History Of Coronary Artery Bypass Research Articles

Quality of life up to one year after revascularisation with percutaneous coronary intervention in patients with previous coronary artery bypass surgery

Abstract Background Approximately 1 out of 11 patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) have a history of coronary artery bypass (CABG) surgery. Most studies investigating patients treated with PCI with prior CABG have focused on harder outcomes such as morbidity, mortality and complications. However, quality of life (QoL) is increasingly recognized as an important outcome measure after PCI. Purpose To determine QoL after revascularisation with PCI in patients with and without a history of CABG. Methods CONCARDPCI, a prospective multicenter cohort study including 3417 consecutive patients revascularised with PCI, was conducted at seven high-volume referral PCI centres in Norway and Denmark. Of these, 312 had a history with CABG. Baseline clinical data were collected from patient´s medical records and national registers. Sociodemographic characteristics were self-reported. Patient-reported outcomes measures were collected at baseline, 2-, 6- and 12-months after discharge. QoL and health status were measured with the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), RAND-12-Item Short Form Health Survey (RAND-12) and the Seattle Angina Questionnaire 7 (SAQ-7). Results Patients with prior CABG were older (mean age 71 vs 65, p<0.001), more often men (84% vs 78%), and had more comorbidities. They were less likely to be current smokers (6% vs 18%, p=0.033) and less likely to be working full time (15% vs 33%). Patients with prior CABG reported a lower QoL on all questionnaires at all measuring time points compared with the no CABG group. Both groups had a significant improvement in the physical and mental component scores from baseline to two months on RAND-12 (p<0.001). In addition, an improvement was found on physical limitation from baseline to two months on SAQ-7 (p<0.001). For both groups QoL was best at baseline using WHOQOL-BREF. Conclusion QoL improved in patients with and without a history of CABG throughout the 12-month follow-up period. However, patients with prior CABG scored worse. These findings are important for future clinical decision-making regarding rehabilitation programs after PCI.SAQ-7 mean domain scores over time

A comparison of on-admission blood cell count-derived parameters on the development of contrast-induced nephropathy in acute coronary syndromes

Contrast-induced nephropathy (CIN) is a clinical entity closely associated with cardiac mortality and morbidity. We aimed to investigate the relationship between CIN after acute coronary syndrome and other bio-inflammatory parameters (Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio) as well as biomarkers such as AST/ALT, SIRI (Systemic Immnun Response Index), AISI (Aggregate Index of Systemic Inflammation), APRI (AST to platelet ratio index), SII (Systemic Immun Inflammation Index) NLR (Neutrophil to lymphocyte ratio), N/LPR (Neutrophil/ (lymphocyte x platelet), PLR (Platelet to lymphocyte ratio), MLR (Monocyte to lymphocyte ratio) and MPVLR (Mean platelet volume to lymphocyte ratio). In this retrospective cross-sectional study, we included 228 patients older than 18 years of age and underwent coronary angiography for acute coronary syndrome between January 2021 and May 2022. We applied the logistic regression analyzes to evaluate the relationship between patients' demographic, clinical characteristics, laboratory parameters, and contrast-induced nephropathy, and to evaluate the predictive power of the AST/ALT, AISI, SIRI, SII, NLR, PLR, MLR, N/LP ratio, MPVLR and other inflammatory based parameters on this primary endpoint. In the univariate analyses, prior history of coronary artery bypass, acute coronary syndrome type, prior ACEi/ARB usage, white blood cell count, hospitalization stay length, contrast amount, MLR, PLR, white blood cell to platelet ratio (WBCPR) were significantly associated with CIN. [p:0.039, p:0.017, p:0.025, p:0.044, p<0.001, p:0.003, p: 0.045, p: 0.044, p:0.044, respectively]. However, multivariable logistic regression analysis showed that WBCPR [OR 0.00 (95% CI 0.00- 0.01) p:0.005] and MLR [OR 13.522 (95% CI 2.15-84.72) p:0.005] might be statistically a significant independent predictor of CIN beside contrast amount [OR 1.92 (95% CI 01.23-3.02) p:0.004]. The WBCPR can be a new valuable independent predictor of CIN. Also, MLR and contrast amount may be a good independent predictor of CIN in acute coronary syndrome.

