The effect of spironolactone in reducing the risk of postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery: randomized single-blind placebo-controlled study.

BACKGROUND: Postoperative atrial fibrillation (POAF), one of the most common cardiac arrhythmias following coronary artery bypass graft (CABG) surgery is associated with unfavorable outcomes. OBJECTIVES: This study investigated the effect of spironolactone administered two weeks before surgery on the incidence of POAF in patients undergoing CABG. METHODS: This randomized single-blind placebo-controlled study was conducted on 130 CABG patients. All patients were randomly divided into intervention and control groups including 65 cases for each group. In the intervention group, patients received 50 mg of spironolactone orally daily for 2 weeks before surgery, and in the control group patients received placebo daily from 2 weeks before surgery. All patients were continuously monitored for the occurrence of POAF for two weeks postoperatively. RESULTS: The mean age of the patients in the intervention and control groups was 61.7 ± 5.4 and 60 ± 6.7 years, respectively. The incidence of POAF in the intervention and control groups was 7.7% and 20%, respectively (Odds Ratio = 0.33, P = 0.042). All demographic and clinical variables were similar in patients with and without POAF (all P > 0.05). CONCLUSIONS: Our findings revealed that in comparison to placebo, the use of spironolactone is associated with reduced incidence of POAF in CABG candidates.

Case report: intracoronary stent fracture complicated with coronary abscess and fistulization into the pericardium.

Background: Stent fractures are a rare complication of angioplasties and are an unusual substrate for coronary abscesses. Case summary: A 63-year-old patient came into the emergency department for ongoing chest pain. The patient had recently undergone coronary stent implantation, 3 months prior. Computed tomography coronary angiography revealed a coronary abscess and stent fracture, with blood effraction into the pericardium. The patient underwent emergency open-heart surgery to clear the infection and perform coronary artery bypass graft surgery. Post-operative outcome was tentatively favourable. The patient suffered acute kidney injury and required haemodialysis. Discussion: Coronary stent fracture is a rare complication which can be life-threatening and which can lead to severe sequelae.

Frailty, age, and treatment effect of surgical coronary revascularization in ischemic cardiomyopathy: a post hoc analysis of the STICHES trial.

Frailty is common among older patients with heart failure (HF). The efficacy of coronary artery bypass grafting (CABG) on the risk of mortality among frail patients with ischemic cardiomyopathy and HF is uncertain, and whether frailty burden modifies the treatment benefits of CABG among these patients is unknown. We performed a post hoc analysis of the STICHES trial, a randomized trial of CABG with medical therapy vs medical therapy alone among participants with ischemic cardiomyopathy with ejection fraction ≤ 35%. Baseline frailty was assessed through a Rockwood Frailty Index (FI), and based on FI cut-offs from prior HF studies, participants with FI ≥ 0.311 were classified as more frail, and those with FI < 0.311 were classified as less frail. A multivariable Cox proportional hazard model with multiplicative interaction terms was constructed to evaluate whether frailty status modified the treatment effect of CABG on mortality in the overall trial cohort and among those < 60 vs ≥ 60 years of age. Of 1187 participants (12.4% female, 2.6% Black, median FI = 0.33 [IQR 0.27-0.39]), 678 were characterized as more frail. Frailty burden did not modify the efficacy of CABG on the risk of all-cause death in the overall cohort (Pint CABG × frailty = 0.2). In age stratified analysis, Baseline frailty status did not modify the treatment effect of CABG on the risk of all-cause mortality among younger (< 60 years, Pint CABG × frailty = 0.2) as well as older participants (≥60 years, Pint CABG × frailty = 0.6). In this post hoc analysis of the STICHES trial, baseline frailty status did not modify the efficacy of CABG in the overall cohort as well as among younger or older participants. Frailty alone should not be used as a criterion to determine the utilization of CABG among patients with ischemic cardiomyopathy.

Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients.

