1.Comparison on short-term safety outcomes between off-pump and on-pump coronary artery bypass grafting by experienced surgeons: a single center study with 31 075 cases.
Zhan HU ; Xin YUAN ; Si Peng CHEN ; Yun Hu SONG ; Wei WANG ; Shui Yun WANG ; Li Qing WANG ; Wei FENG ; Sheng LIU ; Han Song SUN
Chinese Journal of Cardiology 2021;49(2):158-164
Objective: To compare the short-term outcomes between off-pump and on-pump coronary artery bypass graft (CABG) by experienced surgeons with similar surgical team in a single large-volume cardiac surgery center. Methods: A total of 31 075 patients with multivessel coronary disease who underwent isolated off-pump or on-pump CABG between January 1, 2009 and December 31, 2019 by experienced surgeons in Fuwai hospital were enrolled in this retrospective study. Patients was divided into on-pump CABG group and on-pump CABG group on an intention-to treat basis. Short term safety endpoints, including 30 days mortality, composite endpoint of major morbidity or mortality, prolonged postoperative length of stay (PLOS), and prolonged ICU length of stay (PICULOS), and distal anastomosis were compared between the two groups. Mortality was evaluated on 30 days post operation, other endpoints were collected before discharge. After 1∶1 propensity-score matching of baseline characteristics for on-pump and off-pump CABG, postoperative endpoints were compared with use of McNemar's test and further adjusted with the use of a logistic regression model. Results: After propensity-score matching, 10 243 matched pairs of patients were included in the final analysis, there were 4 605(22.5%) females and mean age was (60.7±8.6) years. The standardized differences were less than 5% for all baseline variables in matched cohort. Univariate analysis indicated lower risk of 30 days mortality (0.2% vs. 0.7%, P<0.001), major morbidity or mortality (5.7% vs. 8.8%, P<0.001), PLOS (3.2% vs. 4.9%, P<0.001), PICULOS (9.4% vs. 12.2, P<0.001), and lower number of distal anastomosis ((3.3±0.8) vs. (3.6±0.8), P<0.001) in off-pump CABG group than in on-pump CABG group. After adjustment of cofounders, multivariate analysis showed that off-pump CABG was still associated with a lower risk of 30 days mortality (OR=0.29, 95%CI: 0.09-0.87, P=0.027), composite endpoint of major morbidity or mortality (OR=0.60, 95%CI: 0.53-0.68, P<0.001), PLOS (OR=0.64, 95%CI 0.54-0.75, P<0.001), PICULOS (OR=0.76, 95%CI: 0.69-0.84, P<0.001). Conclusions: Off-pump CABG is related with superior short-term safety outcomes than on-pump CABG by experienced surgeons in our center.
Aged
;
Coronary Artery Bypass
;
Coronary Artery Bypass, Off-Pump
;
Coronary Artery Disease/surgery*
;
Female
;
Humans
;
Middle Aged
;
Postoperative Complications/epidemiology*
;
Retrospective Studies
;
Surgeons
;
Treatment Outcome
2.Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis.
Eun Jeong CHO ; Sung-Ji PARK ; Sung-A CHANG ; Dong Seop JEONG ; Sang-Chol LEE ; Seung Woo PARK ; Pyo Won PARK
Chinese Medical Journal 2014;127(22):3963-3969
BACKGROUNDAngina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS), even in patients without significant coronary artery disease (CAD). However, the incidence of angina pectoris and related CAD in such patients is controversial. There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS. The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.
METHODSData from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995. Clinical and echocardiographic follow-up data were recorded into the database annually. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.
RESULTSTotally 574 patients with severe AS (mean age, (65.9±9.6) years) were enrolled in this study. Significant CAD was found in 61 patients (10.6%). Factors associated with increased likelihood of CAD were age, hypertension, diabetes mellitus, chronic renal failure, carotid disease, and aorta calcification. In Logistic regression analysis, the independent predictor of the presence of CAD was age (P = 0.011). The incidence of CAD increased significantly at 69.2 years of age. Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.
