Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study
| Autor: | Edward Litton, Frances Bass, Anthony Delaney, Graham Hillis, Silvana Marasco, Shay McGuinness, Paul S. Myles, Christopher M. Reid, Julian A. Smith, Sean M. Bagshaw, Heidi Buhr Keri-Anne Cowdrey, Rob Frengley, Janet Ferrier, Eileen Gilder, Seton Henderson, Marco Larobina, Jan Merthens, Matthew Morgan, Lean Navarra, Máté Rudas, Lisa Turner, Kristen Reid, Matthew Wise, Noel Young, Paul Young, D McGiffin, J Duncan, M Kaczmarek, S Seevanayagam, M Shaw, G Shardey, P Skillington, T Chorley, L Baker, B Zhang, C Bright, R Baker, N Canning, null Gilfillan, R Kruger, T Fayers, M Kyte, C Doran, J Smith, H Baxter, P Seah, S Scaybrook, A James, K Goodwin, R Dignan, N Hewitt, K Gerrard, L Curtis, R Tiruvoipati, N Broukal, H Wolfenden, null Muir, M Worthington, C Wong, J Tatoulis, R Wynne, D Marshman, D Sze, M Wilson, L Turner, J Passage, M Kolybaba, G Fermanis, P Newbon, A Newcomb, J Mack, K Duve, P Jansz, T Hunter, P Bissaker, N Dennis, N Burke, S Yadav, K Cooper, R Chard, M Halaka, L Tran, M Huq, B Billah, CM Reid |
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| Rok vydání: | 2017 |
| Předmět: |
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medicine.medical_specialty Canada Time Factors Coronary Artery Disease 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Randomized controlled trial Quality of life law Risk Factors Preoperative Care medicine Humans 030212 general & internal medicine Myocardial infarction Coronary Artery Bypass Stroke Aged Ejection fraction Intra-Aortic Balloon Pumping business.industry Unstable angina Incidence Australia Perioperative Odds ratio medicine.disease United Kingdom Surgery Survival Rate Anesthesiology and Pain Medicine Female Cardiology and Cardiovascular Medicine business Follow-Up Studies New Zealand |
| Zdroj: | Journal of cardiothoracic and vascular anesthesia. 32(5) |
| ISSN: | 1532-8422 |
| Popis: | Objective To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). Design Inception cohort study. Setting A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. Participants Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina). Interventions Outcomes of interest were a composite outcome of in-hospital mortality, postoperative acute myocardial infarction (AMI), acute kidney injury (AKI), or stroke as well as 6-month vital status and quality of life using the EuroQol 5-dimensional questionnaire (EQ5D). Measurements and Main Results The study included 136 participants over a 29-month period. Overall, in-hospital and 6-month mortality occurred in 7 (5%) and 11 (8%) participants, respectively. The composite outcome occurred in 60 (44%). The mean increase in EQ5D summary index at 6 months was 0.10 (standard deviation 0.24, p = 0.01). Perioperative AMI, AKI, or stroke significantly decreased the odds of a clinically meaningful improvement in quality of life (odds ratio 0.32; 95% confidence interval 0.13-0.79; p = 0.014). Preoperative IABC was used in 39 participants and did not predict postoperative outcomes. Conclusions The study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research. |
| Databáze: | OpenAIRE |
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