The advantage of conducting a single centre study and adhering to very strict inclusion criteria was illustrated by the homogenous demographic data of the two groups. This partly outweighed the disadvantage of having included a relatively small number of patients. Early intervention with PTA in addition to OMT seems to have a generally more positive effect compared to OMT only, on haemodynamic, functional as well as QoL aspects during the first 2 years in patients with IC.
The risk of early mortality and low-output syndrome needing intra-aortic balloon support tended to be higher in women compared with men. Women did not run an increased risk of total mortality, recurrent angina or of total non-fatal myocardial infarction. The standard mortality ratio was increased in both men and women, but in particular higher in women, suggesting a more aggressive course of coronary artery disease in operated women than in operated men. However, this difference did not show in the long term follow-up, due to the beneficial effect of coronary artery bypass surgery in both men and women.
EVVP with an ulcer healing rate of 57% and satisfactory symptom improvement seems to be an alternative of surgical treatment for selected patients with PCVI. The durability of this technique seems to be related to clinical severity and the multiplicity of repairs.
Of 1025 patients (912 men, 113 women) who underwent coronary artery bypass grafting and were followed up for a mean of 7.4 years, 45 (4.4%) had diabetes mellitus. Norwegian population is 1.8-2%). Early mortality was not significantly greater among diabetics than in non-diabetics (2.2 vs. 3.1%, odds ratio--OR-0.44, confidence interval--CI- 0.05-3.56). Diabetic patients had no increased risk of perioperative myocardial infarction (OR = 0.87, CI 0.36-2.10) or of low-output syndrome necessitating intraortic balloon pumping (OR = 0.42, CI 0.55-3.05), and no excess incidence of late non-fatal myocardial infarction (relative risk = 0.69, CI 0.10-1.28) or late chronic heart failure (OR = 2.50, CI 0.5-11.0). Long-term mortality was increased in the diabetic patients (relative risk 1.87, CI 1.60-2.14). Thus diabetes did not entail heightened risk of early mortality, perioperative myocardial infarction or low-output syndrome. Nor was there excess risk of recurrent angina pectoris, late non-fatal myocardial infarction or chronic heart failure among the diabetic patients, but the late mortality risk was increased.
VVR may lead to ulcer healing, but when performed at the popliteal level, haemodynamic improvement can be obtained along with a longer recurrence-free period (durability). VVR should be considered in the treatment of patients with SCVI who do not respond to superficial venous surgery and compression treatment.
The long-term results of 1025 patients, 912 men and 113 women, undergoing coronary artery bypass grafting (CABG) at the Cardiovascular Unit of Rikshospitalet, Oslo, between 1982 and 1986, were analyzed on factors associated with the return of angina pectoris and of non-fatal post CABG myocardial infarction. The closing date was 1st January 1993, with a mean follow-up time of 7.4 years. Recurrent angina pectoris was experienced by 118 (11.6%) patients and 102 (10%) patients experienced non-fatal post CABG myocardial infarction during the observation period. Altogether 30 possible risk factors were analyzed. The cumulative incidence of recurrent angina was initially low after operation, followed by a rise after 4 years. One, 5 and 10 years after the operation, survival free from angina rates were 97.8%, 91.8% and 80.6%, respectively. The cumulative incidence of post CABG myocardial infarction was also low initially, followed by a rise after 4 years. The survival free of non-fatal post CABG myocardial infarction rate was 98.9%, 96% and 83.5%, at 1, 5 and 10 years after surgery, respectively. The incremental risk factor of recurrent angina pectoris was hypertension. The independent risk factors of non-fatal post CABG myocardial infarction were hypertension and preoperative stenosis of the left-sided, versus right-sided, coronary arteries. The study emphasizes the favorable effect of coronary bypass surgery on the functional outcome in patients with symptomatic coronary artery disease.
When the left ventricular ejection fraction was 40% or lower, there was a substantial increase in the risk of early mortality in patients submitted to coronary artery bypass grafting. As for the risk of late mortality, there was a practically linear increase in risk with falling values of left ventricular ejection fraction. We found no difference in risk of developing recurrent angina pectoris or of late non-fatal myocardial infarction related to values of left ventricular ejection fraction.
WHAT THIS PAPER ADDS The beneficial effect of statins on long term survival after operative treatment, both open surgery and endovascular aneurysm repair (EVAR) has been confirmed. Statin therapy after abdominal aneurysm repair should be included in the guidelines. Objective: The aim was to summarise the evidence from published epidemiological studies investigating the efficacy of statin therapy on long term survival in patients after abdominal aortic aneurysm (AAA) repair. Data sources: This study was a systematic review with critical appraisal and meta-analysis of observational studies. Review methods: A systematic literature search was carried out throughout February 2020, revealing 14 eligible cohort studies of which 11 were judged to be of high quality. A random effects model was used to synthesise results, and heterogeneity between studies examined by subgroup and meta-regression analyses considering patient and study related variables. Small study effect was evaluated. Results: The pooled estimate showed that statin treatment among 69 790 AAA patients with a median follow up of 3.1 years was associated with a 35% relative reduction in total mortality (rate ratio 0.65, 95% confidence interval 0.57e0.73) with moderate heterogeneity (I 2 ¼ 68%) and no small study effect. Conclusion: Evidence from this systematic review indicates a beneficial effect of statins on long term survival in patients treated by AAA repair.
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