CONCLUSIONSThere was a low incidence of significant CAD in a population of Korean patients with severe AS. Therefore, coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.
Aged ; Angina Pectoris ; diagnosis ; epidemiology ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; epidemiology ; surgery ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; epidemiology ; Echocardiography ; Humans ; Incidence ; Middle Aged
3.Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion.
Jing-Jing GAI ; Lu-Yue GAI ; Xue ZHAI ; Kai-Yi ZHANG ; Qin-Hua JIN ; Yun-Dai CHEN
Journal of Southern Medical University 2015;35(10):1380-1383
OBJECTIVETo compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).
METHODSThe patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.
RESULTSA total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).
CONCLUSIONOur study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.
Chronic Disease ; Cohort Studies ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Occlusion ; surgery ; therapy ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Stroke ; epidemiology ; Treatment Outcome
4.Impact of femoral or radial approach on acute renal injury induced by repeated contrast medium in patients with coronary heart disease.
Peng LI ; Yi KANG ; Zhao Feng WANG ; Chong Huai GU ; Guan Nan AI ; Yi Fei LIU ; Pei XU ; Xiao Zeng WANG ; Xin ZHAO ; Ya Ling HAN
Chinese Journal of Cardiology 2020;48(12):1053-1059
Objective: To investigate the effects of femoral approach versus radial approach on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with coronary heart disease, who received twice contrast agents within a short interval. Methods: A total of 322 patients with coronary heart disease, who admitted to the General Hospital of Northern Theater Command from January 2010 to January 2015, were included in this retrospective analysis. All patients exposed to contrast agents twice within 30 days. The patients were divided into two groups according to the approach of interventional operation: radial artery group (n=235) and femoral artery group (n=87). Serum creatinine (SCr) values were detected at 48 and 72 hours post procedure. Endpoint events were CI-AKI, which was defined as SCr increased>0.5 mg/dl (44.2 μmol/L) or relative ratio ((postoperative SCr-preoperative SCr)/preoperative SCr×100%>25%) within 72 hours after contrast agent use after excluding other causes. Clinical characteristics and the incidence of CI-AKI were compared between the two groups, multivariate logistic regression analysis was used to detect the risk factors of postoperative CI-AKI in these patients. Results: The proportion of smoking, PCI history, STEMI patients and levels of fibrinogen, fasting blood glucose, troponin T was significantly higher in femoral artery group than in radial artery group (all P<0.05). The interval between two procedure sessions was significantly longer in the femoral artery group than in the radial artery group (P=0.001). The incidence of CI-AKI tended to be higher in femoral artery group than in radial artery group after the first operation (18.6% (16/87) vs. 11.9% (28/235), P=0.133). CI-AKI incidence after the second operation was similar between the two groups (P>0.05). Multivariate logistic regression analysis showed that interventional approach was not an independent risk factor for postoperative CI-AKI in patients with coronary heart disease undergoing interventional procedures twice within 30 days (P>0.05);STEMI (OR=2.854, 95%CI 1.100-7.404, P=0.031) and diuretics use (OR=4.002, 95%CI 1.470-10.893, P=0.007) were independent risk factors for CI-AKI after the first operation. Conclusion: There is no correlation between the risk of CI-AKI and interventional approaches in patients with coronary heart disease who undergo interventional surgery twice within 30 days.
Acute Kidney Injury/epidemiology*
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Contrast Media/adverse effects*
;
Coronary Disease
;
Femoral Artery/surgery*
;
Humans
;
Incidence
;
Percutaneous Coronary Intervention/adverse effects*
;
Radial Artery
;
Retrospective Studies
;
Risk Factors
5.Correlates of the Severity of Coronary Atherosclerosis in Long-term Kidney Transplant Patients.
