CABG Surgery Research Articles

Abstract 268: Patients >65 Years of Age With Acute Myocardial Infarction Are Less Likely to Undergo Percutaneous Coronary Intervention and Have a Higher In-hospital Mortality

Background: Studies have shown that patients >65 years of age with ST-elevation myocardial infarction are less likely to undergo a percutaneous coronary intervention (PCI) and are more likely to have a delayed door-to-balloon time above 90 minutes despite proven efficacy in these population. We investigated current outcomes and therapeutic approach in a large unselected population of patients. Methods: In a retrospective study, using the 2014 Nationwide Inpatient Sample (NIS), we analyzed patients >65 years of age presenting with acute myocardial infarction (AMI). We performed univariate analysis of age, sex, race, hospital location, hospital teaching status, insurance type, hospital bed size, Charlson Comorbidity Index and other relevant comorbidities and we included variables with p<0.2 in the multivariate logistic regression model. Results: A total of 115,042 patients with AMI were identified. Patients >65 years of age (54%) had mean age of 78+/_0.04, vs 55 +/_ 0.04, p<0001 and a higher percentage of them were female (45% vs 30%, p<0.001). Patients >65 years of age were were more likely to have hypertension (78% vs 69%, p<0.001), chronic kidney disease (26% vs 9%, p<0.001), heart failure (0.8% vs 0.5%, p<0.001) and diabetes mellites (32% vs 29%, p<0.001). Patients >65 years of age were less likely to receive a PCI including angioplasty (OR=0.66, 95%CI =0.46-0.94, p<0.02) and stent placement (OR=0.64, 95%CI =0.62-0.67, p<0.001). They also had less timely stent implantation (stent within 48 hours: OR=0.66, 95%CI =0.63-0.68, p<0.001). There was no difference in utilization of thrombolysis and CABG surgeries. Patients >65 years of age with AMI had higher incidence of cardiac arrest (OR=1.21, 95%CI =1.06-1.37, p=0.004) as well as higher in-hospital mortality (OR=2.32, 95%CI =2.11-2.56, p<0.001). There was no difference in implantation of cardioverter-defibrillator. Patients >65 years of age were more likely to have shock (OR=1.28, 95%CI = 1.06-1.54, p-=0.009), heart failure (OR=1.62, 95%CI = 1.54-1.71, p<0.001), and were more likely to require mechanical ventilation (OR=0.15, 95%CI = 1.07-1.25, p<0.001). The use of short-term mechanical circulatory support was similar in patients >65 years of age. Despite increased length of stay in patients >65 years of age (Coef. =0.56, 95% CI= 0.45-0.66, p<0.001), the total charges were smaller (Coef. = -3231$, 95% CI=- 5237$ - -1224$, p=0.002). Conclusion: Patients >65 years of age and AMI had worse outcomes and were treated with a different therapeutic approach. They were less likely to be treated with a PCI and receive a timely intervention, which might explain lower total charges. Yet, they had a higher incidence of cardiac arrest and in-hospital mortality as well as higher incidence of shock, heart failure exacerbations and required higher utilization of mechanical ventilation, which could have contributed to the increased length of stay.

Assessment of Wall Shear Stress on the Aortic Valve in Patients with Left Ventricular Assist Device Using Vector Flow Mapping

Purpose De novo aortic insufficiency is one of unresolved complications after left ventricular assist device (LVAD) implant. It has been hypothesized that decreased and oscillatory wall shear stress (WSS) on the aortic valve following LVAD implantation cause leaflet degeneration resulting in AI. We developed novel approach to measure WSS on the aortic valve using vector flow mapping (VFM) images. Methods Aortic root color Doppler image was obtained using intraoperative epiaortic echocardiogram in 6 patients who received LVAD implant and 8 patients undergoing LVAD explant and heart transplant. As a control group, we enrolled 5 patients undergoing CABG surgery. Using obtained images, WSS and oscillatory shear index (OSI) on the right coronary cusp (RCC) was calculated with off-line software, Echo VFM® (Cardio Flow Design, Tokyo, Japan) (Figure). Results Image analysis was successful in all patients. The WSS on the ventricularis of the RCC was significantly lower in the LVAD group compared to control (0.09±0.06 vs. 0.35±0.27 Pa, p Conclusion Significantly lower WSS on the ventricularis may be accountable for AV degeneration and subsequent De Novo AI in patients with LVAD.

