OBJECTIVE: Patients undergoing coronary artery bypass graft (CABG) surgery may experience psychological complications, which can increase mortality. This review aims to explore the efficacy of music therapy as an intervention to reduce anxiety pre- and post-operatively in CABG surgery.
METHODS: This was a quantitative systematic review registered in PROSPERO (REDACTED).
METHODS: This review used the PECOD framework to identify quantitative questions. We systematically searched seven electronic databases (Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PubMed, Embase, PsycArticles, and PsycInfo) for articles published between 1 January 1992 and 13 July 2022. Studies were critically appraised, and the results of this systematic review yielded a narrative summary of the findings.
RESULTS: Four randomized control trials and one quasi-experimental study published in English were included in the review. Narrative analysis indicated that patients undergoing CABG who were assigned to the group receiving music therapy reported significantly reduced anxiety levels compared with controls who did not listen to music. In addition, music therapy can effectively be used as a non-pharmacological intervention to manage anxiety pre- and post-operatively in CABG surgery. No members of the public or patients were involved in the design or conduct of the study.

UNASSIGNED: This study aimed to determine the effects of acupressure on the intestinal function of patients undergoing Coronary Artery Bypass Graft (CABG) surgery.
UNASSIGNED: Studies indicated that cardiovascular patients are prone to constipation. Acupressure is one of the therapeutic and palliative approaches that can be used by doctors, nurses, and even patients themselves.
UNASSIGNED: The present three-group randomized clinical trial study was conducted on 90 patients undergoing CABG surgery. In the intervention group, 48 hours after surgery the patients received acupressure points LI4 and ST25 twice a day (10 am and 6 pm) for three sequential days. In the sham group, the patients received acupressure at a 1.5 cm distance from the LI4-ST25 points, and the patients in the control group received only the usual care. This research used a demographic and medical information questionnaire, Rome IV scale, Bristol stool scale, symptom registration checklist, and daily excretion assessment checklist. The intestinal function indices were completed 24 hours after surgery (before intervention), 48, 72, 96, and 120 hours after surgery.
UNASSIGNED: All three intervention, sham, and control groups were without defecation in 24 hours (before intervention) and 48 hours after surgery. There was a significant difference between the three intervention, sham, and control groups in the number of stools after 72 hours, 96 hours, and 120 hours after the intervention (p<0.001). Also, a significant difference was observed among the three groups in terms of stool consistency 96 hours after the start of the intervention (p=0.032) and 120 hours after the start of the intervention (p<0.001).
UNASSIGNED: The results showed that patients had a significant improvement in the number of bowel movements and stool consistency in the intervention group. In acute conditions, acupressure on LI4-ST25 points can positively affect intestinal function when patients are hospitalized in the intensive care unit.

BACKGROUND: The metabolic score for insulin resistance (METS-IR) is a simple, convenient, and reliable marker for resistance insulin (IR), which has been regarded as a predictor of cardiovascular disease (CVD) and cardiovascular events. However, few studies examined the relationship between METS-IR and prognosis after coronary artery bypass graft (CABG). This study aimed to investigate the potential value of METS-IR as a prognostic indicator for the major adverse cardiovascular events (MACE) in patients after CABG.
METHODS: 1100 CABG patients were enrolled in the study, including 760 men (69.1%) and 340 women (30.9%). The METS-IR was calculated as Ln [(2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m2)/Ln [HDL-C (mg/dL)]. The primary endpoint of this study was the occurrence of major adverse cardiovascular events (MACE), including a composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and stroke.
RESULTS: The following-up time of this study was 49-101 months (median, 70 months; interquartile range, 62-78 months). During the follow-up period, there were 243 MACEs (22.1%). The probability of cumulative incidence of MACE increased incrementally across the quartiles of METS-IR (log-rank test, p < 0.001). Multivariate Cox regression analysis demonstrated a hazard ratio (95% CI) of 1.97 (1.36-2.86) for MACE in quartile 4 compared with participants in quartile 1. The addition of the METS-IR to the model with fully adjusting variables significantly improved its predictive value [C-statistic increased from 0.702 to 0.720, p < 0.001, continuous net reclassification improvement (NRI) = 0.305, < 0.001, integrated discrimination improvement (IDI) = 0.021, p < 0.001].
CONCLUSIONS: METS-IR is an independent and favorable risk factor for predicting the occurrence of MACE and can be used as a simple and reliable indicator that can be used for risk stratification and early intervention in patients after CABG.

