post-CABG Patients Research Articles

Fractional flow reserve in saphenous vein grafts for the detection of myocardial ischemia determined by perfusion imaging

Abstract Background Fractional flow reserve (FFR) is recommended to guide revascularization of native coronary arteries. Revascularization decision-making for saphenous vein grafts (SVGs), however, is based on angiographic estimation of lesion severity, as studies exploring the value of FFR to detect perfusion imaging defined myocardial ischemia in SVGs are scarce. Purpose We aimed to define an optimal FFR threshold and compare its diagnostic performance with the traditional FFR cutoff and with percentage diameter stenosis (%DS) in patients evaluated for SVG disease using myocardial perfusion imaging (MPI) as the reference standard. Methods Symptomatic patients with prior coronary artery bypass grafting (CABG) who underwent single-photon emission computed tomography, positron emission tomography or stress perfusion cardiac magnetic resonance imaging, and had FFR measurements of one or more SVGs were included. Angiographic lesion severity of the SVG was measured using 2D quantitative invasive coronary angiography. We allocated and matched the myocardial territory subtended by the SVG to compare the values of FFR and %DS with ischemia determined by MPI. Results Included were 77 patients (mean age 72 ± 7 years; 86% male) with 91 SVGs. A total of 38 SVGs (42%) supplied an ischemic coronary territory. FFR and %DS correlated moderately (r= -0.51, P<0.001). The optimal cutoff value of FFR was ≤0.94, resulting in a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 63%, 75%, 65%, 74% and 70%, respectively (Figure 1). Corresponding values of FFR≤0.80 and DS%≥50 are shown in Figure 1 as well. Sensitivity, NPV and accuracy of FFR ≤0.94 outperformed that of FFR≤0.80, whereas specificity was lower. FFR≤0.94 outperformed %DS≥50 only in terms of sensitivity. Conclusions The optimal cutoff value of FFR for the detection of MPI-defined disease in SVGs is higher than the traditional FFR cutoff used to guide native coronary artery revascularization. Importantly, the increased sensitivity led to a higher diagnostic performance of the adjusted cutoff. However, the high prevalence of ischemia in post-CABG patients questions whether the optimal cutoff reflects ischemia caused by SVG obstruction.Diagnostic performance of FFR and %DS

The Predictive Value of Pan-Immune-Inflammation Value for Saphenous Vein Graft Disease in Post-Coronary Artery Bypass Grafting Patients

Background: Coronary artery bypass grafting (CABG) remains the gold standard treatment for patients with significant coronary artery disease (CAD) and high-risk profiles for percutaneous coronary intervention. Despite the frequent use of saphenous vein grafts (SVGs) in CABG, their patency rates are lower than those of arterial grafts. Identifying noninvasive methods to determine SVG patency is crucial. Aims: This study investigates the relationship between a novel inflammation marker, pan-immune-inflammation value (PIV), and SVG patency in post-CABG patients. Methods: The study included 507 patients who underwent coronary angiography (CAG) due to clinical indications between 2016 and 2023. Patients who had undergone CABG at least one year prior with at least one SGV used were divided into two groups based on the presence or absence of SVG stenosis (SGVS). Results: Among the 507 patients, 244 had SVGS. Patients with SVGS exhibited higher levels of diabetes mellitus and inflammatory markers such as NLR, SII, CAR, and PIV. Multivariate analysis identified PIV as an independent predictor of SVGS. ROC analysis showed that a PIV cut-off value > 315.5 predicted SVGS with 75.8% sensitivity and 68.6% specificity. Conclusions: PIV, a simple and easily measurable marker, demonstrated strong predictive value for SVGS in post-CABG patients.

Factors predicting depression among persons post-coronary artery bypass graft surgery: A cross-sectional study in Thailand.

