, Mario, Bakaeen, Faisal G, Sandner, Sigrid, Aldea, Gabriel S, Arai, Hirokuni, Chikwe, Joanna, Firestone, Scott, Fremes, Stephen E, Gomes, Walter J, Bong-Kim, Ki, Kisson, Kalie, Kurlansky, Paul, Lawton, Jennifer, Navia, Daniel, Puskas, John D, Ruel, Marc, Sabik, Joseph F, Schwann, Thomas A, Taggart, David P, Tatoulis, James

المصدر: European Journal of Cardio-Thoracic Surgery; Aug2023, Vol. 64 Issue 2, p1-15, 15p

مصطلحات موضوعية: CORONARY artery bypass, THORACIC surgery, CARDIOVASCULAR surgery, SURGERY, SURGEONS

مستخلص: Open in new tab Download slide Preamble The finalized document was endorsed by the EACTS Council and STS Executive Committee before being simultaneously published in the European Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic Surgery (The Annals) and the Journal of Thoracic and Cardiovascular Surgery (JTCVS). [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: 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