Prognostic Value of Neutrophil Lymphocyte Ratio for Early Renal Failure in ECMO Patients

Purpose We aimed to investigate the relationship between the early renal failure during Ecmo and Neutrophil Lymphocyte Ratio, which may be an indicator of a systemic inflammatory response. Methods We retrospectively evaluated the patients with Ecmo due to postcardiotomic shock after elective CABG surgery in our institution between 2012-2018. AKIN and KDIGO criteria were used to group patients into respective AKI Stages. Early renal failure was defined as renal failure within 72 hours of ECMO initiation. Results Of the 119 patients, 68.1% were female. The mean age of the patients was 54.62 ± 12.94, and the mean duration of ECMO was 6.69 ± 5.75 days, and 73.1% were canullated centrally. There was a statistically significant difference between postoperative NLR levels according to the presence of AKIN / KDIGO (p = 0.004; p Conclusion NLR increase was significant in the first three days of Ecmo in patients who developed renal failure. This increase can be due to an inflammatory response that plays a role in the pathogenesis of renal injury during Ecmo run and NLR can be an accessible and useful indicator for early diagnosis of the renal failure and inflammatory response.

CORONARY ARTERY BYPASS GRAFTING USING RADIAL ARTERY OR SAPHENOUS VEIN VERSUS PERCUTANEOUS CORONARY INTERVENTION

Despite evidence that CABG surgery using the radial artery (RA) instead of saphenous vein (SV) grafts provide superior patency rate and outcomes, RA has been underutilised in current comparisons between CABG and PCI. We investigated whether CABG surgery using RA instead of SV grafts is a superior

TRENDS AND FACTORS ASSOCIATED WITH USE OF MULTIPLE ARTERIAL GRAFTS FOR MULTIVESSEL CORONARY ARTERY BYPASS GRAFT SURGERY: A STATE-WIDE ANALYSIS OF 68,357 PROCEDURES

Current evidence suggests that CABG surgery performed using multiple arterial grafts (MAG) may be associated with improved outcomes compared with CABG using a single arterial graft (SAG) or no arterial grafts (NAG). However, the uptake and factors associated with use of MAG-CABG in real-world

Studying the Effect of Aloe Vera Ointment on Wound Healing of CABG Surgery in Diabetic Patients

Background and Purpose: one of morbidities of diabetes is delay in wound healing. Among treatment common procedures in diabetic patients with coronary artery bypass graft. Therefore, delay in CABG wound healing is one of common problems of diabetic patients. Aloe vera plant contains collagen which heightens the tissue granules and contributes in wound healing process with its anti-inflammatory properties. Thus, the researcher tries to examine the effect of Aloe vera on wound healing. Methodology: the study was random clinical trial with intervention and control groups. 60 diabetic patients who attended to Imam Ali Hospital, Kermanshah for CABG surgery have been assigned to two 30-person groups as intervention and control groups. From second day after surgery, after putting out the sternum area chip pipe of intervention group patients, after washing with betadine they were bandaged by 2% aloe vera ointment which was made by Karaj academic Jihad organization medicinal herbs research center in a daily basis. In control group only daily washing with betadine and bandage has been done. This has been conducted till 14 days after surgery. Wound healing in days 7, 4 and 14 after surgery has been evaluated by Bates Jenson wound healing scale. One used SPSS version 16 for analyzing the data. In this study, for describing the samples, one used descriptive statistical methods including tables of frequency distribution, determining average, SD and when it comes to study objectives and hypothesis, determining the homogeneity of samples one uses Chi two and Mann Whitman non-parametric test. Findings: mean and SD of total score of wound healing of two groups is calculated at day 4 after intervention by independent Mann Whitman test that P>0,5 therefore two groups had no significant different in wound healing, in day 7 after intervention the mean and SD of wound healing score had significant different based on Mann Whitman test P<0.001 at day 14 after intervention based on Mann Whitman test, there was a significant different between two groups in terms of wound healing p<0.001. Conclusion: 2% Aloe vera ointment can speed up the healing of wound of CABG surgery in diabetic patients after at least one week use.