Coronary artery bypass graft (CABG) surgery is a highly effective coronary artery disease treatment, providing immediate relief and promising long-term benefits. However, it is a major procedure with significant risks, including the potential for depression. Many patients experience depression following CABG, which can negatively impact their overall recovery, affecting both physical and mental health. This study aimed to determine factors predicting depression in patients following CABG surgery. This cross-sectional study was conducted with data collected between January and April 2024. A total of 272 post-CABG patients from two super tertiary care hospitals in Bangkok, Thailand, were recruited through purposive sampling. All research instruments were validated and tested for reliability. Data were analyzed using multiple regression analysis. The study found that hope, optimism, illness perception, social support, and anxiety were correlated with depression (adjusted R² = 0.381), but these variables explained only 38.1% of the variance (p <0.05). Among these factors, anxiety (β = 0.311), optimism (β = 0.203), social support (β = -0.117), and illness perception (β = -0.143) were significant predictors (p <0.05), while hope was not a significant predictor. Thus, anxiety emerged as the most crucial predictor of depression in patients who have undergone CABG. Nurses play a vital role in preventing and managing depression in post-CABG patients. Screening for anxiety and addressing it can prevent depression, enhance social support, and improve outcomes. To develop effective nursing strategies, it is essential for nurses to assess anxiety and implement interventions that promote social support, optimism, and illness perception. These measures can improve care quality, reduce readmission rates, and enhance patients' overall quality of life.

Effects of an e-Media-Supported, Exercise-Based Phase II Cardiac Rehabilitation in Coronary Artery Bypass Grafting Surgery Patients: A Randomized Controlled Trial.

Background and objective Coronary artery bypass grafting (CABG) surgery patients undergo cardiac rehabilitation (CR) programs postoperatively to improve their course of recovery. The effectiveness of traditional CR programs is hampered by time constraints, financial burdens, transportation issues, and geographic restrictions. The coronavirus 2019 (COVID-19) pandemic and technological advances have led to the emergence of home-based CR programs using e-media, thereby improving accessibility. This study aimed to analyzethe effects of e-media-supported, exercise-based phase II CR in post-CABG patients. Methods A single assessor-blinded randomized controlled trial (RCT) was conducted at a tertiary care hospital to analyze the effectiveness of a validated e-media-supported, exercise-based phase II cardiac rehabilitation in CABG Patients. A total of 40 subjects were included in the study based on the inclusion and exclusion criteria. The subjects were then randomly assigned to two groups: the experimental group received e-media-supported exercise and the control group received routine care. The duration of the intervention was three months. The outcome measures used were functional capacity, left ventricular ejection fraction (LVEF), quality of life, and physical activity (PA).Statistical analysis was conducted using SPSS Statistics v. 22.0 (IBM Corp., Armonk, NY). Results After three months of intervention, the mean distance covered during the six-minute walk test (6MWT) showed a significant increase in both the control and experimental groups. The experimental group demonstrated a statistically significant improvement compared to the control group (p<0.001). Furthermore, the experimental group showed significant improvements in the rate of perceived exertion (RPE), LVEF, and World Health Organization Quality of Life Brief Version (WHOQOL-BREF)andGlobal Physical Activity Questionnaire (GPAQ) scores compared to the control group (all p<0.001). Conclusions Based on our findings, the e-media-supported, exercise-based phase II cardiac rehabilitation is feasible and safe, and significantly improved functional capacity and enhanced quality of life. The PA level of the experimental group was higher than controls at the 12-weekfollow-up after CABG.

The Age Factor in Cardiac Rehabilitation

Coronary artery disease (CAD) is a major global cause of death, and its risk increases with age. This study investigates the relationship between age, patient characteristics, and rehabilitation outcomes in the cardiac rehabilitation (CR) of CAD. A cross-sectional study analyzed 60 medical records of post-coronary artery bypass graft (CABG) or post-percutaneous coronary intervention (PCI) patients who underwent a 6-week CR program after a graded exercise test using the Modified Bruce Protocol. The CR consists of 90% male participants, with an average age of 59.25 ± 6.69 years and an overweight body mass index. CR increases metabolic equivalents in all subjects, while age has a weakly significant negative correlation with the result of CR, so it can be concluded that CR is advantageous for older post-CABG or post-PCI patients.

Fatigue and physical activity in post-CABG patients: the parallel mediation model of kinesiophobia and self-efficacy : a prospective multicentre and cross-sectional study in China

ObjectivesThe objective of this study was to investigate how kinesiophobia and self-efficacy explain the relationship between fatigue and physical activity (PA) in post-coronary artery bypass grafting (post-CABG) patients over the...

