UNASSIGNED: Although variation in the management of patients with non-ST-elevation myocardial infarction (NSTEMI) is well documented across US hospitals, few data exist characterizing variation in outcomes following specific management strategies.
UNASSIGNED: Admissions for NSTEMI to hospitals performing coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between 2016 and 2018 were identified from the National Inpatient Sample. Patients were categorized according to treatment rendered (medical therapy alone, angiography without revascularization, PCI, or CABG). The primary end point was variation in the incidence of composite in-hospital death, postprocedure myocardial infarction, or stroke, stratified by treatment rendered. Secondary outcomes included variation in length of stay (LOS), cost, and use of each treatment modality. Variation was characterized by the median odds ratio.
UNASSIGNED: Among 140,194 hospitalizations for NSTEMI, 35,748 (25.5%) patients received medical therapy alone, 28,678 (20.5%) underwent angiography without revascularization, 58,383 (41.6%) underwent PCI, and 17,385 (12.4%) underwent CABG. Despite adjusting for patient- and hospital-related factors, 2 similar patients were 25% more likely to experience the composite primary outcome following PCI and 45% more likely following CABG at 1 randomly selected hospital than at another. Significant hospital-level variations in LOS and cost were also apparent following each treatment modality.
UNASSIGNED: In a large national analysis of hospitalizations for NSTEMI, significant variation was observed in clinical outcome, LOS, and cost associated with each treatment modality, despite adjustment for patient- and hospital-related factors.

UNASSIGNED: Postoperative atrial fibrillation (POAF) has long been associated with poor perioperative outcomes after coronary artery bypass grafting (CABG). In this study, we aimed to investigate the effect of prolonged POAF durations on perioperative outcomes of CABG.
UNASSIGNED: This retrospective cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from January 2018 to September 2021. We compared patients with POAF durations ≥ 48 hours to patients with POAF durations < 48 hours. Primary outcomes were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney injury (AKI), and significant gastrointestinal bleeding (GIB); secondary outcomes were postoperative length of stay (LOS) and intensive care unit (ICU) duration. Associations between primary outcomes and POAF duration were determined using logistic regression and restricted cubic spline analyses. Differences in baseline characteristics were controlled using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).
UNASSIGNED: Out of 11,848 CABG patients, 3604 (30.4%) had POAF, while 1131 (31.4%) had it for a duration of ≥ 48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.47-6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42-3.99), and significant GIB (adjusted OR: 2.60, 95% CI: 1.38-5.03) were associated with POAF durations ≥ 48 hours; however, neither in-hospital mortality (adjusted OR: 1.60, 95% CI: 0.97-2.65) nor stroke (adjusted OR: 1.28, 95% CI: 0.71-2.34) was. These results remained even following PSM and IPTW analyses.
UNASSIGNED: POAF durations longer than 48 hours were independently associated with poorer perioperative recovery from CABG, with respect to the occurrence of ARF, AKI, and GIB, as well as a longer postoperative LOS and ICU duration. However, it was not associated with greater in-hospital mortality or stroke occurrence. All these findings suggest that postoperative monitoring of POAF and positive intervention after detection may be more helpful in optimizing post-CABG patient outcomes.

UNASSIGNED: To determine the effects of inspiratory muscle training (IMT) alone on inspiratory muscle strength and endurance, pulmonary function, pulmonary complications, and length of hospital stay in patients undergoing coronary artery bypass graft surgery (CABG).
UNASSIGNED: We conducted a literature search across databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus) from inception to December 2021. The eligibility criteria were randomized controlled trials that investigated the effects of IMT versus usual care or sham IMT in patients undergoing CABG.
UNASSIGNED: A total of 12 randomized clinical trials with 918 patients were included in the meta-analysis. Postoperative IMT was associated with improved maximal inspiratory pressure (MIP), maximum inspiratory pressure (PImax), and six-minute walking test (6MWT) and with a decrease in length of hospital stay (LOS). For preoperative IMT, there was statistical significance between intervention and MIP, PImax, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), postoperative pulmonary complications (PPCs), and LOS. Pre- and postoperative IMT resulted in improvements in MIP.
UNASSIGNED: Isolated IMT in patients who underwent CABG improved their inspiratory muscle strength and endurance, pulmonary function, and 6MWT and helped decrease postoperative pulmonary complications and the length of hospital stay.