Hyun Wook KIM ; Shin Wook KANG ; Ho Yung LEE ; Dong Hoon CHOI ; Won Heum SHIM ; Soon Il KIM ; Yu Seun KIM ; Kyu Hun CHOI
Journal of Korean Medical Science 2010;25(5):706-711
Coronary artery disease remains the leading cause of early death and graft loss in renal transplant patients. The aim of this study was to identify clinical and echocardiographic parameters independently associated with the angiographically-determined severity of coronary atherosclerosis in long-term kidney transplant patients. Fifty-two kidney transplant recipients who underwent elective coronary angiography were reviewed retrospectively. Angiographic severity was evaluated using the modified Gensini index (MGI). The mean age at coronary angiography was 52.5+/-7.9 yr with a mean prior transplant duration of 118.1+/-58.8 months. Pearson correlation analysis demonstrated a positive correlation of MGI with transplant duration before coronary angiography and chronic allograft nephropathy, whereas an inverse correlation was demonstrated with ejection fraction and statin use. On subsequent multivariate linear regression analysis, transplant duration before coronary angiography, statin use, and ejection fraction were independently associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. In summary, our study demonstrates that statin use, ejection fraction, and transplant duration before coronary angiography are independent parameters associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. Further investigation is required to reduce the atherosclerotic burden in kidney transplant patients.
Adult
;
Comorbidity
;
Coronary Artery Disease/*diagnosis/*epidemiology
;
Female
;
Humans
;
Incidence
;
Kidney Transplantation/*statistics & numerical data
;
Korea/epidemiology
;
Male
;
Renal Insufficiency/*epidemiology/*surgery
;
Risk Assessment
;
Risk Factors
;
Statistics as Topic
6.Common factors for ischemic cerebral stroke in coronary artery bypass grafting in patients with concomitant carotid and coronary artery severe stenosis.
Lei HUANG ; Feng KUANG ; Zhonggui SHAN ; Yiquan LAI ; Hongwei GUO
Journal of Central South University(Medical Sciences) 2016;41(12):1340-1344
To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases. The surgical outcomes and follow-up results were analyzed retrospectively.
Results: One patient received carotid endarterectomy suffered hemiplegia, whose symptoms were improved after positive clinical treatment. One patient suffered transient ischemic attack, and 5 patients displayed the cerebrovascular syndromes a week later after surgery. Twelve patients suffered nerve function damage 48 hours later after surgery. Nine patients received intra-aortic ballon pump, 1 patient received thoracotomy hemostasis, 3 patients suffered sternal dehiscence; 27 patients showed atrial fibrillation. Two patients died after surgery. The follow-up duration ranged from 1-7 years and the follow-up rate was 90%. The ischemic symptoms were improved in 44 patients. Six patients complained the recurrence of angina, but no abnormalities were found in coronary angiography or computed tomography angiography. One patient died of malignant tumor during the follow-up duration.
Conclusion: For patients with concomitant carotid and coronary artery severe stenosis, it is more likely to suffer ischemic cerebral stroke. However, carotid stenosis is not the only factor, other key factors relevant to ischemic cerebral stroke shouldn't be ignored either.
Atrial Fibrillation
;
epidemiology
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Blood Loss, Surgical
;
statistics & numerical data
;
Carotid Stenosis
;
complications
;
surgery
;
Cerebrovascular Disorders
;
epidemiology
;
Comorbidity
;
Constriction, Pathologic
;
Coronary Angiography
;
Coronary Artery Bypass
;
adverse effects
;
mortality
;
Coronary Artery Disease
;
complications
;
surgery
;
Coronary Stenosis
;
complications
;
surgery
;
Endarterectomy, Carotid
;
adverse effects
;
Female
;
Hemiplegia
;
epidemiology
;
Humans
;
Intra-Aortic Balloon Pumping
;
adverse effects
;
Intraoperative Complications
;
epidemiology
;
Ischemic Attack, Transient
;
epidemiology
;
Male
;
Nervous System Diseases
;
Peripheral Nerve Injuries
;
epidemiology
;
Postoperative Complications
;
epidemiology
;
Retrospective Studies
;
Risk Assessment
;
Risk Factors
;
Stroke
;
epidemiology
;
Surgical Wound Dehiscence
;
epidemiology
;
Thoracotomy
;
adverse effects
7.Changes in the Practice of Coronary Revascularization between 2006 and 2010 in the Republic of Korea.