Exploring the Impact of Cardiac Rehabilitation Programs on Health-Related Quality of Life and Physiological Outcomes in Patients Post Coronary Artery Bypass Grafts: A Systematic Review.

This systematic review explores the impact of cardiac rehabilitation programs (CRPs) on health-related quality of life (HRQoL) and physiological outcomes post-coronary artery bypass graft (CABG) surgery. Acknowledging the increasing importance of CRPs in post-CABG care, the study emphasizes the need for a comprehensive evaluation of their effectiveness. The primary objective is to investigate how CRPs influence HRQoL and physiological outcomes in post-CABG patients, offering insights into the multifaceted impact of these rehabilitation programs. A systematic literature review approach was employed to identify relevant studies published between 2013 and 2023. Inclusion criteria encompassed clinical randomized trials and quasi-experimental studies, with a focus on CRP interventions and their impact on HRQoL and physiological parameters. The review reveals a diverse array of CRP approaches, including exercise training, home-based programs, and telemonitored interventions. Despite methodological variations, a consistent positive impact on HRQoL and physiological outcomes is observed across studies. Noteworthy interventions, such as those incorporating family caregivers, demonstrate holistic benefits. However, limitations include methodological variability and the exclusion of qualitative studies. This systematic review underscores the substantial positive impact of CRPs on HRQoL and physiological outcomes in post-CABG patients. The diverse approaches and consistent improvements across studies provide a robust foundation for healthcare practitioners and researchers. Future efforts should focus on standardizing CRP interventions and conducting well-designed trials to further enhance the evidence base, facilitating more targeted and effective rehabilitation strategies for CABG patients.

Association of Postoperative Atrial Fibrillation Duration after Coronary Artery Bypass Grafting with Poor Postoperative Outcomes.

Postoperative atrial fibrillation (POAF) has long been associated with poor perioperative outcomes after coronary artery bypass grafting (CABG). In this study, we aimed to investigate the effect of prolonged POAF durations on perioperative outcomes of CABG. This retrospective cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from January 2018 to September 2021. We compared patients with POAF durations 48 hours to patients with POAF durations 48 hours. Primary outcomes were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney injury (AKI), and significant gastrointestinal bleeding (GIB); secondary outcomes were postoperative length of stay (LOS) and intensive care unit (ICU) duration. Associations between primary outcomes and POAF duration were determined using logistic regression and restricted cubic spline analyses. Differences in baseline characteristics were controlled using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Out of 11,848 CABG patients, 3604 (30.4%) had POAF, while 1131 (31.4%) had it for a duration of 48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.47-6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42-3.99), and significant GIB (adjusted OR: 2.60, 95% CI: 1.38-5.03) were associated with POAF durations 48 hours; however, neither in-hospital mortality (adjusted OR: 1.60, 95% CI: 0.97-2.65) nor stroke (adjusted OR: 1.28, 95% CI: 0.71-2.34) was. These results remained even following PSM and IPTW analyses. POAF durations longer than 48 hours were independently associated with poorer perioperative recovery from CABG, with respect to the occurrence of ARF, AKI, and GIB, as well as a longer postoperative LOS and ICU duration. However, it was not associated with greater in-hospital mortality or stroke occurrence. All these findings suggest that postoperative monitoring of POAF and positive intervention after detection may be more helpful in optimizing post-CABG patient outcomes.

Heart Rate Variability and Coronary Artery Bypass Grafting: A Systematic Review.

Coronary artery bypass grafting (CABG) is a well-established surgical procedure used to treat significant coronary artery disease. Nevertheless, unfavorable cardiovascular events and complications, including cardiac arrhythmias may be observed in patients after CABG. Previous studies have revealed a relationship between risk of cardiac arrhythmias and abnormal heart rate variability (HRV), which reflects adverse alterations in cardiac autonomic functioning, that may occur in patients after a CABG procedure. The aim of this article was to provide a systematic review of the major research findings in this area. A literature search was carried out using PubMed, Cochrane, and Embase databases and relevant articles, published in English, were analyzed in detail. Studies performed so far have shown time depending changes in HRV after CABG. Time and frequency domain HRV decrease acutely after CABG but recover almost completely to pre-operative values by 6 months after surgery. Some preoperative clinical states such as: heart failure, type 2 diabetes mellitus and depression adversely affect post-CABG HRV. Finally, post-CABG cardiac rehabilitation appears to improve exercise capacity and speed up recovery of HRV. Generally, traditional time and frequency domain HRV parameters fail to predict complications post-CABG. Altered non-linear measures of HRV may identify subgroups of subjects at increased risk of potential complications, including atrial fibrillation post-CABG. However, data available currently does not appear to unequivocally support the hypothesis that early HRV assessment in post-CABG patients predicts long-term mortality.