Multivessel coronary artery disease is present in ∼50% of patients with acute coronary syndrome and, compared with single-vessel disease, entails a higher risk of new ischaemic events and a worse prognosis. Randomized controlled trials have shown the superiority of \'complete revascularization\' over culprit lesion-only treatment. Trials, however, only included patients treated with percutaneous coronary intervention (PCI), and evidence regarding complete revascularization with coronary artery bypass graft (CABG) surgery after culprit lesion-only PCI (\'hybrid revascularization\') is lacking. The CABG after PCI is an open, non-negligible therapeutic option, for patients with non-culprit left main and/or left anterior descending coronary artery disease where evidence in chronic coronary syndrome patients points in several cases to a preference of CABG over PCI. This valuable but poorly studied \'PCI first-CABG later\' option presents, however, relevant challenges, mostly in the need of interrupting post-stenting dual antiplatelet therapy (DAPT) for surgery to prevent excess bleeding. Depending on patients\' clinical characteristics and coronary anatomical features, either deferring surgery after a safe interruption of DAPT or bridging DAPT interruption with intravenous short-acting antithrombotic agents appears to be a suitable option. Off-pump minimally invasive surgical revascularization, associated with less operative bleeding than open-chest surgery, may be an adjunctive strategy when revascularization cannot be safely deferred and DAPT is not interrupted. Here, the rationale, patient selection, optimal timing, and adjunctive strategies are reviewed for an ideal approach to hybrid revascularization in post-acute coronary syndrome patients to support physicians\' choices in a case-by-case patient-tailored approach.

BACKGROUND: The \'gap\' continues to exist between the Indigenous and non-Indigenous populations within Australia, with Indigenous Australians continuing to experience poorer health outcomes, and a reduced life expectancy of 10.6 years for males and 9.5 for females. Indigenous Australians are far more likely to suffer from ischaemic heart disease. We sought to investigate the outcomes of Indigenous Australians undergoing isolated coronary artery bypass graft surgery (CABG) at a single institution.
METHODS: A retrospective cohort study comparing Indigenous with non-Indigenous Australians from prospectively collected data were performed for all patients who underwent isolated CABG at a single centre between 2015 and 2018. The primary endpoint was 30-day mortality with secondary endpoints including deep sternal wound infection, new renal failure, length of stay, stroke and rate of readmission.
RESULTS: A total of 905 patients were included in the study. The Indigenous cohort had 130 patients and the non-Indigenous cohort contained 775 patients. The baseline preoperative characteristics were significantly different between the two cohorts, with Indigenous patients younger (55.7 vs. 64.6 years), more likely to be female (33.1% vs. 16.4%) and to be dialysis-dependent (10% vs. 1.2%). The primary outcome was more likely in Indigenous Australians, with a 30-day mortality rate of 3.1% compared with 0.8%. There was a higher incidence of new renal failure (12.3% vs. 5.9%), red blood cell transfusion (30% vs. 20.8%).
CONCLUSIONS: Indigenous patients undergoing CABG at our institution have significantly more co-morbidities as well as worse post-operative outcomes and strategies to address this are urgently required.