OBJECTIVES: To evaluate the long-term angiographic patency of saphenous vein grafts (SVG) harvested using the no-touch technique compared to the conventional technique. METHODS: This was a single-center, retrospective, cohort study. The inclusion criteria were individuals who underwent a CABG (coronary artery bypass grafting) between January 1995 and July 2020, and who successively needed a clinically-driven angiography. The primary endpoint was long-term patency. The secondary endpoints were differences in patency based on sub-group analysis (single vs. sequential graft, divided by target vessel). RESULTS: The study included 1520 individuals (618 no-touch, 825 conventional and 77 arterial grafts). The mean clinical follow-up time was 8.4 years ± 5.5 years. The patency per patient was 70.7% in the no-touch grafts vs. 46.7% in the conventional grafts (p < 0.001, OR = 2.8). The graft patency was 75.9% in the no-touch grafts vs. 62.8% in the conventional grafts (p < 0.001, OR = 1.8). CONCLUSIONS: The no-touch vein grafts were associated with statistically significantly higher patency at long-term compared to the conventional grafts. CLINICAL TRIAL REGISTRATION: NCT04656366, 7 December 2020.

On-Pump or Off-Pump Impact of Diabetic Patient Undergoing Coronary Artery Bypass Grafting 5-Year Clinical Outcomes.

Background: For diabetic patients undergoing coronary artery bypass grafting (CABG), there is still a debate about whether an off-pump or on-pump approach is advantageous. Methods: A retrospective review of 1269 consecutive diabetic patients undergoing isolated, primary CABG surgery from January 1, 2013 to December 31, 2015 was conducted. Among them, 614 received non-cardiopulmonary bypass treatment during their operation (off-pump group), and 655 received cardiopulmonary bypass treatment (on-pump group). The hospitalization outcomes were compared by multiple logistic regression models with patient characteristics and operative variables as independent variables. Kaplan-Meier curves and Cox proportional-hazard regression models for mid-term (2-year) and long-term (5-year) clinical survival analyses were used to determine the effect on survival after CABG surgery. In order to further verify the reliability of the results, propensity-score matching (PSM) was also performed between the two groups. Results: Five-year all-cause death rates were 4.23% off-pump vs. 5.95% on-pump (p = 0.044), and off-pump was associated with reduced postoperative stroke and atrial fibrillation. Conclusions: These findings suggest that off-pump procedures may have benefits for diabetic patients in CABG.

Different Oxidative Stress and Inflammation Patterns of Diseased Left Anterior Descending Coronary Artery versus Internal Thoracic Artery.

BACKGROUND: Oxidative stress and inflammation are typically implied in atherosclerosis pathogenesis and progression, especially in coronary artery disease (CAD). Our objective was to investigate the oxidative stress and inflammation burden directly associated with atherosclerotic plaque in patients with stable coronary disease undergoing coronary artery bypass graft (CABG) surgery. Specifically, markers of oxidative stress and inflammation were compared in blood samples obtained from the atherosclerotic left anterior descending artery (LAD) and blood samples obtained from the healthy left internal thoracic artery (LITA), used as a bypass graft, within the same patient. METHODS: Twenty patients scheduled for off-pump CABG were enrolled. Blood samples were collected from the LITA below anastomosis and the LAD below the stenosis. Samples were analysed for oxidative stress (sNOXdp, H2O2, NO) and inflammation markers (TNFα, IL-6, IL-1ß, IL-10). RESULTS: The analysis showed a significant increase in oxidative stress burden in the LAD as compared to LITA, as indicated by higher sNOX2-dp and H2O2 levels and lower NO levels (p < 0.01). Also, pro-inflammatory cytokines were increased in the LAD as compared to the LITA, as indicated by higher TNFα and IL-6 amounts (p < 0.01). On the other hand, no significant differences could be seen regarding IL-1ß and IL-10 levels between the two groups. CONCLUSIONS: The oxidative stress and inflammatory burden are specifically enhanced in the LAD artery of stable coronary patients compared to systemic blood from the LITA of stable coronary patients.

