Browsing by Subject "Coronary Artery Bypass"
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Item Clinical Outcomes of Aortic Aneurysm Patients with and without Accompanying Coronary Artery Disease(2017-01-17) Vuppala, Suchith; Tsai, Shirling; Jeon-Slaughter, Haekyung; Banerjee, SubhashBACKGROUND: This study investigates the prevalence of coronary artery disease and adverse cardiac outcomes in patients with Aortic Aneurysms. METHOD: The study analyzed data from 501 Veterans Affairs (VA) out-patients diagnosed with AA between October 1992 and April 2013. AA diagnosis was defined by computed tomography or ultrasound as greater than 1.5 times the normal aortic diameter. CAD was defined using a diagnosis from medical records and severe CAD as those revascularized with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Outcomes included all-cause death, non-fatal myocardial infarction (MI), stroke, PCI or CABG, aneurysm rupture and its endovascular or surgical repair of at 5 years after AA diagnosis. Cochran-Mantel-Haenszel statistics was used to examine associations of CAD with outcomes. RESULTS: One third of the sample had CAD, of which 57% with severe CAD. An abdominal AA was present in 99%. AA patients with CAD had higher major adverse cardiovascular events (MACE) and aneurysm rupture rates than those without (Figure 1.A). Rates of AA endovascular or surgical repair were similar between AA patients with and without CAD (including severe CAD). Severe CAD was significantly associated with an increased risk of 5-year stroke, but not with aneurysm rupture (Figure 1.B). CONCLUSION: Mid-term follow-up of veterans with Aortic Aneurysms revealed that concomitant CAD is associated with an increased risk of all-cause death, non-fatal MI and aneurysm rupture.Item Coronary artery bypass surgery, 1993: risks and benefits, realistic and unrealistic expectations(1993-04-29) Hillis, L. DavidItem Evaluation of the patient after coronary bypass surgery(1980-10-23) Narahara, Kenneth A.Item Factors That Alter the Relationship Between Peak Postoperative CKMB and Troponin T after CABG(2017-01-17) Mehta, Kinjal M.; Pruszynski, Jessica; Peltz, Matthias; Huffman, Lynn C.; Bajona, Pietro; Wait, Michael A.; Correa, Ronald; Ring, W. Steves; Jessen, Michael E.INTRODUCTION: Peak postoperative creatine kinase MB fraction (CKMB) and Troponin T (TnT) levels have been measured after cardiac surgery to assess perioperative myocardial damage, evaluate myocardial protective strategies and predict adverse events. However, the relationship between peak levels of both enzymes has not been fully established in this setting. We compared peak levels of CKMB and TnT in patients after CABG to test the hypothesis that patient and operative characteristics influence the correlation between the values of these biomarkers. METHODS: Data were prospectively collected from 171 consecutive patients undergoing on-pump CABG at a single institution between July 1, 2014 and Dec 31, 2015. Peak values were selected from all serum levels of CKMB and TnT collected during the hospital stay following surgery. Clinical variables were collected based on definitions in the STS Adult Cardiac Surgery Database version 2.181. Linear regression models were used to statistically compare the slope of the linear relationship between peak postoperative CKMB and TnT for the patient cohort. Models were created to compare the slopes by pre-defined clinical variables including (1) gender, (2) age (< or >70), (3) race, (4) tobacco use, presence or absence of (3) hypertension, (4) dyslipidemia, (5) diabetes, (6) renal dysfunction (GFR<60), (7) MI within 21 days, (8) EF (< or > 40%), preoperative use of (9) ACE-inhibitors, (10) beta-blockers, and (11) anticoagulants; and operative variables including (1) cross clamp time (< or > 70 min), (2) CPB time (< or > 100 min), and (3) whether or not intra-operative blood products were received. A lower slope implies less change in CKMB compared to the change in TnT. RESULTS: Overall, the correlation between peak postoperative CKMB and TnT was robust in patients undergoing CABG (m = 19.6, r= 0.783). However, the slope of the relationship was significantly lower in males, patients > 70 years, diabetics, non-smokers, patients with renal dysfunction, patients with lower EF, patients receiving anticoagulants, and patients undergoing CABG following a recent MI. The slope was significantly greater in patients with longer clamp times and who were receiving beta blockers and ACE-inhibitors (Table I). In all other models, the slope of the relationship was similar. CONCLUSION: The relationship between CKMB and TnT following CABG appears to be influenced by patient and operative characteristics. These data do not assess which enzyme more accurately reflects myocardial injury, but does suggest conclusions about myocardial damage may be affected by the biomarker selected in the presence of certain variables. Further study to assess the association between these biomarkers and patient outcomes is warranted.Item Factors That Alter the Relationship Between Peak Postoperative CKMB and