Cognitive Outcome After Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery&lt;SUBTITLE&gt;A Randomized Trial&lt;/SUBTITLE&gt;

Dijk, Diederik van; Jansen, Erik; Hijman, Ron; Nierich, Arno P.; Diephuis, Jan C.; Moons, Karel G.M.; Lahpor, Jaap R.; Borst, Cornelius; Keizer, Annemieke M. A.; Nathoe, Hendrik M.; Grobbee, Diederick E.; Jaegere, Peter P.T. de; Kalkman, Cor J.

doi:10.1001/jama.287.11.1405

Cited by 462 publications

(89 citation statements)

References 30 publications

(32 reference statements)

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“…In a quasi-observational, secondary analysis of 3 studies, the Surgery Depth of Anaesthesia Cognitive Outcome (SuDoCo) [18], Dexamethasone for Cardiac Surgery (DECS) [19, 20], and OCTOPUS [21] studies, associations of exposure to diabetes, hypertension, and obesity with POCD risk were determined. None of the 3 studies had previously been used to investigate this research question.…”

Section: Methodsmentioning

confidence: 99%

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Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Lachmann

Feinkohl

Borchers

et al. 2018

Dement Geriatr Cogn Disord

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Background/Aims: Older people undergoing surgery are at risk of developing postoperative cognitive dysfunction (POCD), but little is known of risk factors predisposing patients to POCD. Our objective was to estimate the risk of POCD associated with exposure to preoperative diabetes, hypertension, and obesity. Methods: Original data from 3 randomised controlled trials (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis on diabetes, hypertension, baseline blood pressure, obesity (BMI ≥30 kg/m²), and BMI as risk factors for POCD in multiple logistic regression models. Risk estimates were pooled across the 3 studies. Results: Analyses totalled 1,034 patients. POCD occurred in 5.2% of patients in DECS, in 9.4% in SuDoCo, and in 32.1% of patients in OCTOPUS. After adjustment for age, sex, surgery type, randomisation, obesity, and hypertension, diabetes was associated with a 1.84-fold increased risk of POCD (OR 1.84; 95% CI 1.14, 2.97; p = 0.01). Obesity, BMI, hypertension, and baseline blood pressure were each not associated with POCD in fully adjusted models (all p > 0.05). Conclusion: Diabetes, but not obesity or hypertension, is associated with increased POCD risk. Consideration of diabetes status may be helpful for risk assessment of surgical patients.

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Section: Methodsmentioning

confidence: 99%

“…Recruitment procedures and inclusion and exclusion criteria have been described in detail previously [18, 20, 21]. In brief, any patients with pre-existing neurological deficits were excluded in all 3 studies; in SuDoCo, MMSE < 24 was also an exclusion criterion, and in DECS, patients with diagnosed mental illness were additionally excluded.…”

Section: Methodsmentioning

confidence: 99%

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Lachmann

Feinkohl

Borchers

et al. 2018

Dement Geriatr Cogn Disord

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“…Therefore, considerable attentions have been devoted to this area (e.g., [14,25,26,43], etc). We focus on a meta-analysis paper [31] on this topic which undertook quantitative systematic reviews to assess whether there were significant differences in neurocognitive outcomes in patients after undergoing off-pump versus on-pump CABG.…”

Section: A Case Study On Neurocognitive Outcomesmentioning

confidence: 99%

“…Here, we get four clinical trials reports, i.e., [14,25,26,43], to survey whether there were significant differences in neurocognitive outcomes in patients after undergoing off-pump versus on-pump CABG.…”

Section: Example 4 (Neurocognitive Outcomes After Off-pump Versus On-mentioning

confidence: 99%

“…A huge number of clinical trials have been carried out in the last few decades and new trials are constantly being designed and implemented. For example, many clinical trials have been carried out to investigate issues including: the intraocular pressure (IOP) lowering efficacy of drugs, such as travoprost, bimatoprost, timolol, and latanoprost, (e.g., [4,7,15,21,30,32,34,37,40]); oral medications for adults with Type-2 diabetes (e.g., [3,9,27,29,35,41]); the neurocognitive outcomes after off-pump versus on-pump coronary revascularisation (e.g., [14,25,26,31,43]). …”