Outcomes of Octogenarians Receiving Aortic Repair

Introduction: Abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5cm in men and 5cm in women. We sought to evaluate current practices of elective AAA repair and one- and two-year outcomes in octogenarians. Methods: We identified octogenarians undergoing elective AAA repair in the Vascular Quality Initiative from 2012-2019. Standard statistical methods were used. Frailty was calculated using previously published methods. Results: 21.39% of all aortic operations were performed on octogenarians; 9,735(23.34%) endovascular (EVAR) and 755(10.31%) open repair (OAR). 41.47% of EVARs were under size thresholds: 47.69% males ≤5.5cm diameter and 21.32% females ≤5.0cm diameter compared with 18.68% OARs: 23.24% males and 10.62% females. Additionally, 31.33% had high frailty scores. One- and two-year mortality was 9.33%±0.30% and 14.76%±0.39% for EVAR and 15.20%±1.34% and 18.94%±1.53% for OAR patients, respectively. Among these patients, high frailty was associated with two-year mortality (EVAR; (HR=2.78[2.35-3.30], p < 0.01) and OAR; (HR=1.86[1.27-2.72], p < 0.01)). For EVAR, other patient factors associated with mortality included heart failure (HR=1.33[1.14-1.55], p < 0.01) and dialysis (HR=1.71[1.13-2.59], p = 0.01). For OAR, history of coronary artery bypass (HR=1. 54[1.01-2.36], p = 0.047) was associated with mortality. Statin use was protective of mortality for all patients (EVAR; (HR=0.70[0.62-0.80], p < 0.01): OAR;(HR=0.60[0.40-0.90], p = 0.01)). Conclusion: Nationally, a large portion of elective AAA repair in octogenarians is performed below recommended size thresholds and a third are frail patients. High two-year mortality after AAA repair in this age group exceeds the published risk of rupture for 5-5.5 cm AAA, suggesting that increase in the size threshold of elective repair among octogenarians should be explored.

Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model

Heart failure (HF) is a chronic disease that negatively affects different aspects of the patients' lives, diminishing their quality of life. This research studied factors that impact the health-related quality of life (HRQoL) of patients with HF, particularly medication adherence and acceptance of illness. In this cross-sectional study, data were collected from 273 patients admitted to a tertiary hospital with the diagnosis of HF. Participants' level of illness acceptance, medication adherence, and HRQoL were assessed using validated questionnaires, and data were analyzed using the regression path analysis. There was found a moderate level of acceptance of illness (24.9 ± 6.79) and low levels of medication adherence (3.44 ± 3.15) and HRQoL (53.81 ± 17.99) among participants. Gender, education, income, history of coronary artery bypass (CABG), the New York Heart Association (NYHA) class, acceptance of illness, and medication adherence were statistically significantly associated with HRQoL. Patients with diminished HRQoL were more likely to be female, less educated, have lower income, higher NYHA class, no prior CABG, low medication adherence, and low level of acceptance of illness. The final path model demonstrated a good fit with the data (χ^2/df = 1.70, CFI = 0.92, RMSEA = 0.05, and p = 0.01). Health care providers should target and promote medication adherence and the acceptance of illness as modifiable factors to help improve the HRQoL of patients with HF.

Bilateral Gouty Arthritis Developing After Covid-19 Infection: A Case Report

Introduction and Purpose: SARS-CoV-2 virus started in Wuhan, China in 2019 and caused the COVID-19 pandemic by affecting the whole world in a short time. Arthralgia is one of the symptoms that can be seen after Covid-19 infection and can be seen in 14.9% of the cases. However, data on rheumatic and inflammatory symptoms such as arthritis are scarce. Viral infections are known causes of acute arthralgia and arthritis. In the literature, there are many examples of reactive arthritis cases developing after Covid-19 infection. Gouty arthritis is the most common form of inflammatory arthritis. Acute gouty arthritis most often affects the first metatarsophalangeal joint in the foot. &#x0D; Case Presentation: A 76-year-old male patient with chronic kidney disease, hypertension, and a history of coronary artery bypass using both leg saphenous 12 years ago was admitted to the emergency service with chest pain and increasing fatigue. Since the Covid-19 PCR result was positive, he was hospitalized for further examination and treatment. On the 14th day of hospitalization, the patient complained about pain around both big toes that started suddenly at night and worsened in the morning. In the patient's history, he stated that he had completely similar complaints several times with an interval of one year in the last 3 years and he recovered spontaneously in 10-15 days.&#x0D; Discussion and Conclusion: Although developing gouty arthritis etiology is not clear for our patient in this case, it is thought to be a secondary condition due to the development of the disease after Covid-19 infection. It was considered that our patient has bilateral gouty arthritis triggered primarily by COVID-19. Due to the limited number of studies, more case reports should be added to the literature on this subject.