Treatment of left main coronary artery thrombus during SARS-CoV-2: early surgical revascularization is key.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause a hypercoagulable state leading to coronary artery thrombosis. The optimal management of this phenomenon has not been well elucidated. We describe a 38-year-old male who developed an ST-elevation myocardial infarction secondary to a left main coronary artery thrombus after SARS-CoV-2. The patient failed anticoagulation and fibrinolysis and developed decompensated heart failure. Ultimately, the patient underwent surgical revascularization, which led to full recovery. This highlights the need for refinement in this population. We recommend that early surgical intervention be considered in patients with ST-elevation myocardial infarction secondary to left main coronary artery thrombus in the setting of SARS-CoV-2.

Chylopericardium and cardiac tamponade as rare complications of coronary artery bypass graft (CABG): A case report.

INTRODUCTION: Chylopericardium, a rare condition involving the accumulation of chylous fluid in the pericardial cavity, arises due to lymphatic system disruption. It is frequently linked to trauma, malignancy, or cardiothoracic surgeries. Although primarily reported in pediatric cases, its occurrence in adults, particularly following coronary artery bypass graft (CABG), is rare. CASE PRESENTATION: We present the case of a 62-year-old male who, one week after CABG, developed progressive dyspnea, weakness, and fatigue. Physical examination revealed signs of cardiac tamponade, and echocardiography confirmed severe pericardial effusion with right ventricular collapse. Pericardial fluid analysis demonstrated chylous fluid with elevated triglycerides and protein levels, diagnosing chylopericardium-induced cardiac tamponade. Despite surgical intervention, an emergency pericardiocentesis was performed to stabilize the patient, followed by a pericardial window, thoracic duct ligation, and aggressive management with total parenteral nutrition (TPN) and albumin; however, the patient's condition deteriorated, resulting in cardiac arrest and death. DISCUSSION: Chylopericardium following cardiac surgery is a rare but serious complication. It typically arises from inadvertent injury to the thoracic duct during the procedure, exacerbated by increased postoperative venous pressure. Diagnosis hinges on pericardiocentesis, revealing milky fluid with high triglycerides and protein levels. While conservative treatment may suffice in minor cases, severe chylopericardium often necessitates surgical intervention. This case underscores the challenge of diagnosing this rare complication and the critical need for timely intervention. CONCLUSION: This case highlights the importance of early recognition and aggressive management of post-CABG chylopericardium. Rapid deterioration, despite prompt treatment, emphasizes the need for heightened clinical awareness to prevent fatal outcomes.

The impact of inflammatory and oxidative stress biomarkers on the sympathetic nervous system in severe coronary atherosclerosis.

Objective: The present study aimed at evaluating the association between sympathetic nervous system activation (SNS) and the severity of coronary artery disease (CAD). In addition, we tested the hypothesis that inflammation and oxidative stress influence the SNS activation. Methods: Adult patients with severe CAD scheduled for coronary artery bypass graft (CABG) surgery were enrolled. SYNTAX I score was calculated based on coronary angiography. Systemic activation of the SNS was estimated through circulating levels of norepinephrine (NE). Plasma levels of pro-inflammatory cytokines (IL 1ß, IL 6 and HIF 1α) and oxidative stress molecules (SOD-1 and LOX-1) were obtained prior to surgery. Results: Circulating NE levels were significantly correlated with the severity of CAD, as assessed by the SYNTAX I score (p 0.002; r 0.329). Elevated levels of circulating pro-inflammatory markers were significantly correlated with increased NE concentrations (for IL-1ß: p < 0.001, r = 0.49; for IL-6 and NE: p = 0.003, r = 0.32; for HIF-1α and NE: p = 0.049, r = 0.21). Additionally, oxidative stress molecules were associated with circulating NE levels (for SOD-1 and NE: p = 0.016, r = 0.26; for LOX-1 and NE: p = 0.004, r = 0.31). Conclusion: In patients with CAD referred for CABG, SNS activation, indicated by plasma NE levels, was correlated with disease severity as assessed by the SYNTAX I score, as well as with markers of inflammation and oxidative stress. This suggests that inflammation, oxidative stress, and SNS activation form an interconnected network, with each component influencing the others. It might be of interest to develop a scoring system including inflammation and oxidative stress markers to identify patients that require a more aggressive approach to lower inflammation, oxidative stress and modulate the sympathetic nervous system. This could be of use especially in the setting of a scheduled intervention -such as CABG surgery.