Heart-Protective Mechanical Ventilation in Postoperative Coronary Artery Bypass Grafting Patients

Introduction: The effect of mechanical ventilation (MV) on hemodynamic parameters of cardiosurgical patients with multiple respiratory and cardiovascular risk factors may be detrimental, demanding not only lung- but heart-protective settings. Objective: This prospective study compared the hemodynamic effect and gas exchanges between several ventilator setting combination of Volume tidal, respiratory rate and end-expiratory pressure in post cardiac surgery patients. Design: Sequential study with a controlled group. Setting: Single cardiosurgical ICU. Patients: 119 patients after on-pump CABG surgery without severe hemodynamic and gas exchange disorders. Interventions: During the 1st postoperative hour (conventional ventilation) the intervention group patients ventilated with Vt 10 ml×kg-1, RR 14 /min, 5 cmH2O. During the 2nd hour, RR to 8 /min (reduced RR In the 3rd hour, Vt decreased to 6 ml×kg-1, RR returned to14 /min and increased to 10 cmH2O (low VT-high PEEP ventilation). In 24 patients from the control group MV settings in the 3rd hour did not change, so they were equal those in 2nd hour. Measurements: Respiratory mechanics, hemodynamic and arterial blood gas data. Main Results: Patients within low VT-high PEEP ventilation period had shown significantly lower alveolar ventilation and thoraco-pulmonary compliance, than during reduced RR ventilation; mean airway pressure and Vds/Vt within low VT-high PEEP ventilation were the highest, however driving pressure was lower. Vt decrease and increase on the 3rd hour did not lead to oxygenation improvement, and was characterized by the worst CO2 elimination. Hemodynamically, the significant CVP and pulmonary artery wedge pressure increase and cardiac output decrease during low VT-high PEEP ventilation were revealed; in 23.2% patients catecholamine therapy was initiated. In contrast, control group patients demonstrated no significant respiratory and hemodynamic changes without low VT-high PEEP ventilation. Conclusions: In postoperative cardiosurgical patients, MV with Vt 6 ml×kg-1 and 10 cmH2O is characterized by significantly worse oxygenation and elimination of CO2, and a less favorable hemodynamic profile than ventilation with Vt 10 ml×kg-1 and 5 cmH2O. Funding: No funding. Declaration of Interest: No competing interest. Ethical Approval: In prospective study approved by the local Ethics Committee of Almazov National Medical Research Centre included 119 on-pump CABG patients’ data during 2016-2017 years.

Adding rivaroxaban to aspirin after CABG surgery.

Adding rivaroxaban to aspirin after CABG surgery.

Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP

Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.

Endocan: a biomarker predicting successful reperfusion after coronary artery by-pass surgery of acute coronary syndrome patients.

Endothelial specific molecule 1 (Endocan) is a biomarker of the inflammatory process occurring in endothelial cells. It was shown that endocan was increased in acute coronary syndromes. We aimed at investigating the endocan levels in acute coronary syndrome patients after coronary bypass surgery. The study included 35 patients who presented with acute coronary syndrome to the Emergency Department. Serum endocan levels and other inflammatory markers were evaluated before and after coronary artery by-pass surgery. The correlation coefficients and their significance were calculated by Pearson's test and the difference in mean values before and after bypass surgery was calculated by paired sample t-test. Statistical analyses were performed using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was taken as p<0.05. There was a significant change in serum hs-CRP and endocan levels and also LVEF before and after CABG operation (p<0.05). Serum endocan level was significantly decreased after successful reperfusion in our study. Thus, it may be an important biomarker in terms of clinical use as an indicator of successful reperfusion.