A pan-resistant Myroides odoratimimus catheter-related bacteremia in a COVID-19 patient and review of the literature.

Myroides spp. are opportunistic environmental Gram-negative bacteria. These affect mostly immunocompromised hosts and generally lead to soft tissue, and urinary tract infections. Bacteremia most commonly develop secondary to soft tissue or catheter related infections and may lead rarely to mortality. Myroides spp. are generally suscetible to fluoroquinolones, piperacillin/tazobactam, trimethoprim/sulfamethoxazole, carbapenems or tetracyclines however, pan-resistant isolates and multiple resistance genes have been reported in clinical isolates of Myroides spp. We report a pan-resistant Myroides odoratimimus bacteremia in a patient with severe COVID-19 ending with fatality and in this context a review of reported Myroides bacteremias are also described. In this study, a 64-year old male patient with history of coronary artery bypass was admitted to ICU with severe COVID-19 pneumonia accompanied by pneumomediastinum and pneumopericardium. Continous renal replacement therapy and extracorporeal membraneous-oxygenation were initiated due to acute renal failure and persistent hypercarbia/hypoxia, respectively. Within four weeks of hospitalization various episodes of bacteremia developed and multiple antibiotics were used. On the 5th week of follow-up, acute phase reactants increased and empirical broad spectrum antibiotics were initiated. Blood culture revealed Gram-negative rods. The patient became hypotensive and despite maximum medical care he was lost due to cardiac arrest. M. odoratimimus was identified by MALDI-TOF and the bacterium was pan-resistant. According to Center for Genomic Epidemiology results the strain was identified as M. odoratimimus PR63039 and the genome analysis revealed antibiotic resistance genes associated with resistance to beta-lactams (bla OXA-347, bla MUS-1, bla EBR-1), tetracyclines (tetX), sulfonamides (sul2), macrolides (ereD), (ermF).

Improving walking speed reduces hospitalization costs in outpatients with cardiovascular disease. An analysis based on a multistrata non-parametric test

BackgroundTo assess the association between walking speed (WS) and its improvement on hospitalization rates and costs in outpatients with cardiovascular disease.MethodsSix hundred forty-nine patients participating in an exercise-based secondary prevention program were studied. Patients were divided at baseline into two groups characterized by low and high WS based on the average WS maintained during a moderate 1-km treadmill-walking test. WS and other covariates were grouped into three domains (demographic factors, medical history and risk factors), and used to estimate a propensity score, in order to create homogeneous groups of patients. All-cause hospitalization was assessed 3 years after baseline as a function of WS. Hospitalization and related costs were also assessed during the fourth-to-sixth years after enrollment. To test whether the hospitalization costs were related to changes in WS after 36 months, a multistrata permutation test was performed by combining within strata partial tests.ResultsThe results support the hypothesis that hospitalization costs are significantly reduced in accordance with an improvement in WS. This effect is most evident among older patients, overweight or obese, smokers, and those without a history of coronary artery bypass surgery.ConclusionsThe present study supports growing evidence of an inverse association between WS, risk of hospitalization and consequent health-care costs. The joint use of propensity score and multistrata permutation approaches represent a flexible and robust testing method which avoids the possible effects of several confounding factors typical of these studies.

A Dubious Achievement: Mapping Catheter Fracture and Embolization During Cryoballoon Pulmonary Vein Isolation.

We present a unique complication occurring during cryoballoon pulmonary vein isolation [(1)][1]. A 51-year-old woman with a history of coronary artery bypass and mechanical aortic valve replacement was referred for cryoballoon (Arctic Front Advance Cardiac CryoAblation Catheter System, Medtronic Inc

Impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE-2 registry

To assess the long term clinical impact of coronary artery disease (CAD) distribution in patients undergoing transcatheter aortic valve replacement (TAVR) using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry. CAD is common in patients undergoing TAVR. However, the impact of CAD distribution before TAVR on short and long-term prognosis remains unclear. FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centres. Three-year mortality was assessed in relation to CAD status. CAD was define as at least one coronary stenosis > 50%. A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of patient presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk-profile and in Logistic Euroscore (from 19.3 ± 12.8% to 21.9 ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44% respectively in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD: HR 0.90; 95% CI 0.78 to 1.07). Significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR 1.42; 95% CI 1.10 to 1.87). Similar results were found after propensity score matching (428 patients per group). CAD is not associated with decreased short and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival suggests the need for revascularization before or at the time of TAVR.

Impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE-2 registry.

Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of CAD distribution before TAVR on short- and long-term prognosis remains unclear. We hypothesized that the long-term clinical impact differs according to CAD distribution in patients undergoing TAVR using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry. FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centers. Three-year mortality was assessed in relation to CAD status. CAD was defined as at least 1 coronary stenosis >50%. A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of the patients presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk profile and in logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (from 19.3% ± 12.8% to 21.9% ± 13.5%, P < 0.001). Mortality at 30 days and 3 years was 9% and 44%, respectively, in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD, hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.78-1.07). A significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR: 1.42; 95% CI: 1.10-1.87). CAD is not associated with decreased short- and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival and the need for revascularization before or at the time of TAVR should be validated in a randomized control trial.

Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease.

BackgroundChronic kidney disease (CKD) is an adverse prognostic marker for valve intervention patients; however, the prevalence and related outcomes of valvular heart disease in CKD patients is unknown.Methods and ResultsIncluded patients underwent echocardiography (1999–2013), had serum creatinine values within 6 months before index echocardiogram, and had no history of valve surgery. CKD was defined as diagnosis based on the International Classification of Diseases, Ninth Revision or an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Qualitative assessment determined left heart stenotic and regurgitant valve lesions. Cox models assessed CKD and aortic stenosis (AS) interaction for subsequent mortality; analyses were repeated for mitral regurgitation (MR). Among 78 059 patients, 23 727 (30%) had CKD; of these, 1326 were on hemodialysis. CKD patients were older; female; had a higher prevalence of hypertension, hyperlipidemia, diabetes, history of coronary artery bypass grafting/percutaneous coronary intervention, atrial fibrillation, and heart failure ≥mild AS; and ≥mild MR (all P<0.001). Five‐year survival estimates of mild, moderate, and severe AS for CKD patients were 40%, 34%, and 42%, respectively, and 69%, 54%, and 67% for non‐CKD patients. Five‐year survival estimates of mild, moderate, and severe MR for CKD patients were 51%, 38%, and 37%, respectively, and 75%, 66%, and 65% for non‐CKD patients. Significant interaction occurred among CKD, AS/MR severity, and mortality in adjusted analyses; the CKD hazard ratio increased from 1.8 (non‐AS patients) to 2.0 (severe AS) and from 1.7 (non‐MR patients) to 2.6 (severe MR).ConclusionsPrevalence of at least mild AS and MR is substantially higher and is associated with significantly lower survival among patients with versus without CKD. There is significant interaction among CKD, AS/MR severity, and mortality, with increasingly worse outcomes for CKD patients with increasing AS/MR severity.

The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions.

Silent embolic cerebral infarction (SECI) is a major complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients with stable coronary artery disease (CAD) who underwent CAG with or without PCI were recruited. Cerebral diffusion-weighted magnetic resonance imaging was performed for SECI within 24 hours. Clinical and angiographic characteristics were compared between patients with and without SECI. Silent embolic cerebral infarction occurred in 12 (12%) of the 101 patients. Age, total cholesterol, SYNTAX score (SS), and coronary artery bypass history were greater in the SECI(+) group (65 ± 10 vs 58 ± 11 years,P= .037; 223 ± 85 vs 173 ± 80 mg/dL,P= .048; 30.1 ± 2 vs 15 ± 3,P< .001; 4 [33.3%] vs 3 [3.3%],P= .005). The SECI was more common in the PCI group (8/24 vs 4/77,P= .01). On subanalysis, the SS was significantly higher in the SECI(+) patients in both the CAG and the PCI groups (29.3 ± 1.9 vs 15 ± 3,P< .01; 30.5 ± 1.9 vs 15.1 ± 3.2,P< .001, respectively). The risk of SECI after CAG and PCI increases with the complexity of CAD (represented by the SS). The SS is a predictor of the risk of SECI, a complication that should be considered more often after CAG.