Does the experience of the endoscopic vein harvester matter to the quality of the vein conduit: A critical thematic literature review.

Coronary artery bypass graft surgery remains the golden standard surgical option for multiple vessel disease. Harvesting the long saphenous vein using endoscopic vein harvesting requires advanced surgical skills dexterity, but the lack of a national standardised training programme allows for variance in the learning curve and the quality of the vein during the learning cycle is unknown. A search of bibliographic databases: CINHAL Plus, Embase, Pubmed and the Cochrane register for randomised controlled trials identified 11 articles eligible for review. The themes emerging were learning curve-associated injuries to the long saphenous vein, intimal wall remodelling of the long saphenous vein and incidence of graft patency rates. Harvesting practitioners with less than 100 cases of experience inflict more conduit injuries leading to endothelial remodelling and narrowed vein grafts at the six-month point resulting in lumen loss. Practitioners with more than 100 cases demonstrated reduced learning curve-related injuries on the conduit. Adopting a formalised structured training programme such as the Manchester Endoscopic Learning Tool has shown to reduce endothelial injury to the long saphenous vein minimising early vein graft failure during the learning cycle.

Independent factors for the development of vasoplegic syndrome in patients undergoing coronary artery bypass surgery.

Objective: Vasoplegic syndrome remains a common complication of cardiac surgery. It has serious implications for the healthcare system and individual patients, as it leads to rising healthcare costs and higher mortality. A better understanding of factors triggering vasoplegic syndrome is essential for the development of effective prevention strategies. We aimed to identify clinical characteristics and intraoperative parameters associated with the development of vasoplegic syndrome in coronary artery bypass graft surgery and the influence of vasoplegia on outcome. Methods: We retrospectively analyzed the data of all patients who underwent isolated coronary artery bypass graft surgery or coronary artery bypass graft surgery combined with atrial appendage occlusion, using the heart-lung machine at our institution from 04/2019 to 12/2020. Vasoplegic syndrome was defined as MAP ≤60 mmHg and norepinephrine equivalence dosage of ≥0.2 µg/kg/min with a central venous saturation ≥60% within 2 days from surgery. Results: Of 647 patients included in this study, 72 (11.1%) developed vasoplegic syndrome. Patients experiencing vasoplegia had longer stay in ICU, more frequently underwent tracheostomy and suffered more often from pneumonia. The duration of extracorporeal circulation, intraoperative application of platelet concentrates and usage of cold crystalloid cardioplegia (Bretschneider) independently predicted development of vasoplegic syndrome. Conclusions: Even in relatively low-risk cardiac surgery, vasoplegic syndrome is a common complication and was associated with serious adverse effects. The use of warm blood cardioplegia (Calafiore) seems to be safer than cold crystalloid cardioplegia (Bretschneider) and might be preferable in patients that are vulnerable to the consequences of vasoplegic syndrome.

To be or not to be on: aspirin and coronary artery bypass graft surgery.

