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- Djupsjo, C, et al.
(författare)
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Preoperative disturbances of glucose metabolism and mortality after coronary artery bypass grafting
- 2020
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Ingår i: Open heart. - : BMJ. - 2053-3624. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Disturbances of glucose metabolism are important risk factors for coronary artery disease and are associated with an increased mortality risk. The aim was to investigate the association between preoperative disturbances of glucose metabolism and long-term all-cause mortality after coronary artery bypass grafting (CABG).MethodsPatients undergoing a first isolated CABG in 2005–2013 were included. All patients without previously known diabetes underwent an oral glucose tolerance test (OGTT) before surgery. They were categorised as having normal glucose tolerance (NGT), pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) or newly discovered diabetes. Data were collected from nationwide healthcare registers. Cox regression was used to calculate adjusted HR with 95% CI for death in patients with pre-diabetes and diabetes, using NGT as reference.ResultsIn total, 497 patients aged 40–86 years were included. According to OGTT, 170 (34%) patients had NGT, 219 (44%) patients with pre-diabetes and 108 (22%) patients had newly discovered diabetes. Baseline characteristics were similar between the groups except for slightly higher age among patients with newly discovered diabetes. There were 133 (27%) deaths during a mean follow-up time of 10 years. The cumulative 10-year survival was 77% (69%–83%), 83% (77%–87%) and 71% (61%–79%) in patients with NGT, pre-diabetes and newly discovered diabetes, respectively. There was no significant difference in all-cause mortality between the groups after multivariable adjustment.ConclusionIn this study, patients with pre-diabetes or newly discovered diabetes prior to CABG had similar long-term survival compared with patients with NGT.
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| 3. |
- Ivert, T, et al.
(författare)
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Dismal outcome if delayed cardiac surgery because of coronavirus disease 2019
- 2022
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Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 35:2
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Tidskriftsartikel (refereegranskat)abstract
- The coronavirus disease 2019 (COVID-19) pandemic was a great burden for health care worldwide. We encountered 21 non-infected adult patients during 2020 who deferred to seek medical treatment since they thought that their difficulties to breathe were due to COVID-19. They were diagnosed late with cardiac disease with the indication for surgery. Deferred surgery for aortic stenosis was the cause of death in 1 patient. Long-standing not-treated endocarditis had caused severe aortic root pathology in 3 patients. Late-diagnosed ST-elevation myocardial infarction in 2 patients had caused papillary muscle and ventricular wall rupture. Eighteen of the patients finally underwent heart surgery at our tertiary care centre with early mortality of 22%. We conclude that late diagnosis of subjects requiring surgical treatment for heart disease was a risk for dismal outcomes during the COVID-19 pandemic.
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| 7. |
- Lidén, K, et al.
(författare)
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Death in low-risk cardiac surgery revisited
- 2020
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Ingår i: Open heart. - : BMJ. - 2053-3624. ; 7:1, s. e001244-
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Tidskriftsartikel (refereegranskat)abstract
- A systematic review of low-risk death has been shown successful in identifying system weaknesses. The aim was to analyse early mortality in low-risk patients undergoing cardiac surgery and to determine the cause of death, classify if they were unavoidable or potentially preventable as a result of technical or system errors.MethodsWe included all low-risk patients who underwent cardiac surgery at our institution from 1 September 2009 to 31 August 2019. In patients operated between 2009 and 2011, we defined low risk as an additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) I less than or equal to 3, and from 2012 and onwards as a EuroSCORE II less than or equal to 1.5. The medical records for the patients who died within 30 days of surgery were thoroughly examined and the cause of death was classified as cardiac or non-cardiac. Furthermore, deaths were categorised as not preventable, preventable (technical error) or preventable (system error).ResultsDuring the study period 3103 low-risk patients underwent surgery, and 11 patients died within 30 days of the operation (0.35%). Six of these (55%) were classified as preventable and five non-preventable. Four of the preventable deaths were classified as technical errors and two were due to system errors.ConclusionsA repeated systematic review of deaths in patients with a low preoperative risk showed that a majority of deaths were preventable, and therefore potentially avoidable. Similar to the previous assessment at our unit, mortality was very low and failure to communicate remains a modifiable factor that should be addressed.
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