OBJECTIVE: We aimed to identify in-hospital outcomes in young (≤ 65 years) and old (> 65 years) patients after coronary artery bypass grafting (CABG) by analyzing the effect of age on adverse events after on-pump or off-pump CABG.
METHODS: Patients older than 65 years were defined as older patients and others were defined as younger patients. The qualitative data were compared by chi-square or Fisher\'s exact tests. The quantitative data were compared by the two-sample independent t-test or Mann-Whitney U test. Multifactor binary logistic regression was used to control for confounders and to investigate the effect of age on dichotomous outcome variables such as death.
RESULTS: In the on-pump CABG population, the postoperative in-hospital mortality, the incidence of postoperative symptomatic cerebral infarction (POSCI) and postoperative atrial fibrillation (POAF) was higher in older patients than in younger patients (P value < 0.05), and age > 65 years was associated with postoperative in-hospital mortality (OR = 2.370, P value = 0.031), POSCI (OR = 5.033, P value = 0.013), and POAF (OR = 1.499, P value < 0.001). In the off-pump CABG population, the incidence of POAF was higher in older patients than in younger patients (P value < 0.05), and age > 65 years was associated with POAF (OR = 1.392, P value = 0.011).
CONCLUSIONS: In-hospital outcomes after CABG are strongly influenced by age. In on-pump CABG, the risk of postoperative death, POSCI, and POAF was higher in older patients, and in off-pump CABG, the risk of POAF was higher in older patients.

Patients undergoing coronary artery bypass graft (CABG) are at high risk for developing postoperative delirium (POD). A simple prediction rule may benefit patients from early identification of POD followed by adequate preventive strategies. The purpose of the current study was to develop and validate a POD prediction rule for patients undergoing CABG (POD-CABG), by considering all possible perioperative factors.
In this prospective cohort study, patients who underwent first elective isolated CABG were continuously enrolled from May 2014 to November 2015 in a tertiary hospital. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Patients\' perioperative risk factors were collected through interviews and review of medical records. The area under receiver-operating characteristic curve (AUC) was used to assess the overall performance of the predictive rule.
A total of 242 and 148 patients were enrolled in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified seven variables that were independently associated with POD: age (≥65 years), gender (female), history of myocardial infarction and diabetes mellitus, postoperative atrial fibrillation, the use of intra-aortic balloon pump, and serum interleukin-6 ≥478 pg/ml at 18 hours after surgery. The AUC of the POD-CABG was 0.84 (95% CI, 0.79-0.90) in the derivation cohort, and was 0.86 (95% CI, 0.80-0.91) after bootstrap resampling. The AUC was 0.81 (95% CI, 0.73-0.88) after the POD-CABG was applied to the validation cohort.
The POD-CABG with inclusion of interleukin-6 demonstrated good performance in predicting POD.

BACKGROUND: Metabolic Syndrome and diabetes mellitus are risk factors for cardiovascular disease. However, the effects of Metabolic Syndrome with or without diabetes on perioperative and long-term morbidity and mortality after Coronary Artery Bypass Graft remain unclear.
METHODS: An retrospective study was performed on 1166 patients who received isolated primary Coronary Artery Bypass Graft in Fuwai hospital. They were divided into three groups: control, Metabolic Syndrome of three factors together with diabetes and Metabolic Syndrome of three factors without diabetes (n = 868, 76 and 222 respectively). Analysis of variance, Chi-rank test, Fisher\'s exact test, Log-rank test, Cox and Logistic regression models were used for data processing. Outcomes were postoperative and 5-year survival and morbidities.
RESULTS: There were no significant differences between groups in in-hospital postoperative complications, epinephrine use, stroke, atrial fibrillation, renal failure, coma, myocardial infarction and repeated revascularization. Patients in the Metabolic Syndrome with diabetes, Metabolic Syndrome without diabetes and control groups, respectively, showed significant difference in perioperative Major Adverse Cerebral Cardiovascular Events (30.3% vs. 21.2%, 16.7%, P = 0.0071) and mortality (11.8% vs. 2.7%, 3.11%, P = 0.0003). The Metabolic Syndrome with diabetes group had higher rates of perioperative mortality than Metabolic Syndrome without diabetes (P = 0.0017, P of Fisher Test = 0.0039). Compared with non-diabetic patients with Metabolic Syndrome, those with Metabolic Syndrome and diabetes had increased long-term mortality (Adjusted HR: 4.3; 95% CI: 1.4-13.3; P = 0.0113) and Major Adverse Cerebral Cardiovascular Events (Adjusted OR: 1.7; 95% CI: 1.0-2.8; P = 0.048). Control and non-diabetic Metabolic Syndrome groups did not differ in long-term mortality but controls had lower rates of Major Adverse Cerebral Cardiovascular Events (Adjusted OR: 0.79; 95% CI: 0.64-0.98; P = 0.0329).
CONCLUSIONS: There were significance differences between the three groups in perioperative Major Adverse Cerebral Cardiovascular Events and mortality after Coronary Artery Bypass Graft. Compared with non-diabetic Metabolic Syndrome patients, patients with Metabolic Syndrome and diabetes had higher long-term Major Adverse Cerebral Cardiovascular Events and mortality. While patients free of MetS and diabetes were associated with lower incidence of long-term Major Adverse Cerebral Cardiovascular Events after Coronary Artery Bypass Graft.