Impact des techniques interventionnelles dans le traitement de la valvulopathie aortique après revascularisation myocardique chirurgicale préalable

IntroductionPatients with a history of coronary artery bypass and aortic valve disease constitute a high-risk group for conventional redo surgery. The transcatheter aortic valve implantation (TAVI) may be an alternative for high-risk patients. The purpose of this study is to evaluate the impact of TAVI in the treatment of aortic valve disease after previous surgical coronary artery revascularization. Patients and methodsThis is a single-center retrospective, observational study, including 87 patients undergoing surgery for surgical heart valve replacement or TAVI from January 2007 to December 2013. ResultsThe introduction of transcatheter aortic valve implantation techniques has doubled the number of redo patients treated for aortic valve disease. From 2010 to 2013, the patients treated by conventional surgery diminished by 30%, with improved postoperative outcomes. This study allowed us to notice differences in patient's in terms of operative risk factors. For the same reasons no comparison was possible between 2 subgroup of patients. Hospital mortality was 6.4% for conventional aortic surgery and 20% for transcatheter aortic valve treatment. ConclusionSurgery remains the standard treatment for aortic valve disease even in redo patients, but TAVI becomes a very interesting tool as it may represent a tailored approach for our patients.

Coronary stent entrapment.

A 64-year-old woman with a history of coronary artery bypass and coronary angioplasty with unexpanded stent entrapment blocked in the circumflex coronary artery and left main is now presenting with crescendo angina pectoris. The Department of Cardiovascular Surgery established that a new surgical intervention presents a very high risk. In this condition, we decide for elective percutaneous coronary intervention for stent restenosis, which is a very difficult procedure in the particular condition of unexpanded stent blocked in the circumflex coronary artery and left main.

Dietary education among patients following coronary artery bypass surgery - a necessity or an unnecessary luxury?

IntroductionDespite rapid progress in cardiology and cardiac surgery, cardiovascular disease still present a serious epidemiological problem in industrialized countries, including Poland. Great interest in risk factors of these diseases is associated with an improper lifestyle, including diet.Aim of the studyWe aimed to assess the dietary intake among patients with a history of coronary artery bypass (CABG) surgery and to determine whether a regular dietary education among this population of patients is necessary.Material and methods212 patients with a history of CABG surgery were enrolled in the study. A questionnaire concerning the diet within 24 hours prior to the visit was used to obtain the necessary data.Results43% of patients ate 4 to 5 servings per day. Milk was consumed most often several times per week or once every day. Meat consumption several times per week was reported by 41% of patients. 54% of patients reported eating fish several times per month. Half of the patients ate several servings of vegetables per day. 84% of patients used salt and other spices to season their meals. The energy value and the intake of protein, fats, carbohydrates and fiber was lower, while sodium intake was higher, than recommended for this group of patients.ConclusionsPatients with a history of CABG have an unhealthy diet, and do not follow the dietary guidelines. It is necessary to carry out systematic nutrition education among this group.

Massive aortic regurgitation following paravalvular balloon valvuloplasty of an edwards sapien valve treated by emergent corevalve implantation: Never cross a transcatheter aortic valve without a pigtail

A 72-year-old patient, with a history of coronary artery bypass and aorto-bifemoral graft, was diagnosed with a symptomatic severe aortic valve stenosis in the presence of moderately decreased left ventricular function. The Heart team decision was to implant an Edwards SAPIEN XT 26 mm valve by transapical approach, therefore avoiding access through the aorto-bifemoral graft. At the end of the procedure, grades 2-3 aortic regurgitation was observed. Since each run of rapid pacing ended in ventricular fibrillation, it was decided to treat the aortic regurgitation conservatively with the option of post-dilation in a second procedure if hemodynamic deterioration was observed. Six days later balloon valvuloplasty was performed because of heart failure requiring endotracheal intubation. Despite transesophageal echocardiography guidance the balloon was inadvertently advanced through the paravalvular space. As a consequence, balloon valvuloplasty was complicated by massive aortic regurgitation and severe hemodynamic instability which was resolved after emergency transfemoral implantation of a CoreValve. Without any further complications, the patient was discharged eight days later.

