OBJECTIVE: To evaluate the effect of adding integrated core and graduated resistance upper limb exercises to inpatient cardiac rehabilitation program in patients with acute sternal instability after coronary artery bypass grafting (CABG).
METHODS: This was a single-center, randomized, controlled, parallel-group intervention study.
METHODS: This study was conducted at the National Heart Institute.
METHODS: Forty post-CABG patients with sternal instability aged 50-60 years completed this study and were randomized into two groups: an intervention group (n = 20) and an active control group (n = 20).
METHODS: The intervention group (A) received a routine inpatient rehabilitation program from the first postoperative day plus integrated core and graduated resistance upper limb exercises, which started from the seventh postoperative day for approximately four weeks, while the control group (B) received only the routine inpatient rehabilitation program.
METHODS: Sternal separation measured by ultrasonography, visual analogue scale for measuring pain, and activities of daily living (ADL) index were main outcome measures.
RESULTS: Patients in the intervention group (A) showed a significant reduction in sternal separation from the supine and long sitting positions, while those in the control group (B) showed a significant increase in sternal separation (p = 0.0001). Both groups showed a reduction in pain, and an increase in the ADL score was observed in Group A. There was a significant interaction between the time and group effects (p = 0.0001).
CONCLUSIONS: Adding integrated core and graduated upper limb exercises to inpatient cardiac rehabilitation for patients with sternal instability after coronary artery bypass grafting significantly improved sternal healing, pain, and ADL.

OBJECTIVE: To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG).
METHODS: A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up.
RESULTS: About 66.6% patients were treated on the native vessel, and 24.2% on grafts vessel. In all, 360 stents [83.3% drug-eluting stent (DES) and 16.6% bare metal stent (BMS)] were implanted. Diabetes mellitus (p=0.03), LVEF<55% for PCI (p=0.04), stent type [BMS (p<0.001) and DES (p<0.001)] and chronic kidney disease [(CKD) p<0.01] were appeared to be the significant predictors of mortality. Age at CABG>50 years (p=0.04), stent type [BMS (p=0.03) and DES (p<0.01)] and CKD (p<0.01) as independent predictors for MACE. Higher event rate was reported in graft-vessel PCI group as compared to native-vessel PCI group: ISR (p<0.01), TLR (p=0.01), mortality (p=0.04), MACE (p<0.01) and MI (p=0.05). Mortality (p<0.001), MACE (p<0.001) and MI (p<0.001) were significantly lower in DES vs. BMS groups.
CONCLUSIONS: Native-vessel PCI was associated with better clinical outcomes than graft-vessel PCI that also with the use of DES as the first choice in patients with a history of CABG.

Despite significant goals achieved in diagnosis and treatment in recent decades, coronary artery disease (CAD) remains a high mortality entity and continues to pose substantial challenges to healthcare systems globally. After the latest guidelines, novel data have emerged and have not been yet considered for routine practice. The scope of this review is to go beyond the guidelines, providing insights into the most recent clinical updates in CAD, focusing on non-invasive diagnostic techniques, risk stratification, medical management and interventional therapies in the acute and stable scenarios. Highlighting and synthesizing the latest developments in these areas, this review aims to contribute to the understanding and management of CAD helping healthcare providers worldwide.

BACKGROUND: The intra-aortic balloon pump (IABP) technique plays a crucial role in providing circulatory support for patients experiencing hemodynamic instability. This study aimed to assess the effectiveness and safety of preoperative prophylactic IABP insertion in patients undergoing acute critical coronary artery bypass grafting (CABG).
METHODS: A comprehensive search was conducted in PubMed, Cochrane Library, and Embase databases, covering the period from January 1995 to September 2022.
RESULTS: The incidence of renal insufficiency, mechanical ventilation exceeding 24 h, and bleeding events in the IABP group did not exhibit significant differences compared to the control group (relative risk [RR] = 0.85, P = 0.26; RR = 0.81, P = 0.08; RR = 0.95, P = 0.87). However, the hospital mortality rate was significantly lower in the IABP group than in the control group (RR = 0.54, P = 0.0007), and the length of ICU stay was shorter in the IABP group (mean difference [MD] = -1.12, P < 0.000001). The IABP group also exhibited a lower incidence of low cardiac output syndrome (LCOS%) compared to the control group (RR = 0.61, P < 0.0001), and a lower incidence of major adverse cardiac and cerebrovascular events (MACCE%) (RR = 0.70, P = 0.001). No significant publication bias was observed in the funnel plot analysis.
CONCLUSIONS: Preoperative prophylactic insertion of IABP is currently considered beneficial in improving outcomes for critically ill patients undergoing CABG. This technique reduces hospital mortality, shortens ICU stays, and lowers the incidence of LCOS% and MACCE%.