Section: Introductionmentioning

confidence: 99%

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An XML Based Framework for Merging Incomplete and Inconsistent Statistical Information from Clinical Trials

Liu

Hunter

et al. 2010

Soft Computing in XML Data Management

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Abstract. Meta-analysis is a vital task for systematically summarizing statistical results from clinical trials that are carried out to compare the effect of one medication (or other treatment) against another. Currently, most meta-analysis activities are done by manually pooling data. This is a very time consuming and expensive task. An automated or even semi-automated tool that can support some of the processes underlying meta-analysis is greatly needed. Furthermore, statistical results from clinical trials are usually represented as sampling distributions (i.e., with the mean value and the SEM). When collecting statistical information from reports on clinical trials, not all reports contain full statistical information (i.e., some do not provide SEMs) whilst traditional meta-analysis excludes trials reports that contain incomplete information, which inevitably ignores many trials that could be valuable. Furthermore, some trials results can be significantly inconsistent with the rest of trials that address the same problem. Therefore, highlighting (resp. removing) such inconsistencies is also very important to reveal (resp. reduce) any potential flaws in some of the trials results. In this paper, we aim to design and develop a framework that tackles the above three issues. We first present an XML-based merging framework that aims to merge statistical information automatically with the potential to add a component to extract clinical trials information automatically. This framework shall consider any valid clinical trial including trials with partial information. We then develop a method to analyze inconsistencies among a collection of clinical trials and if necessary to exclude any trials that are deemed to be illegible. Finally, we use two sets of clinical trials, trials on Type 2 diabetes and on neurocognitive outcomes after off-pump versus on-pump coronary revascularisation, to illustrate our framework.

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Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization

Whitlock

Diaz‐Ramirez

Smith

et al. 2021

JAMA

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IMPORTANCEIt is uncertain whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with a nonsurgical method of coronary revascularization (percutaneous coronary intervention [PCI]). OBJECTIVE To compare the change in the rate of memory decline after CABG vs PCI. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older. Data were modeled for up to 5 years preceding and 10 years following revascularization or until death, drop out, or the 2016-2017 interview wave. The date of final follow-up was November 2017.EXPOSURES CABG (including on and off pump) or PCI, ascertained from Medicare fee-for-service billing records. MAIN OUTCOMES AND MEASURESThe primary outcome was a summary measure of cognitive test scores and proxy cognition reports that were performed biennially in the Health and Retirement Study, referred to as memory score, normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged Ն72 years). Memory score was analyzed using multivariable linear mixed-effects models, with a prespecified subgroup analysis of on-pump and off-pump CABG. The minimum clinically important difference was a change of 1 SD of the population-level rate of memory decline (0.048 memory units/y). RESULTSOf 1680 participants (mean age at procedure, 75 years; 41% female), 665 underwent CABG (168 off pump) and 1015 underwent PCI. In the PCI group, the mean rate of memory decline was 0.064 memory units/y (95% CI, 0.052 to 0.078) before the procedure and 0.060 memory units/y (95% CI, 0.048 to 0.071) after the procedure (within-group change, 0.004 memory units/y [95% CI, −0.010 to 0.018]). In the CABG group, the mean rate of memory decline was 0.049 memory units/y (95% CI, 0.033 to 0.065) before the procedure and 0.059 memory units/y (95% CI, 0.047 to 0.072) after the procedure (within-group change, −0.011 memory units/y [95% CI, −0.029 to 0.008]). The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y (95% CI, −0.008 to 0.038; P = .21). There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y [95% CI, 0.008 to 0.084] after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y [95% CI, −0.024 to 0.031] after on-pump CABG).CONCLUSIONS AND RELEVANCE Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline.

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Cognitive Outcome After Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery<SUBTITLE>A Randomized Trial</SUBTITLE>

Abstract: Patients who received their first CABG surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.

Cited by 462 publications

References 30 publications

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

An XML Based Framework for Merging Incomplete and Inconsistent Statistical Information from Clinical Trials

Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization

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