Comparison of the Effects of Two Exercise Programs of High-intensity Interval Training and Moderate-intensity Continuous Training on Physiological Function of Heart Patients after Coronary Artery Bypass Graft Surgery

Background: Exercise-based cardiac rehabilitation(CR) programs increase physiological function. However, it’s not yet clear which feature of exercise is most effective in improving important physiological performance indicators in heart patients. Therefore, the aim of this study was to compare the effects of high-intensity interval training(HIT) and moderate-intensity continuous training(MCT) on metabolic equivalent of tasks(METs), submaximal myocardial oxygen consumption(MVO2submax), and heart rate recovery(HRR) of heart patients after coronary artery bypass graft(CABG) surgery. Methods: Twenty-four post-CABG patients (15 males and 9 females) with a mean age of 60.75±3.16 years and a mean body mass index (BMI) of 28.40±1.09 kg/m2 were randomly divided into three groups of HIT, MCT and control group (CG). The training groups (HIT and MCT) trained for eight-weeks, three-sessions per week, and 45minutes per session. The research variables (METs, MVO2submax and HRR) were measured and compared in two stages before and after eight-weeks of CR programs. Results: After eight-weeks of CR programs, patients in both training groups showed a significant improvement in METs, MVO2submax and HRR (P&lt;0.05), and the HIT group showed significantly greater improvement in METs (P=0.001) and HRR (P=0.001) compared to the MCT group, as well the MCT group showed a significantly more improvement in MVO2submax (P=0.001) than the HIT group. Also, no cardiovascular adverse events related to HIT or MCT occurred during the implementation of the study. Conclusion: According to the results of the present study, HIT seems to be more effective than MCT in improving METs and HRR of post-CABG patients, and is safe as well.

Construction and validation of risk prediction model for gastrointestinal bleeding in patients after coronary artery bypass grafting

This study aimed to develop a risk prediction model for gastrointestinal bleeding in patients after coronary artery bypass grafting (CABG) and assessed its accuracy. A retrospective analysis was conducted on 232 patients who underwent CABG under general anesthesia in our hospital between January 2022 and December 2022. The patients were divided into gastrointestinal bleeding (GIB) group (n = 52) and group without gastrointestinal bleeding (non-GIB) (n = 180). The independent risk factors for gastrointestinal bleeding in post-CABG patients were analyzed using χ2 test, t test and logistic multivariate regression analysis. A prediction model was established based on the identified risk factors. To verify the accuracy of the prediction model, a verification group of 161 patients who met the criteria was selected between January to June 2023, and the Bootstrap method was used for internal validation. The discrimination of the prediction model was evaluated using the area under the curve (AUC), where a higher AUC indicates a stronger discrimination effect of the model. The study developed a risk prediction model for gastrointestinal bleeding after CABG surgery. The model identified four independent risk factors: duration of stay in the intensive care unit (ICU) (OR 0.761), cardiopulmonary bypass time (OR 1.019), prolonged aortic occlusion time (OR 0.981) and re-operation for bleeding (OR 0.180). Based on these factors, an individualized risk prediction model was constructed. The C-index values of the modeling group and the verification group were 0.805 [95% CI (0.7303–0.8793)] and 0.785 [95% CI (0.6932–0.8766)], respectively, which indicated a good accuracy and discrimination of this model. The calibration and standard curves showed similar results, which further supported the accuracy of the risk prediction model. In conclusion, ICU time, cardiopulmonary bypass time, aortic occlusion time and re-operation for bleeding are identified as independent risk factors for gastrointestinal bleeding in patients after CABG. The risk prediction model developed in this study demonstrates strong predictive performance and provides valuable insights for clinical medical professionals in evaluating gastrointestinal complications in CABG patients.