The optimal revascularization technique in patients with left main coronary artery disease (CAD) remains controversial. We aimed to compare the long-term performance of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in treatment of left main CAD.
PubMed, EMBASE, and the Cochrane Library were searched until November 16, 2016.
Six randomized controlled trials and 22 matched observational studies including 22,487 patients and 90,167 patient-years of follow-up were included. PCI was associated with an overall higher risk for the major adverse cardiac and cerebrovascular events (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.14-1.77), mainly driven by higher rates of myocardial infarction (HR, 1.69; 95% CI, 1.22-2.34) and revascularization (HR, 2.80; 95% CI, 1.86-4.22). The overall risks for all-cause death (HR, 1.05; 95% CI, 0.93-1.20), cardiac death (HR, 1.05; 95% CI, 0.69-1.59), stroke (HR, 0.64; 95% CI, 0.33-1.24), and the composite safety endpoint of death, myocardial infarction, or stroke (HR, 1.06; 95% CI, 0.97-1.16) were similar between PCI and CABG. Stratified analysis based on stent types showed that the increased risk for myocardial infarction associated with PCI was only evident in patients with bare-metal stents or early-generation drug-eluting stents (DES), but not newer-generation DES. Stratified analyses based on study designs showed largely similar findings with the overall analyses, except for a significantly higher incidence of myocardial infarction in adjusted studies (HR, 2.01; 95% CI, 1.64-2.45) but a trend toward higher incidence in randomized trials (HR, 1.39; 95% CI, 0.85-2.27) associated with PCI.
Compared with CABG, PCI with newer-generation DES might be a safe alternative revascularization strategy for treatment of left main CAD, but is associated with more repeat revascularization.

Concurrent lung cancer and coronary artery disease requiring treatment with percutaneous coronary intervention or coronary artery bypass grafting is not rare. An individualized perioperative anticoagulation regimen and minimal surgical trauma will benefit the patient\'s postoperative recovery. We successfully treated a 68-year-old female patient with a lesion in the left anterior descending artery and metastatic right lung carcinoma by simultaneous minimally invasive direct coronary artery bypass grafting via a small left thoracotomy and thoracoscopic wedge resection of the lung lesion. She recovered and was discharged on the eighth postoperative day. The patient showed no symptoms of myocardial ischemia postoperatively. Computed tomography scan did not indicate metastatic lesion of lung carcinoma at 1-year follow-up. In conclusion, minimally invasive direct coronary artery bypass grafting combined with thoracoscopic wedge resection is an effective minimally invasive treatment for concurrent lung cancer and coronary artery disease. This technique eliminates the risk of perioperative bleeding and provides satisfactory mid-term follow-up results.

Postoperative atrial fibrillation (POAF) is a serious, common complication after coronary artery bypass grafting (CABG) surgery. Recently, 5 novel loci were identified to be associated with atrial fibrillation susceptibility using a combination of genotyping, eQTL mapping, and functional validation. In current study, we aim to evaluated the positive findings for POAF susceptibility after CABG among Chinese population, using a population-based, two-stage, nested case-control study with 1,400 patients. NEURL rs12415501 and CAND2 rs4642101 were significantly associated with POAF susceptibility after CABG among Chinese population in both stages. When pooled together, the ORs for each additional copy of minor allele was 1.29 (95% CI: 1.13-1.48, P = 1.7×10-4) for NEURL rs12415501, and 1.21 (95% CI: 1.08-1.36, P = 9.8×10-4) for CAND2 rs4642101. Functional validation experiments found the AF risk allele of NEURL rs6584555 and CAND2 rs4642101 correlated with an increased expression of its corresponding genes (P<0.001). In this independently collected cardiac surgery cohort, we replicated the previous findings, and 2 novel loci are independently associated with POAF risk in patients who undergo CABG surgery in Chinese population.

Copeptin can reflect individual\'s stress state and are correlated with poor outcome of critical illness. The occurrence of postoperative delirium (POD) and cognitive dysfunction (POCD) is associated with worse outcome after coronary artery bypass graft (CABG) surgery. The present study aimed to investigate the ability of postoperative plasma copeptin level to predict POD and POCD in patients undergoing CABG surgery. Postoperative plasma copeptin levels of 108 patients were measured by an enzyme-linked immunosorbent assay. It was demonstrated that plasma copeptin levels were substantially higher in patients with POD than without POD (1.8±0.6 ng/mL vs. 1.1±0.3 ng/mL; P<0.001) and in patients with POCD than without POCD (1.9±0.6 ng/mL vs. 1.1±0.4 ng/mL; P<0.001). Plasma copeptin level and age were identified as independent predictors for POD [odds ratio (OR), 67.386; 95% confidence interval (CI), 12.031-377.426; P<0.001 and OR, 1.202; 95% CI, 1.075-1.345; P=0.001] and POCD (OR, 28.814; 95% CI, 7.131-116.425; P<0.001 and OR, 1.151; 95% CI, 1.030-1.285; P=0.003) using a multivariate analysis. For prediction of POD, the area under receiver operating characteristic curve (AUC) of the copeptin concentration (AUC, 0.883; 95% CI, 0.807-0.937) was markedly higher than that of age (AUC, 0.746; 95% CI, 0.653-0.825; P=0.020). For prediction of POCD, the AUC of the copeptin concentration (AUC, 0.870; 95% CI, 0.792-0.927) was markedly higher than that of age (AUC, 0.735; 95% CI, 0.641-0.815; P=0.043). Thus, postoperative plasma copeptin level may be a useful, complementary tool to predict POD and POCD in patients undergoing CABG surgery.