Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. R...Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses展开更多
Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try ...Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital展开更多
Background: The optimal antiplatelet therapy regimen in the early post-operative CABG period is not well researched. Several studies have proven that use of clopidogrel and aspirin prior to surgery increases bleed ris...Background: The optimal antiplatelet therapy regimen in the early post-operative CABG period is not well researched. Several studies have proven that use of clopidogrel and aspirin prior to surgery increases bleed risks, but very few studies have examined this therapy post-operatively. Due to the limited amount of data surrounding this topic, the goal of this study was to determine if single or dual antiplatelet therapy had better outcomes in those status-post CABG surgery. Methods: This was a retrospective, single center, cohort study performed at Saint Joseph Hospital in Lexington, Kentucky. Data was reviewed through the Society of Thoracic Surgeons (STS) database, pharmacy medication dispensing records, as well as manual chart review. The primary composite endpoint of the study consisted of in-hospital mortality, ischemic or thrombotic events, bleeding events, restenosis rates, and 30-day readmission rates. Results: The number of events with regard to the primary composite endpoint was 32 events with combination therapy and 39 events with aspirin monotherapy (p = 0.39). A greater decrease in hemoglobin and hematocrit was seen in the aspirin monotherapy group (p = 0.02 and p = 0.047). Patients with prior CVA or TIA were more commonly placed on combination therapy after surgery (p = 0.018). There were no differences in outcomes when type of antiplatelet therapy and type of CABG were analyzed. Conclusions: There was no difference seen between single versus dual antiplatelet therapy regarding the primary composite endpoint. There was an increase in bleeding events with aspirin monotherapy as defined by TIMI criteria as well as a statistically significant decrease in Hgb and HCT with aspirin monotherapy. Patients with previous CVA/TIA were more likely to receive combination therapy. The average number of vessels grafted per surgery was lower in the off-pump surgery cohort.展开更多
The benefits of coronary-artery bypass grafting （CABG） without cardiopulmonary bypass in the elderly are still undetermined. METHODS We randomly assigned patients 75 years of age or older who were scheduled for el...The benefits of coronary-artery bypass grafting （CABG） without cardiopulmonary bypass in the elderly are still undetermined. METHODS We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass （off-pump CABG） or with it （on-pump CABG）. The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.展开更多
Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet react...Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet reactivity have an increase in risk of major adverse cardiovascular events. No published studies to date have utilized platelet function monitoring assays prior to coronary artery bypass graft (CABG) surgery, but determination of patients’ antiplatelet effects prior to surgery may decrease time to surgery and length of hospital stay. The purpose of the study was to evaluate the clinical outcomes of non-elective CABG patients analyzed by the VerifyNow P2Y12 platelet-function monitoring assay prior to surgery compared to a similar set of patients not analyzed by the VerifyNow P2Y12 assay. Methods: This was a retrospective, single center, cohort study. The primary endpoints of this study were time to surgery and length of hospital stay. Results: From March 2013 to July 2013, 60 patient charts were reviewed and included in this study. 49 patients were analyzed by the VerfiyNow P2Y12 assay, and 16 of these patients underwent non-elective CABG surgery. Eleven patients underwent non-elective CABG surgery and were not analyzed by the VerifyNow P2Y12 assay. There was no difference between groups regarding time to surgery (p = 0.75) or length of stay (p = 0.42). Based on the assay’s P2Y12 reaction unit results, 69% of VerifyNow P2Y12 patients went to surgery sooner than the institution’s recommendations which generated more bleeding events, half of which were considered major bleeds. Conclusions: Utilization of the VerifyNow P2Y12 assay prior to non-elective CABG surgery does not shorten time to surgery or overall length of hospital stay. However, insufficient P2Y12 reaction units prior to surgery may lead to more bleeding events, thus the application of platelet function monitoring assays prior to procedures may be beneficial as a bleeding risk-assessment tool.展开更多
文摘Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses
文摘Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital
文摘Background: The optimal antiplatelet therapy regimen in the early post-operative CABG period is not well researched. Several studies have proven that use of clopidogrel and aspirin prior to surgery increases bleed risks, but very few studies have examined this therapy post-operatively. Due to the limited amount of data surrounding this topic, the goal of this study was to determine if single or dual antiplatelet therapy had better outcomes in those status-post CABG surgery. Methods: This was a retrospective, single center, cohort study performed at Saint Joseph Hospital in Lexington, Kentucky. Data was reviewed through the Society of Thoracic Surgeons (STS) database, pharmacy medication dispensing records, as well as manual chart review. The primary composite endpoint of the study consisted of in-hospital mortality, ischemic or thrombotic events, bleeding events, restenosis rates, and 30-day readmission rates. Results: The number of events with regard to the primary composite endpoint was 32 events with combination therapy and 39 events with aspirin monotherapy (p = 0.39). A greater decrease in hemoglobin and hematocrit was seen in the aspirin monotherapy group (p = 0.02 and p = 0.047). Patients with prior CVA or TIA were more commonly placed on combination therapy after surgery (p = 0.018). There were no differences in outcomes when type of antiplatelet therapy and type of CABG were analyzed. Conclusions: There was no difference seen between single versus dual antiplatelet therapy regarding the primary composite endpoint. There was an increase in bleeding events with aspirin monotherapy as defined by TIMI criteria as well as a statistically significant decrease in Hgb and HCT with aspirin monotherapy. Patients with previous CVA/TIA were more likely to receive combination therapy. The average number of vessels grafted per surgery was lower in the off-pump surgery cohort.
文摘The benefits of coronary-artery bypass grafting （CABG） without cardiopulmonary bypass in the elderly are still undetermined. METHODS We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass （off-pump CABG） or with it （on-pump CABG）. The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.
文摘Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet reactivity have an increase in risk of major adverse cardiovascular events. No published studies to date have utilized platelet function monitoring assays prior to coronary artery bypass graft (CABG) surgery, but determination of patients’ antiplatelet effects prior to surgery may decrease time to surgery and length of hospital stay. The purpose of the study was to evaluate the clinical outcomes of non-elective CABG patients analyzed by the VerifyNow P2Y12 platelet-function monitoring assay prior to surgery compared to a similar set of patients not analyzed by the VerifyNow P2Y12 assay. Methods: This was a retrospective, single center, cohort study. The primary endpoints of this study were time to surgery and length of hospital stay. Results: From March 2013 to July 2013, 60 patient charts were reviewed and included in this study. 49 patients were analyzed by the VerfiyNow P2Y12 assay, and 16 of these patients underwent non-elective CABG surgery. Eleven patients underwent non-elective CABG surgery and were not analyzed by the VerifyNow P2Y12 assay. There was no difference between groups regarding time to surgery (p = 0.75) or length of stay (p = 0.42). Based on the assay’s P2Y12 reaction unit results, 69% of VerifyNow P2Y12 patients went to surgery sooner than the institution’s recommendations which generated more bleeding events, half of which were considered major bleeds. Conclusions: Utilization of the VerifyNow P2Y12 assay prior to non-elective CABG surgery does not shorten time to surgery or overall length of hospital stay. However, insufficient P2Y12 reaction units prior to surgery may lead to more bleeding events, thus the application of platelet function monitoring assays prior to procedures may be beneficial as a bleeding risk-assessment tool.