The Effect of Holy Quran Audio Therapy on Depression and Anxiety Among Jordanian Patients Following CABG: A Randomized Control Trial

Background: The positive outcomes of the CABG procedure are affected by several factors, including the patient’s psychological status, measured by the level of depression and anxiety. The prevalence of depressive symptoms among Jordanian post-CABG patients is high. However, clinicians do not consider anxiety and depression and their impacts in the daily screenings. The effects of non-pharmacological interventions ( i.e. Holy Quran Audio Therapy and Music Therapy) on anxiety and depression have been investigated in some cardiac populations, although no single study was designed specifically to investigate the effect of Holy Quran Audio Therapy on anxiety and depression post-CABG. Objective: To examine the effect of Holy Quran audio therapy on anxiety and depression among Arabic-speaking post-CABG patients. Materials and Methods: A randomized controlled trial was conducted among 165 post-CABG ICU patients at four major hospitals in (in Amman), (Jordan). They were randomly distributed into control (N = 83) and intervention (N = 82) groups. The intervention group received Holy Quran audio therapy on two days (typically the second and third days after CABG, when patients were alert and not intubated). The therapy session was of ten minutes duration, with four hours in between sessions. Depression and anxiety were measured at baseline and follow-up using the Depression Anxiety Stress Scale. Independent and paired t-tests were used for data analysis. Results: Holy Quran audio therapy was linked to statistically significant positive effects. In which Intervention group of patients displaying lower mean depression and anxiety levels compared to the control group (M [SD]; 8.82 [6.35] vs. 13.38 [5.52]) (M [SD]; 6.26 [1.59] vs. 7.48 [3.44], respectively). Implications for Nursing: Holy Quran audio therapy is a non-invasively and non-pharmacologically intervention that might be used to decrease depression and anxiety. Conclusion: Holy Quran audio therapy significantly improved post-CABG patients’ anxiety and depression and is recommended for Muslim patients to improve their psychological status. Registration Number: The clinical trial studies have the registration number NCT 05419554.

Multi-slice CT coronary angiography versus invasive coronary angiography in the assessment of graft patency after coronary artery bypasses graft surgery

BackgroundThe long-term patency of arterial and venous grafts is crucial for the success of CABG. This study was designed to investigate graft patency using 128-slice coronary computed tomography angiography (CCTA) and compared the results with those obtained using invasive coronary angiography (ICA). In this observational cross-sectional study, we included 40 symptomatic post-CABG patients underwent CCTA and ICA within the same month.ResultsFifty-five percent were aged more than 60 years, and 80% were males. 67.5% had diabetes, 90% had hypertension, and 30% were smokers. Mean body mass index was 28.89 ± 5.17 kg/m2. Mean duration since CABG was 5.25 ± 4.04 years. In total, 124 native vessels and 97 grafts were assessed using CCTA and ICA. CCTA delineated 8 non-cannulated venous grafts and 6 non-cannulated left internal mammary artery grafts. CCTA required a significantly lower radiation dose (1165.77 ± 123.54 vs. 47,589.78 ± 6967.53, p < 0.001).ConclusionCCTA can be as accurate as ICA in assessing bypass grafts with less radiation dose, providing a non-invasive reliable tool for evaluation.

Successful recognition and management of life-threatening multivessel coronary artery vasospasm after conventional coronary artery bypass grafting.

Background: The occurrence of native coronary artery vasospasm after coronary artery bypass grafting (CABG) is a rare phenomenon with potentially catastrophic outcomes. The absence of a clear understanding of contributing factors and an undetermined occurrence rate underscores the importance of coronary angiography as the primary diagnostic tool for this condition. Case Presentation: We present the case of a 70-year-old Asian male with a 14-year history of diabetes mellitus, seven years of Giant Cell Arteritis (GCA), and Ischemic Heart Disease (IHD). The patient experienced severe native coronary artery vasospasm following conventional CABG, prompting intervention through coronary angiography. Management &amp; Results: The patient underwent coronary angiography, revealing multivessel coronary artery vasospasm. Intracoronary administration of nitroglycerin and diltiazem was initiated promptly. The swift identification and treatment of vasospasm were instrumental in preventing severe myocardial injury. Conclusion: Coronary artery vasospasm post-CABG poses a significant threat, emphasizing the need for early identification and intervention. The successful management presented in this case underscores the importance of timely recognition and the administration of vasodilators in mitigating potential myocardial damage. This report contributes to the growing understanding of this rare but critical complication, highlighting the necessity for vigilance in post-CABG patient care.