Yoon Jung CHOI ; Jin Bae KIM ; Su Jin CHO ; Jaelim CHO ; Jungwoo SOHN ; Seong Kyung CHO ; Kyoung Hwa HA ; Changsoo KIM
Yonsei Medical Journal 2015;56(4):895-903
PURPOSE: Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization. MATERIALS AND METHODS: Revascularization and in-hospital mortality among Koreans > or =20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100000 person-years was calculated directly from the distribution of the 2008 Korean population. RESULTS: The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals. CONCLUSION: The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.
Adult
;
Aged
;
Aged, 80 and over
;
Coronary Artery Bypass/*statistics & numerical data/trends
;
Coronary Artery Disease/*surgery
;
Drug-Eluting Stents
;
Female
;
Hospital Mortality
;
Humans
;
Male
;
Middle Aged
;
Myocardial Revascularization/*methods/*trends
;
Percutaneous Coronary Intervention/*statistics & numerical data/trends
;
Republic of Korea/epidemiology
8.2015 Young Surgeon's Award Winner: Long-term Prognosis in Patients with Diabetes Mellitus after Coronary Artery Bypass Grafting: A Propensity-Matched Study.
Philip Yk PANG ; Yeong Phang LIM ; Kim Kiat ONG ; Yeow Leng CHUA ; Yoong Kong SIN
Annals of the Academy of Medicine, Singapore 2016;45(3):83-90
INTRODUCTIONWe aimed to determine the impact of diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease.
MATERIALS AND METHODSA retrospective review was conducted for 5720 consecutive patients who underwent isolated first CABG between 1982 and 1999. Outcomes were reviewed to include in-hospital mortality and long-term survival. Mean follow-up was 13.0 ± 5.8 years. To obtain comparable subgroups, 561 diabetic patients were matched with 561 non-diabetic controls based on estimated propensity scores.
RESULTSMean age was 59.3 ± 9.1 years with 4373 (76.5%) males. Amongst 5720 patients, 1977 (34.6%) had DM. Hypertension and dyslipidaemia were the most common cardiovascular comorbidities, present in 2920 (51.0%) and 2664 patients (46.6%) respectively. Emergency surgery was performed in 563 patients (9.8%). In-patient mortality occurred in 115 patients (2.0%), 48 (2.4%) in the DM group and 67 (1.8%) in the non-DM group, (P = 0.102). In the unmatched cohort, overall 20-year survival rates were 30.9 ± 1.6% in diabetics and 49.2 ± 1.0% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 56.0 ± 2.0% in diabetics and 68.4 ± 1.0% in non-diabetics (P <0.001). In the propensity-matched group, overall 20-year survival rates were 35.4 ± 2.5% in diabetics and 48.9 ± 2.9% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 57.8 ± 3.0% in diabetics and 70.2 ± 2.9% in non-diabetics (P = 0.001). Multivariable Cox regression analysis identified age (hazard ratio (HR): 1.03/year), female gender (HR: 1.43), DM (HR: 1.51), previous myocardial infarction (HR: 1.54) and left ventricular ejection fraction (LVEF) <35% (HR: 2.60) as independent factors influencing long-term cardiac mortality.
CONCLUSIONDespite low operative mortality, long-term survival and freedom from cardiac death are significantly lower in patients with DM compared to non-diabetics. Aggressive treatment of DM, cardiovascular comorbidities and smoking cessation are essential to improve long-term survival in diabetic patients.
Age Factors ; Aged ; Awards and Prizes ; Case-Control Studies ; Comorbidity ; Coronary Artery Bypass ; Coronary Artery Disease ; epidemiology ; surgery ; Diabetes Mellitus ; epidemiology ; Dyslipidemias ; epidemiology ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Hypertension ; epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; epidemiology ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Retrospective Studies ; Sex Factors ; Singapore ; epidemiology ; Stroke Volume
9.Severe coronary artery disease in Chinese patients with abdominal aortic aneurysm: prevalence and impact on operative mortality.