UNASSIGNED: Ischemic heart disease (IHD) is a major global health issue and a leading cause of death. This study compares the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the management of IHD, focusing on their impact on revascularization, myocardial infarction (MI), and post-procedural stroke. This study aimed to evaluate and compare the effectiveness of PCI and CABG in treating IHD based on an exhaustive literature review of the past 5 years, emphasizing recent advancements and outcomes in IHD management.
UNASSIGNED: A comprehensive literature review analyzed 32 randomized controlled trials (RCTs) retrieved from databases such as PubMed, Cochrane Library, and Google Scholar. The study specifically assessed the incidences of revascularization, stroke, and MI in patients treated with either PCI or CABG. The comparison between CABG and PCI exclusively focused on lesions with a SYNTAX score exceeding 32.
UNASSIGNED: Our findings highlight CABG\'s significant efficacy over PCI in reducing revascularization and MI. The aggregated Mantel-Haenszel (M-H) value for revascularization was 1.85 (95% confidence interval (CI): 1.65 - 2.07), signifying CABG\'s advantage. Additionally, CABG demonstrated superior performance in diminishing MI occurrences (M-H = 2.71, 95% CI: 1.13 - 6.53). In contrast, PCI was more effective in reducing stroke (M-H = 0.80, 95% CI: 0.60 - 1.10).
UNASSIGNED: The study confirms CABG\'s superiority in reducing revascularization and MI in IHD patients, highlighting PCI\'s effectiveness in reducing stroke risk. These findings underscore the importance of personalized treatment strategies in IHD management and emphasize the need for ongoing research and evidence-based guidelines to aid in treatment selection for IHD patients.

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BACKGROUND: This study aimed to evaluate the vasodilatory effect of nitroglycerin (NTG) in cardioplegia solution on changes in troponin I and creatine phosphokinase-MB (CPK-MB) levels during coronary artery bypass graft (CABG) surgery.
METHODS: A randomized controlled double-blind clinical trial was performed on 44 patients who were candidates for CABG surgery. These patients were divided into two groups. In the first group (NTG group), 3 mg/kg NTG was added to the cardioplegia solution, while 10 cc placebo (distilled water) was added to the cardioplegia solution in the second group (control group). Troponin I and CPK-MB levels were then assessed before and after the surgery.
RESULTS: In this study, 72.7% and 27.3% of patients in the NTG group and 68.2% and 31.8% of patients in the control group were male and female, respectively. In addition, 9.1% within the age range of 40-50 years, 27.3% within the age range of 50-60 years, and 63.6% within the age range of more than 60 years were present in the NTG group. Moreover, 18.2% within the age range of 40-50 years, 36.4% within the age range of 50-60 years, and 45.5% within the age range of more than 60 years were present in the control group. Although the mean cardiopulmonary bypass (CPB) and cross-clamp time was insignificantly higher in the NTG group compared to the control group. In addition, troponin I and CPK-MB levels after surgery in the NTG group with the mean of 2090.68 ± 1856.07 and 97.27 ± 38.17 were significantly lower than those of the control group with the mean of 2697.02 ± 5586.56 and 137.95 ± 227.99, respectively (P-value <0.05).
CONCLUSIONS: According to the results of this study, although troponin I and CPK-MB levels increased significantly after CABG surgery, this increase was significantly lower in the intervention group compared to the control group following the administration of NTG.

Sternal non-union and fractured sternal wires are rare but devastating complications of median sternotomy for cardiac surgery, and these can lead to chronic pain, instability, and impaired quality of life. Patients may present with various symptoms such as clicking sensations, chest wall discomfort, and even respiratory difficulties. The underlying causes are multifactorial, including patient comorbidities, surgical technique, and postoperative management. The treatment options range from conservative measures to complex surgical interventions, such as sternal debridement, rewiring, and reconstruction with rigid fixation systems. Novel therapeutic technologies, including amniotic membranes and platelet-rich plasma, have shown promise in promoting wound healing and reducing complications in these challenging cases. We present the case of a 58-year-old male who underwent coronary artery bypass grafting (CABG) and subsequently developed sternal dehiscence requiring Robicsek repair. Despite undergoing this procedure, the patient experienced poor sternal healing, and hence he was referred to our center, presenting with shortness of breath, pain due to fractured sternal wires, and sternal non-union. The patient underwent a complex sternal reconstruction involving redo full median sternotomy, removal of sternal wires, and sternal plating, along with the application of amniotic membranes and platelet-rich plasma to the sternal wound. The procedure successfully stabilized the sternum. This report highlights the benefits of a multifaceted approach to addressing repeated sternal breakdown following CABG and the potential therapeutic benefits of novel technologies in promoting wound healing.