Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study

IntroductionStrict glucose control is an everyday practice in the perioperative period. Elevated glucose level has a deleterious impact on clinical results, but a therapeutic target has not been stated yet.AimTo determine a glucose concentration range affecting long-term outcomes after coronary artery bypass surgery (CABG).Material and methodsThis study is a retrospective evaluation of consecutive patients treated in a university hospital in Poland from 2004 to 2008. Patients were divided into 2 groups: an impaired glucose metabolism group (IGM) if they had 1) known DM or 2) perioperative hyperglycaemia defined as ≥ 200 mg/dl; and a non-IGM group. The end point (EP) was all-cause mortality.ResultsOne thousand two hundred and eleven patients were covered by the analysis. The observation time was from 01.01.2004 until 01.08.2012. Patients who had maximal glucose concentrations < 242 mg/dl had the lowest mortality risk (EP in 21.1%); a higher risk was noted in the group with glucose concentrations 242–324 mg/dl (EP in 30.8%); and a very high risk was found for the group where glucose concentration was > 324 mg/dl (EP in 44.2%) (p = 0.041). Patients with IGM had a shorter survival at the end of the study (p < 0.001). The longest survival was observed in patients whose maximal glucose level was ≤ 242 mg/dl (p < 0.001) and the minimal glucose concentration was in the range 61–110 mg/dl (p < 0.001).ConclusionsTight glucose concentration control should be performed irrespective of a diabetes diagnosis and proper treatment introduced when necessary. Maximal glucose concentration should be kept < 242 mg/dl, while the minimum should be in the range 60–110 mg/dl.

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“…We are also monitoring long-term outcomes after OPCAB, and the first results have already been reported elsewhere [13, 14]. …”

Section: Methodsmentioning

confidence: 93%

Blood glucose concentration for predicting poor outcomes in patients with and without impaired glucose metabolism undergoing off-pump coronary artery bypass surgery – long-term observational study

Szychta

Majstrak

Opolski

et al. 2016

pwki

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“…It is estimated that up to 50% of patients undergoing cardiac surgery need a blood transfusion in their postoperative course [3]. What is more, due to the deteriorating profile of patients referred for coronary artery bypass grafting (CABG), there is an observed trend of increasing number of red blood cell transfusions, reaching about three units per patient [7]. High demand for blood products raises economical and organisational issues.…”

Section: Discussionmentioning

confidence: 99%

Endogenic erythropoietin secretion in patients undergoing off-pump coronary artery bypass grafting

Drohomirecka

Kuśmierczyk²,

Kocańda³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: Erythropoietin (EPO) deficiency or inadequate EPO secretion in response to bleeding may result in profound or prolonged anaemia after cardiac surgery. Aim:The aim of the study was to evaluate the changes in EPO secretion in patients undergoing off-pump coronary artery bypass grafting (OPCAB).Methods: Blood samples from 43 patients (mean age 65.1 ± 7.6 years) were obtained before surgery and on the 1 st , 2 nd , and 6 th day post isolated OPCAB. EPO levels ≥ 4.3 mIU/mL were considered normal.Results: Thirteen (30%) patients had the preoperative EPO level below normal range even though their preoperative haemoglobin was ≥ 13 g/dL. In patients with basal EPO deficiency lower peak EPO levels were observed compared to the group with normal basal EPO levels, even though reduction in haemoglobin concentrations was comparable in both groups. Moreover, lower reticulocytosis was noted on day 1 (8.5 ± 4.0‰ vs. 11.7 ± 4.4‰; p = 0.04) and a tendency toward lower values was seen on day 2 (9.6 ± 4.3‰ vs. 13.0 ± 5.8‰; p = 0.07) among patients with preoperative EPO deficiency.Conclusions: Erythropoietin deficiency is common in patients scheduled for OPCAB, and it results in diminished increase in EPO secretion in response to bleeding. Consequently, in patients with EPO deficiency, reticulocytosis is lower than it could be predicted based on the observation of patients with normal EPO levels and similar blood loss.