Tao SUN ; Yu-tong CHENG ; Hong-ju ZHANG ; Shun-hua CHEN ; Dong-hua ZHANG ; Ji HUANG ; Jing-mei ZHANG ; Zhi-zhong LI
Chinese Medical Journal 2012;125(6):1030-1034
BACKGROUNDLittle is known about the prognosis of coronary artery disease (CAD) in Chinese patients with abdominal aortic aneurysm (AAA). The aim of this study was to evaluate the predictors of in-hospital all-cause mortality of severe CAD in Chinese patients who were hospitalized for AAAs.
METHODSFrom January 2003 to August 2009, 368 patients were operated on for AAAs. The clinical characteristics were retrospectively collected. The primary outcome was the in-hospital all-cause mortality. The clinical risk factors were subjected to a multivariate analysis to determine the predictors of in-hospital all-cause mortality.
RESULTSDuring their hospitalization, 23% (85/368) of the patients underwent coronary angiography, which revealed significant lesions in 93% (79/85) of the patients. In 25 cases, coronary artery bypass grafting (CABG) was performed before the AAA repair and in 16 cases of percutaneous coronary intervention (PCI) was performed. Ten patients with AAA alone died before discharge, and eight patients diagnosed with AAA combined with CAD died. There was no statistical difference in the postoperative death between the two groups. The logistic analysis showed that age > 70 years and CAD (vessels ≥ 2) were the significant factors in predicting the adverse clinical outcome.
CONCLUSIONSThe prevalence of severe CAD in Chinese patients with AAAs seemed lower than those that were reported. Myocardial evaluation and subsequent revascularization before AAA surgery could improve the clinical outcome for these patients who have severe CAD.
Adult ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; complications ; mortality ; surgery ; China ; epidemiology ; Coronary Artery Disease ; epidemiology ; mortality ; surgery ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Retrospective Studies
10.Does Bilateral Pedicle Internal Thoracic Artery Harvest Increase the Risk of Mediastinitis?.
Suk Jung CHOO ; Sang Kwon LEE ; Sung Woon CHUNG ; Jong Won KIM ; Si Chan SUNG ; Young Dae KIM ; Mi Ju BAE ; June Hong KIM ; Kook Jin CHON ; Han Cheol LEE
Yonsei Medical Journal 2009;50(1):78-82
PURPOSE: Bilateral in situ internal thoracic artery (ITA) bypassing may result in excellent myocardial revascularization without increasing the risk of deep sternal wound infection. Although there have been concerns with the use of pedicled bilateral ITA, the risk of infection may not be greater than the use of skeletonized ITA. MATERIALS AND METHODS: The present study was retrospectively undertaken to determine if pedicled BITA grafts are associated with a higher risk of sternal wound complications. A total of 207 patients who underwent bilateral ITA bypasses with or without existing diabetes mellitus, and 162 patients of those received bilateral pedicled ITA and 98 patients received unilateral ITA bypass grafts. RESULTS: No sternal wound complications were noted in either the bilateral ITA or unilateral left ITA groups. CONCLUSION: Bilateral pedicled ITA harvesting was not associated with a greater incidence of infectious sternal complications compared to patients receiving unilateral ITA bypass grafts.
Aged
;
Coronary Artery Disease/epidemiology/*surgery
;
Diabetes Mellitus/epidemiology
;
Female
;
Humans
;
*Internal Mammary-Coronary Artery Anastomosis/statistics & numerical data
;
Male
;
Mammary Arteries/*transplantation
;
Mediastinitis/*epidemiology
;
Middle Aged
;
Retrospective Studies
;
Risk Factors
;
Sternum
;
Surgical Wound Infection/epidemiology
;
Tissue and Organ Harvesting/*adverse effects/statistics & numerical data