Suture-Less Circumcision by Glutaraldehyde Albumin Glue Enhanced Laser Tissue Welding—A Comparative Study

Background: Suture-less circumcision by Feracrylate glue creates a weak and non waterproob bond. Hence, there is wound dehiscence and delayed healing which favor infection in many patients. I am describing a new technique for suture-less circumcision which is free from above limitations. Methods: In my center in the time span of 2 years, I did 51 cases of circumcision with Laser tissue welding technique (group A). Age range was 5 months to 21 years. During the same time span, in 56 patients circumcision was done by Feracrylate glue (group B). The age range was 3 months to 22 years. This group was kept as a control. Patients in both groups were randomly distributed. The technique of circumcision by Laser tissue welding is as follows. Patient is under short GA, the prepuce above the artery forceps is chopped off by scissors and bleeders are coagulated by bipolar cautery. Now, 0.9 ml 40% human albumin is taken in 1 ml syringe and mixed with 0.1 ml of 10% glutaraldehyde solution. The syringe is shaken vigorously to mix both the components. The skin and mucosa of penis are held by tooth forceps and a thin layer of this mixture is layered over it all around. Infrared Laser of 5 watts power and 850 nm illuminated over this bond for 60 seconds to polymerize it. Results: In group A, 2 (3.9%) patients developed partial wound gape, no patient had complete wound gape. 3 (5.88%) patients had grade 2 infections which settled with conservative treatment of oral antibiotics. In group B, 6 (10.71%) patients had partial wound gape and 8 (14.28%) patients had complete wound gapping. 11 (19.64%) patients developed grade 2 and 8 (14.28%) patients grade 3 wound infection. All these 19 patients’ post-operative antibiotics were started and given for 7 - 10 days. The Glutaraldehyde albumin mixture bond is already described in medical literature (Bioglue) for its use to seal coronary anastomosis after CABG operation, to seal sutures of cardiac surgery and for aortic dissection, etc. It is a surgical adhesive composed of purified bovine serum albumin (BSA) and glutaraldehyde and is already American FDA approved. It creates a flexible mechanical seal independently of the body’s clotting mechanism. In my technique, 0.9 ml of 40% human albumin is mixed with 0.1 ml 10% glutaraldehyde solution which costs only 50 cents which is a massive 1000 times cost reduction. Laser application polymerizes the glue and forms a waterproob bond in less than a minute. In my technique, percentage of glutaraldehyde used is only 10% compared to 50% in bioglue, hence it is non-toxic to the tissues. Conclusion: Suture-less circumcision by glutaraldehyde albumin glue enhanced Laser tissue welding is a safe, cheap and effective technique of performing circumcision. It is an important advance in circumcision surgery after a long time. The technique becomes a foundation for its vast application in other areas of surgery.

Diagnostic accuracy of 256 slices computed tomography coronary angiography in post coronary artery bypass graft Egyptian patients

