The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery : cardiovascular topics (original) (raw)
Related papers
Journal of the American …, 2007
The aim of this study was to determine the impact of the metabolic syndrome (MS) on operative mortality after a coronary artery bypass grafting surgery (CABG). Background Diabetes and obesity are highly prevalent among patients undergoing CABG. However, it remains unclear whether these factors have a significant impact on operative mortality after this procedure. We hypothesized that the metabolic abnormalities associated with MS could negatively influence the operative outcome of CABG surgery. Methods We retrospectively analyzed the data of 5,304 consecutive patients who underwent an isolated CABG procedure between 2000 and 2004. Of these 5,304 patients, 2,411 (46%) patients met the National Cholesterol Education Program-Adult Treatment Panel III criteria for MS. The primary end point was operative mortality. Results The operative mortality after CABG surgery was 2.4% in patients with MS and 0.9% in patients without MS (p Ͻ 0.0001). The MS was a strong independent predictor of operative mortality (relative risk 3.04 [95% confidence interval (CI) 1.73 to 5.32], p ϭ 0.0001). After adjusting for other risk factors, the risk of mortality was increased 2.69-fold (95% CI 1.43 to 5.06; p ϭ 0.002) in patients with MS and diabetes and 2.36-fold (95% CI 1.26 to 4.41; p ϭ 0.007) in patients with MS and no diabetes, whereas it was not significantly increased in the patients with diabetes and no MS. Conclusions This is the first study to report that MS is a highly prevalent and powerful risk factor for operative mortality in patients undergoing a CABG surgery. Thus, interventions that could contribute to reduce the prevalence of MS in patients with coronary artery disease or that could acutely modify the metabolic perturbations of MS at the time of CABG might substantially improve survival in these patients.
2010
The aim of this study was to determine the impact of the metabolic syndrome (MS) on operative mortality after a coronary artery bypass grafting surgery (CABG). Background Diabetes and obesity are highly prevalent among patients undergoing CABG. However, it remains unclear whether these factors have a significant impact on operative mortality after this procedure. We hypothesized that the metabolic abnormalities associated with MS could negatively influence the operative outcome of CABG surgery. Methods We retrospectively analyzed the data of 5,304 consecutive patients who underwent an isolated CABG procedure between 2000 and 2004. Of these 5,304 patients, 2,411 (46%) patients met the National Cholesterol Education Program-Adult Treatment Panel III criteria for MS. The primary end point was operative mortality. Results The operative mortality after CABG surgery was 2.4% in patients with MS and 0.9% in patients without MS (p Ͻ 0.0001). The MS was a strong independent predictor of operative mortality (relative risk 3.04 [95% confidence interval (CI) 1.73 to 5.32], p ϭ 0.0001). After adjusting for other risk factors, the risk of mortality was increased 2.69-fold (95% CI 1.43 to 5.06; p ϭ 0.002) in patients with MS and diabetes and 2.36-fold (95% CI 1.26 to 4.41; p ϭ 0.007) in patients with MS and no diabetes, whereas it was not significantly increased in the patients with diabetes and no MS. Conclusions This is the first study to report that MS is a highly prevalent and powerful risk factor for operative mortality in patients undergoing a CABG surgery. Thus, interventions that could contribute to reduce the prevalence of MS in patients with coronary artery disease or that could acutely modify the metabolic perturbations of MS at the time of CABG might substantially improve survival in these patients.
Research in Cardiovascular Medicine, 2014
Background: The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension. Objectives: The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG). Patients and Methods: This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P < 0.001). The most prevalent complications were bleeding [20 (8.5%)] and dysrhythmia [18 (7.7%)]. At three months follow-up, the frequency rates of readmission [24 (10.2%)] and mediastinitis [9 (3.8%)] were higher than other complications. Diabetes and MetS were risk factors for a long ICU stay (> 5 days) and atelectasia (P < 0.05). Significant associations were observed between diabetes and pulmonary embolism (P = 0.025) and mediastinitis (P = 0.051). Conclusions: Identification of MetS before CABG can predict the surgery outcome. Patients with MetS have increased risks for longer ICU stay and atelectasia.
Metabolic Syndrome Affects Midterm Outcome After Coronary Artery Bypass Grafting
The Annals of Thoracic Surgery, 2012
Background. Metabolic syndrome (MetS) is frequently associated with coronary artery disease, but data on the impact of MetS on long-term outcome of patients undergoing coronary artery bypass grafting are still lacking. The aim of the present study was to assess the effect of MetS on mortality and morbidity late after coronary artery bypass grafting.
