Impact of Modifiable Risk Factors on Long-Term Outcomes after Coronary Artery Bypass Surgery

Leviner, Dror B.; Zafrir, Barak; Jaffe, Ronen; Saliba, Walid; Flugelman, Moshe Y.; Sharoni, Erez

doi:10.1055/s-0040-1719154

Cited by 6 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A potential explanation may be the confounding effects of major predictors such as smoking. Smoking patients are known to have lower BMIs [ 38 , 39 ], while they carry a high risk of short- and long-term adverse cardiac events after CABG [ 40 , 41 ]. In this study, we performed comprehensive adjustments for many potential confounders.…”

Section: Discussionmentioning

confidence: 99%

The association between different body mass index levels and midterm surgical revascularization outcomes

Masoudkabir

Yavari²,

Jameie³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

Background There are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed “the obesity paradox”. This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG. Methods This historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m2): 18.5≤BMI<25, 25≤BMI<30, 30≤BMI<35, 35≤BMI<40, and BMI≥40. Patients with BMIs below 18.5 kg/m2 were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided. Results Of 17 751 patients (BMI = 27.30 ±4.17 kg/m2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m2 kg/m2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints. Conclusions Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.

show abstract

Section: Discussionmentioning

confidence: 99%

The association between different body mass index levels and midterm surgical revascularization outcomes

Masoudkabir

Yavari²,

Jameie³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…It was reported that within 5 years after CABG, 20%-30% patients experienced MACE and 15% died (22,23). Due to the high residual risk of cardiovascular morbidity and mortality, implantation and optimization of postoperative secondary prevention is highly recommended (24,25). Management of lipid abnormalities remains one of the primary goals in secondary prevention, for the reason that hyperlipidemia is associated with increased future cardiovascular events and graft deterioration (26,27).…”

Section: Discussionmentioning

confidence: 99%

Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: A secondary analysis of the DACAB trial

Xue

Líu

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

PurposeThe objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).MethodsThis is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C <1.8, 1.8–<2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke, and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2–6.1) years.ResultsDuring the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8–<2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with the postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in the LDL-C 1.8–<2.6 mmol/L group [adjusted hazard ratio (aHR) = 1.92, 95% CI, 1.12–3.29; P = 0.019] and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29–6.64; P < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with an increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06–2.18; P = 0.022).ConclusionsFor CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.

show abstract

“…Modifikasi terhadap faktor risiko harus ditargetkan pada modifikasi dini terhadap perubahan gaya hidup dan pemberian obat yang sesuai. Peran pencegahan sekunder mengukur dan mengontrol faktor risiko dalam rangka mengurangi kejadian kardiovaskuler yang tidak diharapkan dan terjadinya kematian termasuk kejadian setelah pembedahan (Leviner, Zafrir, Jaffe, Saliba, Flugelman, & Sharoni, 2021).…”

Section: Pembahasanunclassified

Faktor- faktor yang mempengaruhi lama rawat pada pasien pasca bedah Coronary Artery Bypass Graft (CABG)

Rochayati,

Lestari,

Handayani

2023

J.HolHealth

View full text Add to dashboard Cite

Background: Monitoring length of stay (LOS) while in the ICCU after CABG and examining risk factors can be a guiding initiative in improving services. Long LOS will not only lead to high costs and utilization but will also worsen outcomes for patients and their families. The length of stay in the ICCU room is an important indicator of the quality of critical care in patients undergoing CABG surgery.Purpose: To determine the factors that affect the length of stay of postoperative Coronary Artery Bypass Graft (CABG) patients in the ICCU ward of RSUP Dr. Kariadi Semarang.Method: Quantitative with a retrospective descriptive research design. The study sample was 69 post-CABG patients who were treated in the ICCU.Results: This shows that the factors that affect the length of stay of post-CABG patients in the ICCU are the length of time using POAF mechanical ventilation, the incidence of AKI, and pneumonia (with a p value <0.05).Conclusion: Post-operative factors such as prolonged use of mechanical ventilation, post-operative atrial fibrillation (POAF), pneumonia, and acute kidney injury (AKI) have an influence on the length of stay in post-CABG patients in the ICCU while preoperative factors (age, sex, comorbidities, LVEF), intraoperative factors (CPB duration, duration of anesthesia, number of grafts and aortic clamping time) and postoperative (potassium values, creatinine values, POCD, pericardial effusion, pleural effusion, and pulmonary edema) did not affect the length of postoperative patient care. CABG in the ICCU room.Keywords: Patient; Length of hospitalization; Coronary Artery Bypass Graft (CABG).Pendahuluan: Monitoring lama rawat (Length of Stay/ LOS) selama di ruang ICCU setelah tindakan CABG dan pemeriksaan terhadap faktor risiko dapat menjadi inisiatif panduan dalam peningkatan pelayanan. LOS yang panjang tidak hanya akan menyebabkan biaya dan utilisasi yang tinggi tetapi juga akan memperburuk outcome bagi pasien dan keluarga. Lama rawat di ruang ICCU merupakan indikator penting terhadap kualitas pelayanan kritis pada pasien yang menjalani operasi CABG.Tujuan: Untuk mengetahui faktor-faktor yang mempengaruhi lama rawat pasien pasca bedah Coronary Artery Bypass Graft (CABG) di ruang ICCU RSUP Dr. Kariadi Semarang.Metode: Kuantitatif dengan desain penelitian deskriptif retrospectif. Sampel penelitian sebanyak 69 pasien pasca CABG yang dirawat di ruang ICCU.Hasil: Menunjukkan bahwa faktor yang mempengaruhi lama rawat pasien pasca CABG di ruang ICCU adalah lama pemakaian ventilasi mekanik POAF, kejadian AKI, dan pneumoni (dengan p value <0.05).Simpulan: Faktor post operatif seperti lama pemakaian ventilasi mekanik, kejadian post operatif atrial fibrilasi (POAF), pneumoni dan kejadian Acute Kidney Injury (AKI) memiliki pengaruh terhadap lama rawat pada pasien pasca CABG di ruang ICCU sedangkan faktor pre operatif (usia, jenis kelamin, komorbid, LVEF), faktor intra operatif (lama CPB, lama anestesi, jumlah graft dan lama aorta klem) dan post operatif (nilai kalium, nilai kreatinin, POCD, efusi pericard, efusi pleura, dan edema pulmonary) tidak berpengaruh terhadap lama rawat pasien pasca CABG di ruang ICCU.

show abstract

Impact of Modifiable Risk Factors on Long-Term Outcomes after Coronary Artery Bypass Surgery

Cited by 6 publications

References 29 publications

The association between different body mass index levels and midterm surgical revascularization outcomes

The association between different body mass index levels and midterm surgical revascularization outcomes

Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: A secondary analysis of the DACAB trial

Faktor- faktor yang mempengaruhi lama rawat pada pasien pasca bedah Coronary Artery Bypass Graft (CABG)

Contact Info

Product

Resources

About