Objective: Evaluate the diagnostic accuracy of 256 slices computed tomography (CT) coronary angiography (CA) (multidetector CT [MDCT]) in the assessment of native coronary arteries and grafts in post-coronary artery bypass graft (CABG) surgery Egyptian patients. Patients and Methods: It included 70 patients with a history of isolated CABG with recurrent chest pain. We excluded patients with a history of redo CABG or other open-heart surgeries, renal impairment, severe claustrophobia, chronic liver disease, dye allergy, tachycardia with contraindication to beta blockers (BB), pregnancy. All patients were subjected MDCT and CA. Both examinations were done within 3 months. Results: In our study, 161 grafts evaluated (63 left internal mammary artery [LIMA] in situ grafts, 5 right internal mammary artery (RIMA) and 2 radial grafts, and 91 venous grafts). CA failed to detect 3 LIMA and 7 venous grafts. All were seen only by MDCT. For grafts CT compared to CA has sensitivity (91.5%, 84.8%), specificity (98%, 100%), accuracy (95.65%, 96.9%), positive predictive value (PPV) (96.43%, 100%), and negative predictive value (NPV) (95.24%, 96.2%) in the assessment of significant stenosis and total occlusion of grafts, respectively. For grafted vessels CT has sensitivity (94%, 100%), specificity (98%, 100%), accuracy (96.94%, 100%), PPV (95.92%, 100%), and NPV (97%, 100%) in the assessment of significant stenosis and total occlusion of grafted vessel, respectively. For native vessels CT has sensitivity (100%, 97.7%), specificity (84.2%, 98.4%), accuracy (97.14%, 98.1%), PPV (96.6%, 97.7%), and NPV (100%, 98.37%) in the assessment of significant stenosis and total occlusion of native vessels, respectively. Conclusion: Our study demonstrated a high diagnostic accuracy of MDCT for the assessment of bypass grafts and grafted or native coronary arteries compared with CA. Detection of grafts or native vessels occlusion was better than detection of substantial stenosis. MDCT is a good negative test for native vessels as it has a high sensitivity since it tends to overestimate stenosis degree, so patients with negative MDCT angiographic results mostly have patent vessels.

Challenges of managing a post-arrest resuscitated patient for urgent CABG and concomitant non-cardiac surgery under same anaesthesia

Challenges of managing a post-arrest resuscitated patient for urgent CABG and concomitant non-cardiac surgery under same anaesthesia

A Study to assess the effectiveness of Honey Warm Water on level of Constipation among patients undergone CABG with Constipation in selected Hospitals at Rajkot

A study to assess the effectiveness of honey warm water on level of constipation among patients undergone cabg with constipation in selected hospitals at Rajkot. The objectives of the study were a) To assess the level of constipation among patients undergone CABG. b) To assess the effectiveness of honey warm water on level of constipation among patients undergone CABG. c)To find out the association between level of constipation and after taking honey warm water with their selected demographic variables. The research approach selected for the study was quantitative research approach and Quasi-experimental study Time-series research design. The study was conducted at selected hospital at Rajkot. The conceptual framework for this study was based on Weidnbach nursing practice model. The study had been conducted in Unicare Hospital, Rajkot. Non-probability purposive sampling technique had been adopted to select the desired samples. The sample size was 40. As a part of intervention, honey warm water was administered for 10 ml of honey will take mixed with 100 ml of warm water. At the early morning when the patients having empty stomach this mixture of honey warm water was provided to the post CABG surgery patients for three days, to get the best result. The data was collected through Constipation Assessment Scale. The collected data were analyzed through descriptive statistics (frequency and percentage) and inferential statistics ('Annova-test ’and chi-square) to test the hypothesis. The study shows that the calculated chi square value is below the level of tabulated value at the level of 0.05. Thus stated the hypothesis is rejected & null hypothesis was accepted. So its inferred that there is no significant association between the demographic variables and level of constipation among post-operative CABG patients. The obtained ‘F ’value 26.752 at 0.001 level hence the hypothesis was accepted. It is inferred that honey warm water was effective in reducing level of constipation among post-operative CABG.

Effectiveness of self instructional module on knowledge regardingmyocardial infarction and its management among staff nurses

Introduction Myocardial infarction MI also known as a heart attack occurs when blood flow decreases or stops to a part of the heart causing damage to the heart muscle. ... An MI may cause heart failure an irregular heartbeat cardiogenic shock or cardiac arrest. Most MIs occur due to coronary artery disease.Objective The thrombolytic therapy in acute myocardial infarction are to restore coronary artery patency salvage myocardium reduce infarct size and facilitate coronary artery repairMethods One group pre-test and post-test without a control group using pre-experimental design was used with purposive sampling technique. Information was collected from 50 Registered Staff Nurses using structured knowledge questionnaire. SIM was implemented and post-test was conducted after 7 days using same questionnaire.Results. The overall pre test knowledge scores of Staff Nurses on Myocardial infarction and its management was found to be 36.5 and the overall post test knowledge scores was found to 76.2 and enhancement in the mean percentage knowledge score was found to be significant at 5 level for all the aspects under study. There was significant association between post test knowledge scores and selected demographic variables with age chi2 7.53 gender chi2 6.61 marital status chi2 6.45 professional educational qualification chi2 6.27 witnessing MI chi2 6.55 and inservice education on myocardial infarction chi2 9.37.Conclusion Overall findings showed that there is knowledge deficit among staff nurses regarding Myocardial infarction and its management and SIM was effective in improving their knowledgeKeywords includes drug therapy thrombolytic therapy and percutaneous coronary intervention PCI and coronary artery bypass graft CABG surgery.