Outcomes of Primary Percutaneous Intervention of the Unprotected Left Main Coronary Artery Stenosis in Myocardial Infarction

The aim of our study was to examine the 30-day and 1-year survival rate for patients undergoing percutaneous coronary artery intervention (PCI) of unprotected left main (ULM) stenosis by the presence (acute myocardial infarction [AMI] group) or absence (non-AMI group) of AMI at the time of hospital admission. We retrospectively reviewed 64 patients undergoing PCI of ULM stenosis at our regional heart institute between 2000 and 2008. Patients had no history of coronary artery bypass grafting. Thirty-six men and 28 women underwent PCI for ULM stenosis. Overall Kaplan-Meier survival at 30 days and 1 year was 71.5% and 57.8%, respectively. Thirty-three patients (51.6%) presented with AMI. Those with AMI had lower survival at both 30 days (59.2 vs 83.9%; P = 0.04) and 1 year (45.2 vs 70.2%; P = 0.04) compared with those without AMI. Compared with a lesion involving only the ostial/mid LM, diffuse disease (N = 11) was associated with an increased mortality at 1 year (hazard ratio 0.27; 95% confidence interval 0.09-0.79). A stent size >3 mm was associated with lower mortality at 1 year (hazard ratio 0.42; 95% confidence interval 0.19-0.93). We found that AMI at presentation was significantly associated with higher mortality in patients undergoing ULM stenting. LM lesion location and stent size were both significantly associated with mortality. ULM stenting is an option in patients who are unable to undergo coronary artery bypass grafting, but patients should understand the overall high risk of mortality, particularly if they present with AMI.

Risk Factors for Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma in the Thessaloniki Eye Study

To investigate risk factors for primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) in the Thessaloniki Eye Study. Cross-sectional, population-based study. Randomly selected subjects 60 years of age and older (n=2554) participated in the Thessaloniki Eye Study. Glaucomatous damage and presence of pseudoexfoliation (PEX) were defined according to specific criteria. Open-angle glaucoma (OAG) subjects were compared with nonglaucoma subjects (controls), POAG subjects were compared with controls without PEX, and PEXG subjects were compared with controls with PEX for demographic, lifestyle, ophthalmic, and systemic factors. Factors with P < .2 in the univariate analysis were retained for multivariate analyses. In multivariate analysis restricted to persons who participated in clinic visits and who had at least 1 phakic eye (n=2078), intraocular pressure (odds ratio [OR], 1.21 per 1 mm Hg; P<.001), PEX (OR, 2.81; P<.001), history of coronary artery bypass or vascular surgery (OR, 1.95; P=.017), and moderate-to-high myopia (≥ -3 diopters; OR, 2.40; P=.009) were associated with higher odds for OAG. In analysis including all clinic visits (n=2261), age became significantly associated (OR, 1.05; P=.004). In multivariate analysis for POAG (n=1840), associations were found for age (OR, 1.04 per year; P=.048), IOP (OR, 1.19 per 1 mm Hg; P<.001), history of coronary artery bypass or vascular surgery (OR, 2.09; P=.01), and history of diabetes treated with insulin (OR, 3.05; P=.045). In multivariate analysis for PEXG (n=238), the latter was associated with increased IOP (OR, 1.25 per 1 mm Hg; P<.001). IOP was the only factor associated with both POAG and PEXG, whereas moderate-to-high myopia showed borderline significance in both. Vascular systemic diseases and their treatment were associated only with POAG. The implications of these differences for the pathogenesis between the 2 common types of OAG should be explored further.

Perioperative antiplatelet therapy in patients at risk for coronary stent thrombosis undergoing noncardiac surgery

Sirs:Premature discontinuation of antiplatelet therapy is themost important predictor of thrombotic events after coro-nary stent implantation [5]. However, noncardiac surgeryoften requires the interruption of the standard dual-anti-platelet therapy using aspirin (75–100 mg/day) andclopidogrel (75 mg/day). Even though the problem for theperioperative management of these particular high-riskpatients has been addressed in guidelines, no clear rec-ommendation for high-risk patients is given in thoseguidelines [3, 10].Here we report on seven patients at high-risk for bothperioperative bleeding and stent thrombosis, respectively.In these patients the peri- and postoperative time interval ofthe interruption of dual-oral-antiplatelet therapy has beenbridged by using a short-acting intravenous GPIIb–IIIa-inhibitor. The demographic details are shown in Table 1.A3-month follow-up has been performed by telephoneinterview.Patient 1, a 71-year-old man, presented with a tibialimpression fracture after a car accident. He had a history ofcoronary artery bypass graft surgery plus a thrombarterec-tomyoftheleftcarotidarteryin2000.Whenhewasadmittedto the hospital for surgical tibial fracture realignment, thepatient developed an acute coronary syndrome (ACS). TheECGshowed anatrialfibrillation of90beatsperminutewithsignsofaformer inferiorwall myocardialinfarction(Qwave