Recovery free of heart failure after acute coronary syndrome and coronary revascularization

Abstract

AimsPrevious studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies.Methods and resultsNova Scotia residents (1995–2012) undergoing CABG within 3 weeks of ACS were included. The primary outcome was freedom from readmission to hospital due to HF. Descriptive statistics were generated, and a Cox proportional hazards model assessed outcome with adjustment for clinical characteristics. Of 11 936 Nova Scotians who underwent isolated CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in 210 (6%) of subjects prior to discharge. A total of 3054 patients were included in the long‐term analysis. During follow‐up, HF necessitating readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2 years. The adjusted Cox model demonstrated significantly better freedom from HF for younger, male subjects without metabolic syndrome and no history of chronic obstructive pulmonary disease, renal insufficiency, atrial fibrillation, or HF.ConclusionsOur findings have outlined important clinical variables that predict freedom from HF. Furthermore, we have shown that 12% of patients undergoing CABG after ACS develop HF (2 years). Our findings support our next phase in which we plan to prospectively collect blood and tissue specimens from ACS patients undergoing CABG in order to determine novel biological mechanism(s) that favour resolution of post‐ACS inflammation.

Impact of Obesity on Postoperative Outcomes following cardiac Surgery (The OPOS study): rationale and design of an investigator-initiated prospective study

“…To this biobank, we can link clinical history and blood sample analyses with gene, protein and cellular expression profiles of critical regulators of CVD and metabolic disease. 47 48 …”

Single Versus Multiple Arterial Revascularization in Patients With Reduced Renal Function

“…It represents an independent risk factor for adverse outcomes including bleeding, infection, readmission, and decreased short-and long-term survival. [5][6][7] In patients with renal insufficiency undergoing CABG, the use of typical MAR strategies such as bilateral internal thoracic arteries (ITAs) or the radial artery (RA) raises additional concern pertaining to future vascular access for hemodialysis and the potential development of a steal syndrome. 8 It is remarkable that data related to the effects of MAR versus SAR use on long-term outcomes in patients with renal insufficiency are lacking; furthermore, cardiac patients with renal insufficiency are often excluded from participating in randomized controlled trials.…”

“…Chronic renal insufficiency is prevalent in cardiac surgery patients. It represents an independent risk factor for adverse outcomes including bleeding, infection, readmission, and decreased short- and long-term survival 5–7 . In patients with renal insufficiency undergoing CABG, the use of typical MAR strategies such as bilateral internal thoracic arteries (ITAs) or the radial artery (RA) raises additional concern pertaining to future vascular access for hemodialysis and the potential development of a steal syndrome 8 …”