Impact of Oral Anticoagulation on Clinical Outcomes in Postoperative Atrial Fibrillation

IntroductionThe impact of postoperative oral anticoagulation (OAC) with warfarin on postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) was the focus of this examination of patients from the randomized endo-vein graft prospective (REGROUP) Trial. Material and methodsREGROUP was a prospective randomized Veterans Affairs cooperative study comparing endoscopic versus open vein harvest in elective CABG patients (March 2014-April 2017) at 16 Veterans Affairs facilities. This study compared new-onset POAF patients who were treated with warfarin versus no-warfarin. Outcomes included stroke during active follow-up and a major adverse cardiac event composite of mortality, acute myocardial infarction, and repeat revascularization during active and passive follow-up. ResultsOf the 316/1103 (28.6%) of REGROUP patients who developed new-onset POAF, 45 patients were excluded - mainly for preoperative warfarin use. Of the remaining 269 patients, 85 received OAC with warfarin (OAC group); 184 did not (no-OAC group). Stroke rates during active follow-up (32 [IQR 24-38] mo) were 3.5% OAC group versus 5.4% no-OAC group (P = 0.76); major adverse cardiac eventrates were 20% OAC versus 11.4% no-OAC (P = 0.06). On longer follow-up of (median 4.61 [IQR 3.9-5.1] y), discharge OAC use was associated with all-cause mortality after adjusting for Society of Thoracic Surgeons mortality risk (20.0% versus 11.4% no-OAC use; HR = 2.00, 95% CI: 1.05-3.81, P = 0.035). ConclusionsREGROUP patients with POAF treated with OAC had similar stroke and higher mortality rates versus no-OAC patients. Further investigation of the risk-benefit ratio of OAC in post-CABG patients and which POAF patient subgroups might derive the most benefit with anticoagulation appears warranted.

Acute Occlusion of a “Protected” Left Main Coronary Artery Manifesting as an Acute Coronary Syndrome with Heart Failure: How much Protected it is?

Despite the progress made in technological advancements, the utilization of stenting for both protected and unprotected left main coronary artery (LMCA) disease remains associated with elevated rates of long-term mortality and significant adverse clinical events, sometimes manifesting as cardiogenic shock. A considerable number of individuals retain the opportunity to receive catheter-based interventional therapy as a viable substitute for re-operative coronary artery bypass grafting (CABG). Despite the changed appearance, patients with acute blockage of the protected LMCA still have major adverse cardiac events (MACE) at a similar rate. Acute occlusion of the unprotected LMCA as an acute coronary syndrome (ACS) is uncommon, but that of the protected LMCA is relatively rare. We present a case of a post-CABG patient who developed ACS as a posterior wall myocardial infarction and acute left ventricular failure due to obstruction of a protected LMCA with substantial stenosis across its distal segment extending to the left circumflex (LCx) artery. The pharmaco-invasive management of the protected LMCA thrombotic occlusion with primary percutaneous coronary intervention resulted in significant patient improvement. These lesions are amenable to complex and high-risk coronary intervention with current technology, and the results have been quite encouraging in terms of long-term survival.

