Perioperative bleeding is associated with a higher risk of postoperative AKI in ACS patients who underwent OPCAB. Moreover, blood and blood products transfusion most correlated with AKI after surgery. Prevention of severe bleeding and reducing blood transfusion requirement may improve the outcomes of OPCAB.

The effect of CYP2C19 gene polymorphism on clinical outcomes of patients with coronary artery disease (CAD) treated with clopidogrel remains controversial. Ethnicity has been proposed to influence clopidogrel response following stent implantation in CAD patients with different CYP2C19 genotypes. Furthermore, Asian populations are reported to have a relatively greater prevalence of CYP2C19 loss-of-function (LOF) alleles. We aimed to evaluate the impact of CYP2C19 gene polymorphism on clinical outcomes in Asian populations who underwent percutaneous coronary interventions (PCI) and received clopidogrel therapy. We conducted a comprehensive search in PubMed, EMBASE, and Cochrane Library from their inceptions to January 20, 2017. Studies that reported clopidogrel therapy information, clinically relevant outcomes (adverse cardiovascular events, stent thrombosis and bleeding), and CYP2C19 genotypes among Asian populations were included. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death and myocardial infarction. The safety endpoint was any kind of bleeding. We retrieved 20 studies of 15056 patients reporting 1301 cardiovascular events. The primary analysis showed at least one CYP2C19 LOF allele (*2 and/or *3) carriers were at an increased risk of MACE compared with non-carriers (10.58% vs. 6.07%, OR: 1.99, 95% CI: 1.64 to 2.42, p < .001). Stent thrombosis (ST) was also more frequent in LOF allele carriers (2.22% vs. 0.44%, OR: 4.77, 95% CI: 2.84 to 8.01, p < .001). Inversely, the risk of bleeding was lower in LOF allele carriers (OR: 0.66, 95% CI: 0.46 to 0.96, p < .001). Subgroup analysis was performed to assess differences by high (600 mg) or routine (300 mg) loading dose of clopidogrel and by different nationalities. The risk of MACE in LOF allele carriers remained significantly higher even in high loading dose group (high loading dose: OR 1.72, 95% CI: 1.37 to 2.16, and routine loading dose: OR 2.22, 95% CI: 1.68 to 2.94, p for subgroup heterogeneity = 0.16). Subgroup analysis between three nationalities of China, Korea, and Japan demonstrated that the risk of MACE among Chinese LOF allele carriers was the greatest (OR: 2.28; 95% CI:1.91 to 2.73). In conclusion, among Asian populations with CAD undergoing stent implantation, CYP2C19 LOF allele carriers are at greater risk of adverse cardiovascular events and lower risk of bleeding compared with non-carriers. Genetic testing may be helpful for clinicians to personalize antiplatelet therapy especially in Asian population.

Background: Cardiac injury is recognized as one of the most common critical complications during exacerbation of coronavirus disease 2019 (COVID-19). This study aimed to investigate the effect of cardiac injury on the clinical course of COVID-19 and to examine its potential mechanism and treatments. Methods and Results: A total of 222 hospitalized patients with COVID-19 from Wuhan were selected for the study during February 10 to March 28, 2020. Demographic, laboratory, and clinical data on admission and during hospitalization were compared between patients with COVID-19 with or without cardiac injury. On admission, cardiac injury ( n = 29) was associated with advanced age, more underlying coronary artery disease, and a lower Pa o 2 . Troponin levels were correlated with inflammatory markers (C-reactive protein: r = 0.348, P < 0.001; interleukin 6: r = 0.558, P < 0.001) and d -dimer levels ( r = 0.598, P < 0.001). During hospitalization, another six patients suffered from cardiac injury and cardiac injury ( n = 35), resulting in higher rates of ventilation (invasive: 51.4 vs. 1.6%, P < 0.001; non-invasive: 31.4 vs. 1.1%, P < 0.001) and mortality (54.3 vs. 1.1%, P < 0.001). Cardiac injury on admission was a predictive factor for mortality (adjusted hazard ratio = 4.73, 95% confidence interval = 1.35–16.63, P = 0.015). Receiver operating characteristic curve analysis showed that, on admission, a troponin level of 36.35 pg/mL was predictive for mortality with a sensitivity of 73.7% and a specificity of 92.1%. Conclusions: Cardiac injury complicates the disease course and increases the mortality rate of COVID-19. Troponin levels should be checked at admission and during hospitalization for triage, better monitoring, and managing those with COVID-19, especially in the most severe patients. Condensed Abstract: Cardiac injury is not uncommon in COVID-19. In a cohort of 222 patients with COVID-19, cardiac injury was found in 29 patients on admission and in another 6 patients during hospitalization. The admission level of troponin was well-correlated with inflammatory factors and d -dimer levels and strongly predicted mortality. Cardiac injury is a manifestation secondary to hypoxia and systemic infection, but which nevertheless further complicates the disease course and increases the mortality rate. Troponin levels should be checked at admission and during hospitalization for triage, better monitoring, and managing those with COVID-19, especially in the most severe patients.