UNASSIGNED: This study leverages the GSE4386 dataset, obtained from atrial tissue samples post-coronary artery bypass graft (CABG) surgery, to investigate the impact of anesthetic agents (sevoflurane and propofol) on gene expression and immune cell infiltration.
UNASSIGNED: Hierarchical clustering and box plots were employed for dataset preprocessing, highlighting a significant outlier (sample GSM99282), subsequently removed to ensure data integrity. Differentially expressed genes (DEGs) were identified using volcano plots based on specific log-fold-change and P-value thresholds. Additional analyses included the Friends approach, Spearman\'s correlation, and gene set enrichment analysis (GSEA), exploring functional annotations and pathways.
UNASSIGNED: Heatmaps and bubble plots depicted DEGs, revealing distinct expression patterns between the sevoflurane and propofol groups. Friends analysis identified top genes based on log fold changes, further correlated using Spearman\'s method. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses illustrated functional annotations of DEGs, while GSEA highlighted enriched biological categories. Immune cell infiltration analysis showcased varied cellular presence post-CABG. ESTIMATE algorithm scores demonstrated differences in immune, stroma, and estimate scores. Microenvironment Cell Populations-counter (MCPcounter) revealed an increased abundance of cytotoxic lymphocytes in the sevoflurane group, confirmed by a single sample GSEA. CIBERSORT algorithm identified distinct immune cell compositions, highlighting differences in macrophage M0 prevalence between sevoflurane and propofol groups.
UNASSIGNED: This comprehensive analysis provides insights into anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-CABG surgery. The identified DEGs and immune cell compositions offer potential biomarkers and therapeutic targets for refining anesthetic strategies in cardiac surgeries.

Takayasu arteritis is a rare type of large vessel vasculitis that commonly affects individuals of Asian descent. Coronary artery involvement is rare. We report the case of a young female with history of Takayasu arteritis who underwent stenting and reported with in-stent restenosis. She was managed with robot-assisted coronary artery bypass grafting using bilateral internal mammary arteries.

暂无摘要。

One of the most frequent complications following coronary revascularization is cardiac myonecrosis characterized by an elevation of cardiac biomarkers, particularly with the implementation of high-sensitivity cardiac troponin. In the last decades, various definitions of periprocedural myocardial injury and infarction have been proposed, based on different cardiac biomarkers, various thresholds, and the need for additional ischemic features. In this review, we aim at providing insights on the mechanisms involved in periprocedural myocardial injury and infarction following percutaneous coronary intervention or coronary artery bypass grafting, the strengths and limitations of the available definitions and their clinical implications. We also provide an updated description of preventive strategies that have been evaluated in randomized controlled trials to avoid these complications as well as patient-level and lesion-level risk factors to better anticipate and rebalance the indication for coronary revascularization and plan adequate post-procedure monitoring.

UNASSIGNED: This systematic review explores the impact of cardiac rehabilitation programs (CRPs) on health-related quality of life (HRQoL) and physiological outcomes post-coronary artery bypass graft (CABG) surgery. Acknowledging the increasing importance of CRPs in post-CABG care, the study emphasizes the need for a comprehensive evaluation of their effectiveness. The primary objective is to investigate how CRPs influence HRQoL and physiological outcomes in post-CABG patients, offering insights into the multifaceted impact of these rehabilitation programs.
UNASSIGNED: A systematic literature review approach was employed to identify relevant studies published between 2013 and 2023. Inclusion criteria encompassed clinical randomized trials and quasi-experimental studies, with a focus on CRP interventions and their impact on HRQoL and physiological parameters.
UNASSIGNED: The review reveals a diverse array of CRP approaches, including exercise training, home-based programs, and telemonitored interventions. Despite methodological variations, a consistent positive impact on HRQoL and physiological outcomes is observed across studies. Noteworthy interventions, such as those incorporating family caregivers, demonstrate holistic benefits. However, limitations include methodological variability and the exclusion of qualitative studies.
UNASSIGNED: This systematic review underscores the substantial positive impact of CRPs on HRQoL and physiological outcomes in post-CABG patients. The diverse approaches and consistent improvements across studies provide a robust foundation for healthcare practitioners and researchers. Future efforts should focus on standardizing CRP interventions and conducting well-designed trials to further enhance the evidence base, facilitating more targeted and effective rehabilitation strategies for CABG patients.

UNASSIGNED: Coronary artery bypass graft (CABG) surgery is a common procedure to improve blood flow to the heart muscles, but patients often face challenges during the recovery period. Self-efficacy and depression play crucial roles in patient outcomes. Telephone follow-up and social network follow-up have been introduced as interventions to enhance self-efficacy. This study aims to compare the effectiveness of telephone follow-up and social network follow-up on self-efficacy and depression in CABG patients.
UNASSIGNED: The study is a single-blinded, randomized controlled trial conducted at Shahid Rajaee Heart Hospital in Tehran, Iran. The sample size was determined to be 99 patients who met the inclusion criteria. Data were collected using a demographic questionnaire, Sullivan\'s cardiac self-efficacy questionnaire, and the Beck Depression Inventory (BDI). Participants were assigned to three groups: control, telephone follow-up, and WhatsApp follow-up using randomization. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA).
UNASSIGNED: The results revealed significant improvements in self-efficacy and reductions in depression scores for both the telephone and WhatsApp follow-up groups compared to the control group following the intervention (p < 0.001). Additionally, the mean self-efficacy score was higher and the mean depression score was lower in the WhatsApp follow-up group than in the telephone follow-up group after the intervention (p < 0.001).
UNASSIGNED: The findings provide valuable insights for healthcare professionals in choosing appropriate interventions to enhance patients\' self-efficacy levels and improve mental health outcomes. Both telephone follow-up and social network follow-up interventions have their own advantages and can be effective in supporting patients\' recovery after CABG surgery.