Agreement of continuous non-invasive arterial blood pressure monitoring (CNAP) and pulmonary artery catheter thermodilution method in estimating the hemodynamic parameters of post CABG patients

Abstract Background The use of hemodynamic parameters in monitoring patients after coronary artery bypass surgery is an essential element of clinical practice. It helps intensivist and physicians to properly manage patients after surgery where hemodynamic parameters are usually dynamic and complicated. Pulmonary artery guided thermodilution (PACT) has been the gold standard in assessing the adequacy of cardiac output, however, its invasive nature is also associated with more complex procedures and the risk of complications, including infections. With the emergence of new non-invasive hemodynamic monitoring devices such as the CNAP (continuous non-invasive arterial pressure), alternative methods for hemodynamic monitoring is now possible. Compared to invasive methods, it is easier to use with an error-free application, safer, less risk of infection and more cost effective. Purpose To determine the agreement of Continuous non-invasive arterial pressure (CNAP) and pulmonary artery guided thermodilution in monitoring the hemodynamic parameters of patients who underwent coronary artery bypass graft surgery. Methods This is a cross-sectional study conducted at the cardiovascular surgical intensive care unit and included 63 patients with Coronary artery disease who underwent elective coronary artery bypass graft surgery. Cardiac output, Cardiac Index, Stroke volume and Systemic vascular resistance were simultaneously obtained using both the CNAP and PACT. Three consecutive sets of measurements were recorded for each patient with a 3 hour interval; during arrival at the ICU, 3 hours post op, and 6 hours post op. Results The mean difference between PACT-CO and CNAP-CO was -0.81 L/min (SD -1.18 to -0.44) with a 95% limits of agreement of -3.74 to 2.11 L/min on the 0 hour, -0.81L/min (SD -1.22 to -0.41) with a 95% limits of agreement of -1.98 to 1.18 L/min on the 3rd hour, and -0.77L/min (SD -1.08 to -0.46) with a 95% limits of agreement of -3.22 to 1.68 L/min on the 6th hour post op. The results showed a significant difference between the PACT and CNAP. However, a positive correlation was noted between PACT-CO and CNAP-CO, the correlation coefficient on the 0, 3rd and 6th hour were 0.5384, 0.5158, and 0.6265 respectively. Conclusion CNAP derived hemodynamic parameters had a high mean difference compared to the PACT and there was no agreement between the two methods. However, it was able to have a positive correlation with the PACT, making it possible for the CNAP to track the hemodynamic changes during the post operative course.

Simplified bedside nomogram for predicting long-term mortality and major adverse cardio-cerebrovascular events following on-pump coronary artery bypass graft

Abstract Background When facing patients asking their physicians how their risk of mortality and morbidities will be in the distant future after their cardiac surgery, the lack of predictive models on long-term outcomes is noticed in the clinical practice. Current risk scores, such as the Society of Thoracic Surgeons (STS) and the European System for Cardiac Operative Risk Evaluation (EURO-Score), were designed to predict short-term mortality and need modifications to be used for long-term mortality. Furthermore, these scores involve several factors that might increase the prediction models' complexity. Simplified bedside-friendly models can overcome these complications and render the predictive model more feasible to be used by clinicians. Purpose This study aimed to determine predictors of in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE) among patients undergoing on-pump coronary artery bypass graft (CABG). Subsequently, we aimed to design a simplified bedside nomogram for each of the outcomes using pre-operative predictors. Methods From 2007 to 2017, this single-center, retrospective cohort included 22846 post-CABG patients. Predictors of in-hospital mortality and long-term outcomes were identified using logistic and Cox regression models, respectively. Subsequently, nomograms were established using pre-operative predictors based on parametric survival regression (multiple Weibull models) coefficient. Model performance was measured using the area under the curve (AUC), Harrell’s concordance index (C-index), and calibration curves. Results The study population aged 65.06±9.95 years (74% males). During a median follow-up of 96.85 [70.12-121.17] months, 249 in-hospital mortality, 4172 all-cause mortality, and 7508 MACCEs occurred. Predictors of each study outcome are demonstrated in Figure 1. In-hospital mortality nomogram included glomerular filtration rate (GFR) ≤60, hypertension, valvular heart disease, age, and diabetes (Figure 2) and demonstrated acceptable discrimination ability (AUC: 0.74, 95% confidence interval (CI): 0.70-0.77). Variables in all-cause mortality and MACCE nomograms were consistent, comprising age, heart failure with reduced ejection fraction, GFR≤60, and diabetes (Figure 2). The C-index for all-cause mortality and MACCE prediction was 0.71 (95%CI: 0.70-0.73) and 0.69 (95%CI: 0.68-0.72), respectively. Furthermore, visual assessment of calibration curves indicated good prognostic predictive accuracy for all the three nomograms. Conclusions The designed simplified nomograms had acceptable internal (according to C-index) and external (according to calibration curves) validity for predicting post-CABG in-hospital mortality, all-cause mortality, and MACCE. These nomograms could be implemented in the routine cardiovascular practice after validating in other centers.