Anti-Angiogenic Vascular Endothelial Growth Factor-A Isoform: VEGF-A165b is Present in Human Right Atrial Appendage, but is not Altered in Diabetes

Introduction: The alternative splice variant of vascular endothelial growth factor (VEGF-A): VEGF-A165b is anti-angiogenic and has been described to regulate angiogenesis in cancer, retinopathy, and obesity. In this study, we describe for the first time, presence of VEGF-A165b in human cardiac tissue, and sought to determine whether VEGF-A165b is altered in patients with diabetes. Methods and Results: A total of 33 right atrial appendage biopsies were collected from consenting patients during cardiac or vascular surgery at the John Hunter Hospital. Patient demographics and co-morbidities were recorded on the day of surgery and confirmed via access to medical records. A majority of patients (82%) were male; 32% of patients had previous MI, n = 10 (30%) patients had diabetes. Detection of VEGF-A165b levels were determined using the ELISA kit (R&D systems). Patients with diabetes tended to have lower VEGF-A165b expression (p = 0.1). There was no difference in VEGF-A165b expressions in patients with previous myocardial infarction or diastolic impairment. On multivariate analysis, presence of diabetes is not associated with changes in VEGF-A165b expression, independent of age, BMI, gender, and cardiovascular co-morbidities. Conclusions: VEGF-A165b is present in human cardiac tissue. In patients who underwent CABG surgery, there was no difference in VEGFA-165b expression between patients with vs without diabetes. Larger study population is required to dissect the regulatory mechanisms of cardiac VEGF-A165b in metabolically-induced cardiovascular pathologies.

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

Objectives:The rising percentage of patients scheduled for primary CABG with HbA1c>8.6% is alarming reflecting higher burden on the patient, operative procedure and the operating surgeon. Although some articles in the literature argue that decompensated diabetes increases mortality and morbidity, other studies are arguing that there is no relation between them. This study aims at tracing the occurrence of the proposed adverse complications after primary CABG operations related to HbA1c values>8.6% in diabetics subjected to tight glycemic control; in a trial to conclude how far the value of HbA1c could be accepted to carry out the surgery safely. Methods:This prospective study included 80 adult diabetic patients who presented with IHD requiring primary CABG. It was conducted between January 2016 and December 2018. Group (I) included 42 patients with HbA1c values 8.6%. We compared the following: perioperative MI, low cardiac output syndrome, operative mortality, rhythmic complications, hemorrhagic complications, respiratory complications, cerebrovascular accidents, acute renal failure development, superficial and deep surgical wounds infections, overall hospital complications and overall one-year mortality and survival. Results: Mean HbA1c% value was 7.5 ± 1.11% for group (I) and 9.3 ± 1.03% for group (II). Prior to surgery, the mean FBG level was 136.9±41.7 mg/dl for group (I) and 152.2±27.3 mg/dl for group (II) with tight glycemic control measures. Although group (II) showed higher values in the studied parameters (pre-, intra- and post-operatively), no statistically significant differences appeared between the two subsets of patients regarding the proposed adverse complications. The overall hospital complication rate was 13(30.95%) and 14(36.84%) for group (I) and (II) respectively (p>0.05). In the follow-up period, both groups expressed comparable results with no statistical significance. The overall one-year survival was 95.23% and 94.73% in group (I) and (II) respectively (p>0.05) and the overall mortality was 5% (two deaths from each group) (p>0.05). Conclusion:Although patients with IHD undergoing primary CABG and having decompensated diabetes with HbA1c values>8.6% have more insulted cardiovascular condition, these higher HbA1c values do not add more additional impact on the proposed adverse intra- and postoperative complications as with lower values with the aid of strict (tight) glycemic control measures in the immediate preoperative period.