Aspirin's role in secondary prevention for patients with known coronary artery disease (CAD) is well established, validated by numerous landmark trials over the past several decades. However, its perioperative use in coronary artery bypass graft (CABG) surgery remains contentious due to the delicate balance between the risks of thrombosis and bleeding. While continuation of aspirin in patients undergoing CABG following acute coronary syndrome is widely supported due to the high risk of re-infarction, the evidence is less definitive for elective CABG procedures. The literature indicates a significant benefit of aspirin in reducing cardiovascular events in CAD patients, yet its impact on perioperative outcomes in CABG surgery is less clear. Some studies suggest increased bleeding risks without substantial improvement in cardiac outcomes. Specific to elective CABG, evidence is mixed, with some data indicating no significant difference in thrombotic or bleeding complications whether aspirin is continued or withheld preoperatively. Advancements in pharmacological therapies and perioperative care have evolved significantly since the initial aspirin trials, raising questions about the contemporary relevance of earlier findings. Individualized patient assessments and the development of risk stratification tools are needed to optimize perioperative aspirin use in CABG surgery. Further research is essential to establish clearer guidelines and improve patient outcomes. The objective of this review is to critically evaluate the existing evidence into the optimal management of perioperative aspirin in elective CABG patients.

A systematic review and meta-analysis of differences between men and women in short-term outcomes following coronary artery bypass graft surgery.

We provide an update regarding the differences between men and women in short-term postoperative mortality after coronary artery bypass grafting (CABG) and highlight the differences in postoperative risk of stroke, myocardial infarction, and new onset atrial fibrillation. We included 23 studies, with a total of 3,971,267 patients (70.7% men, 29.3% women), and provided results for groups of unbalanced studies and propensity matched studies. For short-term mortality, the pooled odds ratio (OR) from unbalanced studies was 1.71 (with 95% CI 1.69-1.74, I2 = 0%, p = 0.7), and from propensity matched studies was 1.32 (95% CI 1.14-1.52, I2 = 76%, p < 0.01). For postoperative stroke, the pooled effects were OR = 1.50 (95% CI 1.35-1.66, I2 = 83%, p < 0.01) and OR = 1.31 (95% CI 1.02-1.67, I2 = 81%, p < 0.01). For myocardial infarction, the pooled effects were OR = 1.09 (95% CI = 0.78-1.53, I2 = 70%, p < 0.01) and OR = 1.03 (95% CI = 0.86-1.24, I2 = 43%, p = 0.18). For postoperative atrial fibrillation, the pooled effect from unbalanced studies was OR = 0.89 (95% CI = 0.82-0.96, I2 = 34%, p = 0.18). The short-term mortality risk after CABG is higher in women, compared to men. Women are at higher risk of postoperative stroke. There is no significant difference in the likelihood of postoperative myocardial infarction in women compared to men. Men are at higher risk of postoperative atrial fibrillation after CABG.

Effectiveness of Osteopathic Manipulative Treatment on Hemodynamic and Pulmonary Response in Coronary Artery Bypass Graft Patients: A Meta-Analysis.

In the realm of cardiovascular care, the quest for innovative and holistic approaches to enhance patient outcomes persists. This study analyzes osteopathic manipulative treatment (OMT) and its potential impact on pain intensity, length of hospitalization, respiratory function, and hemodynamic response in patients undergoing coronary artery bypass grafting (CABG). OMT, with its emphasis on physical manipulation of the body's muscles and tissues, presents a potential treatment beyond the realms of conventional post-operative care. Google Scholar was used to identify four relevant articles for further review. RevMan 5.4 was utilized for meta-analytic evaluation in order to produce forest plots with associated standardized mean difference (SMD), confidence interval (CI), and heterogeneity (I²). Output from collection and analysis revealed statistically significant decreases in negatively viewed outcomes, including length of stay (SMD 0.39; 95% CI -0.02,-0.76; I² ≤ 0%) and pain control (SMD 1.67; 95% CI -1.34,-0.67; I² ≤ 94%). Parameters for respiratory function and hemodynamic response, including vital capacity (SMD 0.91; 95% CI 0.57,1.24; I² ≤ 96%) and maximal aerobic capacity (SMD 0.50; 95% CI 0.19, 0.82; I² ≤ 0%), showed a statistically significant increase. These findings suggest the incorporation of OMT as a viable adjunct for postoperative management in CABG patients, yielding favorable reductions in adverse outcomes such as length of hospitalization and pain. Moreover, it has demonstrated enhancement in maximal aerobic and vital capacity. This study suggests that the addition of osteopathic management to post-bypass standards can ultimately prevent certain morbidities associated with this specific patient population.

