Comparison of Fentanyl Versus Morphine-Ketamine-Lidocaine Infusion for Postoperative Pain Following Coronary Artery Bypass Grafting (CABG): A Randomized Clinical Trial

BackgroundPatients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD.MethodsThe clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed.ResultsThe baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046).ConclusionsThe CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.

Surgical collateralization: The hidden mechanism for improving prognosis in chronic coronary syndromes

Referral patterns and outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were compared between 2 centers within 1 jurisdiction wherein only 1 center utilizes multidisciplinary review for all patients. Management of advanced coronary artery disease often involves PCI and CABG for improvements in quality of life and survival. Indications exist for PCI and CABG, with CABG demonstrating benefit in three-vessel disease (TVD). A total of 27,961 patients underwent cardiac catheterization in 2 centers within the same single-payer health jurisdiction (Center A and B) from 2017 to 2018. Rates of PCI, CABG, and outcomes of 1-year mortality, rehospitalization, myocardial infarction, and stroke were compared. More patients in Center A received PCI and less received CABG compared with Center B even among patients with TVD ( P <0.001). Multivariable logistic regression identified Center B as protective for mortality for TVD patients ( P <0.001) and those undergoing PCI ( P =0.004), but not CABG ( P =0.06). Center A's 1-year mortality was increased for all patients ( P =0.004) and those with TVD ( P =0.011). Discordant outcomes exist between these 2 centers. While patients in Center A were more likely to undergo PCI than Center B and experienced decreased 1-year survival, the difference was not significant for CABG. In part, the differences are attributable to contrasting referral practices and the discrepant rates of PCI and CABG between centers. Review of all coronary artery disease patients with a multidisciplinary Heart Team including a surgical opinion may lead to a more evidence-based referral practice aligned with current clinical guidelines.

Many of the previous randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease reported equivalent or better survival with CABG as compared with PCI at 5-year follow-up. However, 5-year follow-up might be too short to evaluate the true differences in long-term clinical outcomes between PCI and CABG. Among 8934 patients enrolled in the extended 10- to 14-year follow-up study of the CREDO-Kyoto registry cohort-1 (Coronary Revascularization Demonstrating Outcome study in Kyoto) conducted in the bare-metal stent era, 5152 (PCI: n=3490 and CABG: n=1662) patients had multivessel coronary artery disease without left main disease. Median follow-up duration was 11.2 (interquartile range: 10.2-12.2) years. The cumulative 10-year incidence of all-cause death was not significantly different between PCI and CABG (32.2% versus 31.7%; log-rank P=0.93). After adjusting for confounders, however, the mortality risk of PCI was significantly higher than that of CABG (hazard ratio, 1.19 [95% confidence interval, 1.02-1.39]; P=0.03). Within 5 years after the index procedure, the risk for all-cause death was significantly higher after PCI than after CABG (hazard ratio, 1.41; 95% CI, 1.12-1.79; P=0.004). By a landmark analysis at 5 years, however, the cumulative 10-year incidence of and adjusted risk for all-cause death beyond 5 years were not significantly different between PCI and CABG (19.3% versus 20.0%; log-rank P=0.22 and hazard ratio, 1.02, 95% confidence interval, 0.83-1.26; P=0.82). CABG as compared with PCI was associated with better 10-year survival in patients with multivessel coronary artery disease. However, the benefit of CABG compared with PCI on late mortality beyond 5 years was not observed in this study.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease Requiring Dialysis (5-Year Outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3)

Low-volume coronary artery bypass surgery: Measuring and optimizing performance

BackgroundHeart failure might be an important determinant in choosing coronary revascularization modalities. There was no previous study evaluating the effect of heart failure on long‐term clinical outcomes after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG).Methods and ResultsAmong 14 867 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013 in the CREDO‐Kyoto PCI/CABG registry Cohort‐3, we identified the current study population of 3380 patients with three‐vessel or left main coronary artery disease, and compared clinical outcomes between PCI and CABG stratified by the subgroup based on the status of heart failure. There were 827 patients with heart failure (PCI: N=511, and CABG: N=316), and 2553 patients without heart failure (PCI: N=1619, and CABG: N=934). In patients with heart failure, the PCI group compared with the CABG group more often had advanced age, severe frailty, acute and severe heart failure, and elevated inflammatory markers. During a median 5.9 years of follow‐up, there was a significant interaction between heart failure and the mortality risk of PCI relative to CABG (interaction P=0.009), with excess mortality risk of PCI relative to CABG in patients with heart failure (HR, 1.75; 95% CI, 1.28–2.42; P<0.001) and no excess mortality risk in patients without heart failure (HR, 1.04; 95% CI, 0.80–1.34; P=0.77).ConclusionsThere was a significant interaction between heart failure and the mortality risk of PCI relative to CABG with excess risk in patients with heart failure and neutral risk in patients without heart failure.

Comparison of Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting in Patients ≥65 Years With Multivessel Coronary Artery Disease

Traditional Coronary Artery Bypass Graft (CABG) is currently among of the chief methods in dealing with patients suffering from atherosclerotic coronary heart disease. The current study aimed to measure and compare the levels of proinflammatory cytokines and oxidative stress marker in patients who underwent multivessels Minimally Invasive Coronary Artery Bypass Graft Surgery (MICS– CABG) versus off-pump Coronary Artery Bypass Grafting (off-pump CABG) in the cardiothoracic department, Assiut University hospitals, Upper Egypt. the study included 67 patients, all of them suffering from atherosclerotic coronary artery disease, which confirm by cardiac catheter angiography. The patients were divided randomly into two groups, first group (A) included 34 patients to whom Multi Vessels Coronary Artery Bypass Graft Surgery (MICS-CABG) under off pump had been done. The second group (B) included 33 patients whom underwent off pump Coronary Artery Bypass Grafting (off-pump CABG). Tumor Necrosis Factor-Α (TNF-α), interlukin-2 (IL-2), lipid peroxides, Superoxide Dismutase (SOD), total thiols and Nitric Oxide (NO) were estimated in sera of all patients by their corresponding methods; 48 h before the operation, 15 min before the operation end and 72 h after the operation. After testing the normality, Mann-Whitney U test and Spearman correlation coefficient were used to compare the two groups and tested the variables’ correlations with the duration of the operation. p≤0.05 was considered significant. Serum TNF-α, IL-2 and lipid peroxides levels were significantly higher while total thiols and SOD were significantly lower, intraoperative and postoperatively, while No was significantly higher intraoperative only, in off-pump CABG group compared to MICS-CABG group and in both groups, intraoperative and postoperatively compared to preoperative levels. Especially in the postoperative samples, TNF-α, IL-2 and NO levels correlated positively while those of SOD correlated negatively with the operation duration the clinical data obtained presented in details in the result sector and revealed that. MICS-CABG group associated with less post-operative pain, less need for blood transfusion, less hospital stays and rapid regain to normal activity. The current study revealed that MICS-CABG is an effective procedure that is associated with small surgical trauma and lower inflammations and oxidative stress compared to off-pump CABG.

Is surgery or percutaneous revascularization the preferred strategy for patients with significant left main coronary stenosis? Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis

Long-Term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Ostial/Midshaft Lesions in Unprotected Left Main Coronary Artery From the DELTA Registry: A Multicenter Registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Treatment

Should Coronary Artery Bypass Grafting Be Regionalized?

Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Versus Without Chronic Kidney Disease