2017
Introduction: Metabolic syndrome (MS) is considered as an important risk factor for advanced coronary artery disease. This condition can increase the mortality and morbidity in the patients undergoing coronary artery bypass graft (CABG) surgery. The aim of the study was compared mortality and morbidity after off Pump- CABG surgery between patients with and without the Metabolic syndrome. Materials & Methods: This prospective cross-sectional study was conducted on 120 patients, who underwent off-pump CABG surgery between October 2014-October 2016. The participants were equally divided into two groups including the patients with and without MS (MS and non-MS, respectively). Results: According to the results, 68 (56.6%) patients were male. Furthermore, out of the 60 participants with MS, 36 (60%) cases were male. The mean ages of the MS and non-MS groups were 64.96±9.6 and 65.62±10.6 P=0.6 years, respectively. No statistically significant difference was observed between the two groups ...
European Journal of Cardio-Thoracic Surgery, 2000
In coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) the in¯ammatory response is suggested to be minimized. Coronary anastomoses are performed during temporary coronary occlusion. In¯ammatory response and myocardial ischaemia need to be studied in a randomized study comparing CABG in multivessel disease with versus without CPB. Methods: Following randomization 30 consecutive patients received CABG either with (n 16) or without CPB (n 14). Primary study endpoints were parameters of the in¯ammatory response (interleukin (IL)-6, interleukin-10, ICAM-1, P-selectin) and of myocardial injury (myoglobin, creatine kinase-MB (CK-MB), troponin I) (intraoperatively, 4, 8, 16, 24 and 48 h after surgery). The secondary endpoint was clinical outcome. Results: The incidence of major (death: CABG with CPB n 1, not signi®cant (n.s.)) and minor adverse events (wound infection: with CPB n 2, without CPB n 1, n.s.; atrial ®brillation: with CPB n 3, without CPB n 2, n.s.) was comparable between both groups. The release of IL-6 was comparable during 8 h of observation (n.s.). Immediately postoperatively IL-10 levels were higher in the operated group with CPB (211.7^181.9 ng/ml) than in operated patients without CPB (104.6^40.3 ng/ml, P 0:0017). Thereafter no differences were found between both groups. A similar pattern of release was observed in serial measures of ICAM-1 and P-selectin, with no difference between both study groups (n.s.). Eight hours postoperatively the cumulative release of myoglobin was lower in operated patients without CPB (1829.7^1374.5 mg/l) than in operated patients with CPB (4469.8^4525.7 mg/l, P 0:0152). Troponin I release was 300.7^470.5 mg/l (48 h postoperatively) in patients without CPB and 552.9^527.8 mg/l (P 0:0213). CK-MB mass release was 323.5^221.2 mg/l (24 h postoperatively) in operated patients without CPB and 1030.4^1410.3 mg/l in operated patients with CPB (P 0:0003). Conclusions: This prospective randomized study suggests that in low-risk patients the impact of surgical access on in¯ammatory response may mimic the in¯uence of long cross-clamp and perfusion times on in¯ammatory response. Our ®ndings indicate that multiregional warm ischaemia, caused by snaring of the diseased coronary artery, causes considerably less myocardial injury than global cold ischaemia induced by cardioplegic cardiac arrest.
PubMed, 2013
Background: This study was conducted to determine whether Diabetes Mellitus (DM) is a predictor of short term mortality ; morbidity, or early readmission to hospital after Coronary Artery Bypass Graft (CABG). Methods: We analyzed a large cohort of 952 patients who had undergone isolated CABG. The preoperative, intera operative and postoperative risk factors as well as the complications and 30-day mortality rates were compared between the diabetics and non-diabetics. Among the 952 patients; 734 ones (77.1%) were in non-diabetic group and 218 (22.9%) were diabetics. Results: Having DM did not increase the risk of 30-day mortality. In addition, DM did not affect the major complications; arrhythmia, Myocardial Infarction(MI), infective complications, neurological complications, Pulmonary Embolism (PE) except renal complications that was higher in the diabetics (5.5% vs 1.4%; P<0.001, OR=4.2) However reoperation for bleeding was higher in non-diabetic patients (7.9% vs 4.6%; P=0.009, OR=1.7). Nevertheless ,no significant difference was observed between the two groups regarding mechanical ventilation time (hour), reintubation, length of ICU stay (day), length of hospital stay (day), and readmitting as postoperative variables. Conclusions: Except for renal complications, DM was not associated with adverse outcomes in the patients undergoing isolated CABG.