Effect of Adding Integrated Core and Graduated Upper Limb Exercises to Inpatient Cardiac Rehabilitation on Sternal Instability After Coronary Artery Bypass Grafting: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of adding integrated core and graduated resistance upper limb exercises to an inpatient cardiac rehabilitation program in patients with acute sternal instability after coronary artery bypass grafting (CABG). DESIGN: This was a single-center, randomized, controlled, parallel-group intervention study. SETTING: This study was conducted at the National Heart Institute. PARTICIPANTS: Forty patients with post-CABG with sternal instability aged 50-60 years completed this study and were randomized into 2 groups: an intervention group (n=20) and an active control group (n=20). INTERVENTION: 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 4 weeks, whereas the control group (B) received only the routine inpatient rehabilitation program. MAIN OUTCOME MEASURES: Sternal separation measured by ultrasonography, visual analog 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, whereas those in the control group (B) showed a significant increase in sternal separation (P=.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=.0001). CONCLUSION: 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.

CCTA-Guided Invasive Coronary Angiography in Patients With CABG: A Multicenter, Randomized Study.

BACKGROUND: Coronary computed tomography angiography (CCTA) in patients with post-coronary artery bypass graft (CABG) has a high diagnostic accuracy for visualization of grafts. Invasive coronary angiography (ICA) in patients with CABG is associated with increased procedural time, contrast agent administration, radiation exposure, and complications, compared with non-CABG patients. The aim of this multicenter, randomized controlled trial was to compare the strategy of CCTA-guided ICA versus classic ICA in patients with prior CABG. METHODS: Patients with prior CABG were randomly assigned (1:1 ratio) to have a CCTA before ICA (CCTA-ICA, group A) or not (ICA-only, group B). The primary end point of the study was the total volume (milliliters) of the contrast agent administered. RESULTS: A total of 251 patients were randomized, and 225 were included in analysis; 110 in group A and 115 in group B. The total contrast volume was higher in group A (184.5 [143-255] versus 154 [102-240] mL; P=0.001). The contrast volume administered during the invasive procedure was lower in group A (101.5 [60-151] versus 154 [102-240]; P<0.001). Total fluoroscopy time was decreased in group A (480 [259-873] versus 594 [360-1080] seconds; P=0.027), but total effective dose was increased (24.1 [17.7-32] versus 10.8 [5.6-18] mSv; P<0.001). The rate of contrast-induced nephropathy, periprocedural complications, and major adverse cardiac events during 3 to 5 and 30 days did not differ significantly between the 2 groups. CONCLUSIONS: A CCTA-directed ICA strategy for patients with CABG is associated with expedition of the invasive procedure, and less fluoroscopy time, at the cost of higher total contrast volume and effective radiation dose, compared with the classic ICA approach. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04631809.

Robot-Assisted Minimally Invasive Coronary Artery Bypass Grafting: Total Arterial Revascularization Using the Double-Docking Technique.