Koroner bypass cerrahisi geçiren hastalarda 1-yıllık mortaliteyi öngörmede lojistik EuroSCORE, SYNTAX ve EuroSCORE II’nin karşılaştırılması

Objectives: EuroSCORE II, logistic EuroSCORE and SYNTAX scores were compared in patients who underwent CABG in order to find the ideal scoring system for mortality.Methods: This retrospective study attempted to examine the preoperative demographic characteristics, echocardiographic findings, operation notes and files, perfusion cards and observation notes of 228 patients who had undergone CABG surgery in our clinic.Results: It was found that predictive point of SYNTAX score was greater than 27.5 (&amp;gt;27.5), the logistic regression (LR +) value was 1.5 in order to determine mortality rate. Predictive value of EuroSCORE II was higher than 1.82 (&amp;gt;1.82) and LR+ value was 2.20. It was found that EuroSCORE II was enough to predict one-year mortality rate although its positive predictive value was low. Predictive value of logistic EuroSCORE was higher than 5.71 (&amp;gt;5.71) and the LR+ value was 5.13 to assess the mortality rate. Logistic EuroSCORE was also sufficient to predict one-year mortality rate.Conclusion: Logistic EuroSCORE was found to be the most effective scoring system in predicting one-year mortality in this study. We conclude that randomized clinical trials need to be performed in order to find an ideal cardiac risk scoring system.

Management of acute myocardial infarction occurring during sport practice: Contemporary data from the ‘obseRvatoire des Infarctus de Côte d’Or’ (RICO) survey

Over the last decade, acute myocardial infarction (AMI) management has considerably evolved, but current management of sport-related AMI remains poorly investigated. We aimed to analyze the acute therapeutic strategies used in AMI occurring during sport activity. We retrospectively analyze consecutive patients from an AMI database (RICO survey) who underwent a coronary angiography (CA) in a university hospital after a sport-related AMI within 2011 to 2017 ( n = 100). Most were male (86%), with median age at 58 (50–67) y. Out-of-hospital sudden cardiac arrest (OHSCA) was experienced by 20%; at admission. At the acute phase, 3% underwent ECMO and 2% had an IABP. Intravenous fibrinolysis was given in 14% (26% of the 54 STEMI patients), successfully in 64%. CA was performed through a radial approach in 89%; OCT or IVUS was used in 2 patients. Thromboaspiration was performed in 30%, balloon predilatation in 26% and direct stenting in 73%. Most PCI were performed using drug eluting stent (DES) (69%) with 1 stent (78%), 2 stents (15%), 3 stents (7%) or no stent (5%). Median time from symptoms to reperfusion was 145 (105–228) and to PCI 163 (126–240) min. A re-intervention during hospitalization was performed in 20% of patients, with implantation of 1 stent (39%) 2 stents (35%), 3 stents (17%), 4 stents (4%); all stents but one were DES. Seven patients underwent CABG surgery in addition to PCI. No ICD was implanted. During hospitalization, 10 patients died (all initially presented with OHSCA); all victims treated with ECMO died and only one with IABP survived (used for management of early stent thrombosis). From this large series, thrombolysis was rare, but thromboaspiration was performed in nearly one third of patients; culprit lesions were often treated by direct stenting, with a DES in more than 2/3 of cases. A re-intervention procedure was often needed to treat other lesions, more often with DES rather than CABG.

Long-term mortality benefit of CABG surgery over PCI in patients with diabetes mellitus.

Long-term mortality benefit of CABG surgery over PCI in patients with diabetes mellitus.