The effect of resistance training on PCSK9 levels in patients undergoing cardiac rehabilitation after coronary artery bypass grafting: a randomized study

BackgroundResistance training is commonly recommended as part of secondary prevention for post-coronary artery bypass graft (CABG) patients in conjunction with aerobic exercise. Despite its potential benefits, there is currently a lack of studies investigating the impact of resistance training on proprotein convertase subtilisin kexin 9 (PCSK9).AimTo evaluate the effect of intensive resistance training on proprotein convertase subtilisin kexin 9 (PCSK9) levels among post-CABG patients undergoing cardiac rehabilitation (CR).MethodsIn this prospective, open-label, randomized trial, 87 post-coronary artery bypass graft (CABG) patients were randomly assigned into two groups: moderate to high intensity resistance training and aerobic training (n = 44) or aerobic training alone (n = 43) for a total of 12 sessions. Changes in PCSK9 levels was determined as a primary endpoint, while secondary endpoints included changes in the six-minute walk test (6-MWT) results, aerobic capacity, WHO-5 well-being index, fasting blood glucose, and lipid profile. Both groups underwent intention-to-treat analysis.ResultsFollowing completion of cardiac rehabilitation program, the intervention group demonstrated a significant decrease in mean PCSK9 levels when compared to the control group (β = -55 ng/ml, 95% CI -6.7 to -103.3, p = 0.026), as well as significant improvements in the 6-MWT result (β = 28.2 m, 95% CI 2.4–53.9, p = 0.033), aerobic capacity (β = 0.9 Mets, 95% CI 0.1–1.7, p = 0.021), and WHO-5 well-being index (β = 8.1, 95% CI 2.0–14.4, p = 0.011) in patients who received resistance and aerobic training. No statistically significant changes were observed in fasting blood glucose, cholesterol, LDL-C, HDL-C, and triglyceride levels.ConclusionResistance training in CR significantly reduced PCSK­9 levels and increases patient’s functional capacity and quality of life. (NCT02674659 04/02/2016).

Abstract 12010: Duration of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery is Associated With Poor Perioperative Outcomes

Background: Postoperative atrial fibrillation (POAF) is one of the most common complications after coronary artery bypass graft surgery (CABG). It has long been associated with poor perioperative outcomes, but few studies have been carried out regarding the effect of POAF duration on those outcomes. Research Questions: Does prolonged duration of POAF have an adverse effect on perioperative outcomes of CABG? Methods: This retrospective cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from January 2018 to September 2021. We compared POAF duration ≥48 hours patients with POAF duration &lt;48 hours patients. Primary outcomes examined were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney injury (AKI), as well as significant gastrointestinal bleeding (GIB); secondary outcomes were postoperative length of stay (LOS), intensive care unit (ICU) stay. Associations between primary outcomes and POAF duration were determined using logistic regression and restricted cubic spline analyses. Results: Out of 11 848 CABG patients, 3604 (30.4%) had POAF; 1131 (31.4%) of POAF patients had it for duration ≥48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.47 - 6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42 - 3.99), and significant GIB (adjusted OR: 2.60, 95% CI: 1.38 - 5.03), but not in-hospital mortality (adjusted OR: 1.56, 95% CI: 0.92 - 2.65) or stroke (adjusted OR: 1.29, 95% CI: 0.70 - 2.33) was associated with POAF duration ≥48 hours. These findings were still applicable, even after conducting propensity score matching and inverse probability of treatment weighting analyses. Conclusions: POAF duration longer than 48 hours was independently associated with poorer perioperative recovery from CABG, with respect to the occurance of AFR, AKI and GIB, as well as longer postoperative LOS and ICU stay. However, it was not associated with greater in-hospital mortality or stroke occurrence. All these findings suggest that postoperative monitoring of POAF and positive intervention after detection could optimize post-CABG patient outcomes.