The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery : cardiovascular topics

Swart, Marius; Jager, W. H. de; Kemp, Johann T; Nel, Paul J; Staden, Sarel L Van; Joubert, Gina

doi:10.5830/cvja-2012-055

Cited by 8 publications

(16 citation statements)

References 27 publications

(21 reference statements)

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“…Among coronary artery disease patients, its prevalence is 42.7% in males and 64.0% in females, with an overall prevalence of 53.0% 16. In our study, 42% of the patients had the MS, which is similar to other studies in MS patients undergoing CABG (42, 48, 47%) 11,12,17…”

Section: Discussionsupporting

confidence: 91%

“…Criteria used to define the MS may also lead to discrepant results, namely, cut-off points of criteria for the MS in various populations or even parameters of the MS (waist circumference instead of BMI) may vary. These differences may have a confounding effect on assessing the association between pre-operative MS and postoperative complications 11,12…”

Section: Discussionmentioning

confidence: 99%

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The effects of the metabolic syndrome on coronary artery bypass grafting surgery

Özkan¹,

Özdemir²,

Uğur³

et al. 2017

CVJA

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SummaryBackgroundThe metabolic syndrome (MS) is a clustering of factors that are associated with increased cardiovascular risk. A low-grade inflammatory process acts as the underlying pathophysiology, which suggests that the MS may have a detrimental effect on coronary interventions, including coronary artery bypass grafting (CABG) surgery performed with cardiopulmonary bypass (CPB). We aimed to evaluate the effect of the MS on morbidity and mortality rates in the early postoperative period in patients undergoing CABG.MethodsWe prospectively included 152 patients (109 males and 43 females; mean age 60.1 ± 8.6 years) who underwent elective CABG on CPB between January and September 2011. Early postoperative morbidity and mortality rates were compared between subjects with and without the MS. Diagnosis of the MS was based on the American National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria.ResultsOf the study group, 64 patients (42%) had the MS. The two groups were similar in age and gender. In the postoperative period, rates of atrial fibrillation, wound infection, pulmonary complications, and lengths of intubation, hospitalisation and intensive care unit stay were significantly higher in MS patients (p < 0.01). The MS was significantly associated with wound infection (OR 6.64, 95% CI: 1.72–25.75), pulmonary complications (OR 6.44, 95% CI: 1.58–26.33), arrhythmia (OR 5.47, 95% CI: 1.50–19.97) and prolonged intubation (OR 1.17, 95% CI: 1.05–1.32). The mortality rate was 3.1% in the MS group and 1.1% in the non-MS group, with no significant difference (p > 0.05).ConclusionThe MS was associated with a higher rate of early postoperative morbidity following CABG, without having a significant effect on the mortality rate.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The effects of the metabolic syndrome on coronary artery bypass grafting surgery

Özkan¹,

Özdemir²,

Uğur³

et al. 2017

CVJA

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“…14,15,32 In a recent review of a case series of coronary artery bypass surgical patients, those suffering with MetaS had a longer postoperative stay although overall outcome was not affected. 33 Many of the complications of MetaS (including atherosclerosis) are inflammatory in nature with the pathological adipose stores being the source of pro-inflammatory adipokines. 34 It is estimated that more than a quarter of the American adult population has MetaS; its prevalence is probably over-represented in the surgical population, with half of all patients undergoing cardiac surgery being afflicted by this syndrome.…”

Section: Discussionmentioning

confidence: 99%

Surgery Results in Exaggerated and Persistent Cognitive Decline in a Rat Model of the Metabolic Syndrome

Feng¹,

Degos²,

Koch³

et al. 2013

Anesthesiology

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Background Postoperative cognitive decline can be reproduced in animal models. In a well-validated rat model of the Metabolic Syndrome, we sought to investigate whether surgery induced a more severe and persistent form of cognitive decline similar to that noted in preliminary clinical studies. Methods In rats that had been selectively bred for low and high exercise endurance, the low capacity runners (LCR) exhibited features of Metabolic Syndrome (obesity, dyslipidemia, insulin resistance, and hypertension). Tibial fracture surgery was performed under isoflurane anesthesia in LCR and high capacity runner (HCR) rats and cognitive function was assessed postoperatively in a trace-fear conditioning paradigm and Morris Water Maze; non-operated rats were exposed to anesthesia and analgesia (sham). Group sizes were n = 6. Results On postoperative D7, LCR rats had shorter freezing times than postoperative HCR rats. Five months postoperatively, LCR rats had a flatter learning trajectory and took longer to locate the submerged platform than postoperative HCR rats; dwell-time in the target quadrant in a probe trial was shorter in the postoperative LCR compared to HCR rats. LCR and HCR sham rats did not differ in any test. Conclusion Postoperatively, LCR rats diverged from HCR rats exhibiting a greater decline in memory, acutely, with persistent learning and memory decline, remotely; this could not be attributed to changes in locomotor or swimming performance. This Metabolic Syndrome animal model of surgery-induced cognitive decline corroborates, with high fidelity, preliminary findings of postoperative cognitive dysfunction in Metabolic Syndrome patients.

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“…Overall, these data have shown a significant correlation between CMS and poor short‐term morbidity and mortality outcomes after CABG. However, there is controversy regarding these outcomes data, specifically whether or not there is a significant mortality difference 15 . Furthermore, there is limited data on long‐term survival in patients with metabolic syndrome who underwent CABG.…”

Section: Introductionmentioning

confidence: 99%

Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

et al. 2020

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Introduction Cardiometabolic syndrome (CMS) is diabetes mellitus (or insulin resistance) plus any two of the following risk factors: hypertension, obesity, and hyperlipidemia. The correlation of metabolic syndrome with cardiovascular disease and the increase in the prevalence of patients with risk factors have solidified the importance of continued focus on metabolic syndrome. We retrospectively evaluated single‐center data to determine if there is an association between CMS and outcomes. Methods The local Society of Thoracic Surgeons Adult Cardiac Database was queried for consecutive coronary bypass (CABG) cases from 2002 to 2010. Short and long‐term outcomes were compared between groups of patients with CMS and then risk‐adjusted using multiple regression models with adjusted odds ratios and hazard ratios. Results Of 11 021 CABG cases, 3881 (35.2%) had CMS, with an annual prevalence that increased from 32% to 40% during the study. Patients with CMS were more likely to have prior cerebrovascular diseases, strokes, renal insufficiency, and worse New York Heart Association status. Unadjusted postoperative comparisons revealed that patients with CMS had higher rates of stroke, renal failure, dialysis, deep sternal wound infection, and longer intensive care unit and hospital length of stay. Risk‐adjusted odds ratios did not reveal a significant impact on short‐term outcomes, however, adjusted hazard ratios continued to demonstrate significant decreases in long‐term survival in patients with CMS. Conclusions Patients with CMS were more likely to present with increased comorbidities. Patients with CMS undergoing CABG were at risk for worse short‐term secondary postoperative outcomes and reduced long‐term survival. The data supports the need for further investigation for risk reduction surrounding operative revascularization.

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The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery : cardiovascular topics

Cited by 8 publications

References 27 publications

The effects of the metabolic syndrome on coronary artery bypass grafting surgery

The effects of the metabolic syndrome on coronary artery bypass grafting surgery

Surgery Results in Exaggerated and Persistent Cognitive Decline in a Rat Model of the Metabolic Syndrome

Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

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