Troponin T After CABG(2019-04-02) Mehta, Kinjal Mukesh; Jessen, Michael; Pruszynski, Jessica; Huffman, LynnBACKGROUND: Peak postoperative creatine kinase MB fraction (CKMB) and Troponin T (TnT) levels have been measured after cardiac surgery to assess perioperative myocardial damage, evaluate myocardial protective strategies and predict adverse events. However, the relationship between peak levels of both enzymes has not been fully established in this setting. We compared peak levels of CKMB and TnT in patients after CABG to test the hypothesis that patient and operative characteristics influence the correlation between the values of these biomarkers. OBJECTIVE: To examine the relationship between peak levels of cTnT and CKMB following CABG in defined subsets of patients with pre-defined comorbidities to test the hypothesis that patient and operative characteristics influence the correlation between the values of these biomarkers. METHODS: Data were prospectively collected from 885 consecutive patients undergoing on-pump CABG at a single institution between July 2011 and June 2017. Peak values were selected from all serum levels of CKMB and TnT collected during the hospital stay following surgery. Clinical variables were collected based on definitions in the STS Adult Cardiac Surgery Database version 2.181. Analysis of covariance (ANCOVA) and linear regression models were used to statistically compare the slope of the linear relationship between peak postoperative CKMB and TnT for the patient cohort. Models were created to compare the slopes by pre-defined clinical variables including (1) age, (2) sex, (3) race, (4) current smoking status (5) hypertension, (6) dyslipidemia, (7) ejection fraction (EF), (8) diabetes, (9) renal dysfunction (GFR<60), (10) recent MI, preoperative use of (11) ACE-inhibitors, (12) beta-blockers, and (13) anticoagulants; and operative variables including (1) cross clamp time (< or > 70 min), (2) CPB time (< or > 100 min), and (3) intra-operative blood products transfusion. RESULTS: Overall, the correlation between peak postoperative CKMB and TnT was robust in patients undergoing CABG. However, the slope of the relationship was significantly lower in males, diabetics, patients with dyslipidemia, patients with hypertension, patients with lower EF, patients who received red blood cell transfusions, and patients receiving beta-blockers. The slope was significantly greater in patients with renal dysfunction, current smokers, patients with a recent MI, patients with longer cross clamp times, patients with longer CPB time, and patients receiving ACE inhibitors. CONCLUSION: The relationship between CKMB and TnT following CABG appears to be influenced by patient and operative characteristics. These data do not assess which enzyme more accurately reflects myocardial injury, but does suggest conclusions about myocardial damage may be affected by the biomarker selected in the presence of certain variables. Further study to assess the association between these biomarkers and patient outcomes is warranted.Item [News](1988-05-21) Rutherford, SusanItem Paclitaxel-Eluting Vs. Bare Metal Stent Implantation in Saphenous Vein Graft Lesions: Very Long-Term Follow-up of the SOS (Stenting of Saphenous Vein Grafts) Trial(2015-01-26) Sosa, Alan; Chao, Howard; Guerra, Andres; Han, Henry; Christopoulos, George; de Lemos, James A.; Obel, Owen; Addo, Tayo; Roesle, Michele; Haagen, Donald; Rangan, Bavana V.; Banerjee, Subhash; Brilakis, Emmanouil S.BACKGROUND: The very long-term (>3 year) outcomes after implantation of drug-eluting as compared with bare metal stents (BMS) in saphenous vein grafts (SVGs) have received limited study. METHODS: In the Stenting Of Saphenous vein grafts (SOS) trial 80 patients were randomized to BMS or paclitaxel-eluting stents (PES). During a median follow-up of 35 months use of PES was associated with better clinical outcomes. We report very long-term outcomes on 62 patients enrolled at the highest enrolling institution. RESULTS: Of the 62 studied patients 31 received a BMS and 31 a PES. Both study groups had similar baseline characteristics. During a median follow-up of 6.9 years the study patients experienced 116 major adverse cardiovascular events (MACE). Compared with patients who received BMS those who received PES had lower incidence of MACE (hazard ratio [HR]=0.56, P=0.04), target lesion revascularization (HR=0.20, P=0.001), target vessel revascularization (HR 0.41, P=0.02), target vessel failure (HR=0.35, P=0.001), and definite or probable stent thrombosis (HR=0.14, P=0.03). There was no significant difference in all-cause mortality (HR=1.77, P=0.15) and myocardial infarction (HR=0.52, P=0.10) between the two groups. CONCLUSION: The early benefit observed with use of PES vs BMS in SVGs persisted during very long-term follow-up.Item Prolongation of life in ischemic heart disease(1984-10-18) Atkins, James M.Item [Southwestern News](2002-10-23) Baxter, MindyItem [Southwestern News](2004-10-14) Siem, Staishy Bostick; Abila, ReyesItem [UT Southwestern Medical Center News](2009-01-22) Morales, Katherine