OBJECTIVE: The right internal mammary artery is considered to be the second choice for arterial conduits for coronary artery bypass grafting (CABG). However, the widespread use of bilateral internal mammary artery (BIMA) grafting is limited owing to increased technical demands, lengthy procedure, and high incidence of sternal wound complications. We compared the early clinical outcomes of a novel robot-assisted double-docking technique (DDT) with an open sternotomy technique for total arterial revascularization using BIMA. METHODS: Between June 2019 and June 2023, 445 patients with multivessel coronary artery disease underwent open sternotomy CABG using BIMA grafting and 145 patients underwent robot-assisted BIMA grafting using DDT. Comparative analysis of 104 pairs of matched patients obtained using propensity score matching was performed. Procedural characteristics, postoperative 30-day mortality, and composite outcome (major adverse cardiac and cerebrovascular events) at a median follow-up of 1.5 years were evaluated. RESULTS: Preprocedural characteristics were well balanced between the groups after propensity matching. The number of distal anastomoses performed in the conventional group was statistically higher than that performed using DDT (P < 0.001). The durations of postsurgical ventilation, intensive care unit stay, and in-hospital stay were significantly lower with the DDT than with conventional CABG (P < 0.001). There was no significant difference in all-cause mortality or major adverse cardiac events between the DDT and conventional CABG groups at a median follow-up of 1.5 years. CONCLUSIONS: The DDT is feasible and efficacious for revascularization of multiple coronary targets in select individuals. It is equivalent to open sternotomy in terms of early clinical outcomes and superior to open sternotomy with regard to rates of sternal infection and intensive care unit and in-hospital stay.

Emerging therapeutic and diagnostic strategies for coronary artery disease: Current trends and future perspectives.

Coronary vascular disease (CVD) is the general term used to cover conditions like narrowed blood vessels that may cause stroke or heart attack. Coronary artery disease (CAD) is one of the CVD and it is the most severe disease worldwide. The traditional treatment for CAD includes Coronary Artery Bypass Graft Surgery (CABG) and Percutaneous Coronary Intervention (PCI). The evolution of science and technology has led to advancement in the treatment of CAD. Nanoparticles are very suitable for the treatment of CAD by using it as a capsule for targeted drug delivery. Non-coding RNAs like si-RNA and mi-RNA are used as therapeutic agents due to their unique characteristics. In recent years, this si-RNA and miRNA usage in treating diseases has significantly increased. These are used as therapeutic agents for CAD treatment due to their properties like unique mode of action and regulation of gene expression. Another treatment for CAD is stem cells. These are used in CAD treatment because they improve blood supply to the areas where the blood vessels are narrowed down due to atherosclerosis and also, they promote cardiac cell regeneration. These RNA and stem cells are usually encapsulated with nanoparticles to avoid degradation. In this article let us discuss in detail about the treatments of CAD.

Acetylsalicylic acid alone or in combination with either enoxaparin or unfractionated heparin for postoperative thromboprophylaxis in coronary artery bypass surgery patients. A randomised clinical trial assessing surrogate outcomes.

INTRODUCTION: Coronary artery bypass graft surgery has considerable effects on patient haemostasis. Heparins as thromboprophylaxis may be beneficial but may also increase the risk of bleeding complications. OBJECTIVES: To assess the effects of heparins on haemostasis in post-coronary artery bypass graft patients. METHODS: Across one year, we randomised 60 participants scheduled for an elective coronary artery bypass graft-procedure with or without aortic valve replacement. The trial was a prospective, open-label (though blinded for the laboratory), randomised, single-centre trial with three intervention groups (n = 20 in each): group 1 received acetylsalicylic acid, group 2 received subcutaneous low molecular weight heparin and acetylsalicylic acid, and group 3 received intravenous unfractionated heparin and acetylsalicylic acid. Primary outcomes were platelet activation (Multiplate® ASPI-test) and time to clot initiation (TEG® R-time). We secondly assessed several additional Multiplate® and TEG® parameters. RESULTS: Group 3 (intravenous unfractionated heparin) compared with group 1 (acetylsalicylic acid alone) showed evidence of 1) increased clot initiation time (R-time + 0.9 min; 95 % CI: +0.4 to +1.4 min; P = 0.009), and 2) decreased 30-min lysis (-1.3 %; 95 % CI: -2.1 to -0.5 %; P = 0.02). The remaining analyses of primary and secondary outcomes showed no evidence of a difference between the three groups. DISCUSSION: Intravenous unfractionated heparins may increase the clot initiation time post-operatively after coronary artery bypass graft surgery and reduce lysis. Otherwise, there seems to be no effect of low molecular weight or unfractionated heparin on haemostatic parameters after coronary artery bypass surgery patients.