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“…Необходимо отметить влияние коморбидных состояний на увеличение риска фактической операционной летальности, что проявляется и в увеличении показателя прогнозируемой летальности по ES II, несмотря на строгие критерии отбора на оперативное лечение. При ретроспективном анализе историй болезни, отмечено увеличение факторов риска у пациентов, направленных на АКШ в 2008г, по сравнению с 2004г [20]. Поэтому степень операционного риска для женщин -кандидаток на хирургическое лечение ИБС -должна оцениваться индивидуально с учетом наличия вышеперечисленных факторов.…”

Section: результаты и обсуждениеunclassified

Prevalence of comorbidities and their influence on complications and outcomes of coronary bypass surgery for coronary heart disease in gender perspective

Klester¹,

Иванов²,

Буднев³

et al. 2016

Kardiovask. ter. profil.

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ГБОУ ВПО Алтайский государственный медицинский университет МЗ РФ. Барнаул; 2 Краевое ГБУЗ "Краевая клиническая больница". Барнаул, Россия Цель. Изучить частоту распространения сопутствующей патологии системы кровообращения, органов дыхания и пищеварения, мочеполовой системы для повышения качества прогноза развития осложнений и неблагоприятных исходов при аортокоронарном шунтировании у больных ишемической болезнью сердца, в т. ч. с учетом гендерных различий. Материал и методы. Под наблюдением находились 127 больных (73,2%-мужчины, 26,8%-женщины), прооперированных в плановом порядке по поводу ишемической болезни сердца в Алтайской краевой клинической больнице. Средний возраст больных на момент операции составил 58,9±6,3 года. Коронарное шунтирование проводилось по показаниям в условиях искусственного кровообращения и фармакохолодовой кардиоплегии. Результаты. Индекс коморбидности по Charlson (ИКСh) составил 4,7 [4,1-5,3] балла; у мужчин-3,6 [3,2-4,1], у женщин-5,2 [4,7-5,6] (p<0,05). Низкая коморбидность (ИКCh ≤3) наиболее часто диагностирована у мужчин-38,7% vs 17,6% (р=0,04), высокая (ИКCh >5) у женщин-58,8% vs 36,6% (р=0,04). ИКCh коррелировал со следующими операционными осложнениями: сердечной недостаточностью, потребовавшей инотропной поддержки в течение >5 сут. (r=0,73); периоперационным инфарктом миокарда (r=0,71); острым нарушением мозгового кровообращения, подтвержденным компьютерной томографией (r=0,56); нарушениями ритма сердца: фибрилляцией предсердий, пароксизмальной желудочковой тахикардией (r=0,52); дыхательной недостаточностью, приведшей к пролонгированной искусственной вентиляции легких в течение >5 сут. (r=0,48). Заключение. ИКСh имеет гендерные различия и характеризуется высоким риском неблагоприятного прогноза у женщин: выживаемость <15% в ближайшие 10 лет. К факторам риска операционной летальности при коронарном шунтировании в анализируемой женской популяции относятся: возраст >70 лет, наличие хронической сердечной недостаточности, сахарного диабета, хронической болезни почек (≥III ст.) и длительность искусственного кровообращения. Ключевые слова: коронарное шунтирование, коморбидность, женский пол.

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Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study

Abstract: Patients referred for coronary artery surgery are becoming higher-risk patients with a greater number of comorbidities, and surgical techniques are becoming progressively more sophisticated.

Cited by 7 publications

References 15 publications

Blood glucose concentration for predicting poor outcomes in patients with and without impaired glucose metabolism undergoing off-pump coronary artery bypass surgery – long-term observational study

Blood glucose concentration for predicting poor outcomes in patients with and without impaired glucose metabolism undergoing off-pump coronary artery bypass surgery – long-term observational study

Endogenic erythropoietin secretion in patients undergoing off-pump coronary artery bypass grafting

Prevalence of comorbidities and their influence on complications and outcomes of coronary bypass surgery for coronary heart disease in gender perspective

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