Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease.

INTRODUCTION: This article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients. METHODS: This article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation. RESULTS: 1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation. CONCLUSION: Our research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.

Associations Between Psychological Factors and Adherence to Health Behaviors After Percutaneous Coronary Intervention: The Role of Cardiac Rehabilitation.

BACKGROUND: Cardiac rehabilitation (CR) participation after percutaneous coronary intervention (PCI) for coronary heart disease lowers the disease burden and risk of recurrent cardiac events. Examining psychological factors may improve post-PCI health behavior adherence. PURPOSE: To determine whether psychological factors are associated with post-PCI health behavior adherence, and the role of CR participation. METHODS: Data from 1,682 patients (22.1% female, Mage = 64.0, SDage = 10.5 years) from the THORESCI cohort were included. Adjusted mixed models were used to examine associations between psychological factors and the 1-year course of health behaviors, using interactions to test for moderation by CR participation. RESULTS: Psychological factors were associated with the trajectories of adherence to medical advice, exercise, and diet. The strongest association found was between optimism and the trajectory of dietary adherence (B: = -0.09, p = .026). Patients with high optimism levels had a worse trajectory of dietary adherence compared to patients with low to middle optimism levels. Participation in CR buffered the associations of high anxiety, pessimism, and low to middle resilience, but strengthened the associations of high stress in the past year with the probability of smoking. CONCLUSIONS: Psychological factors are associated with post-PCI health behavior adherence, but the pattern of associations is complex. Patients with high levels of anxiety, pessimism, and low to middle resilience levels may disproportionately benefit from CR. Cardiac rehabilitation programs could consider this to improve post-PCI health behavior adherence. CLINICAL TRIALS REGISTRATION #: NCT02621216.

For patients with coronary heart disease who have undergone percutaneous coronary intervention (PCI), participating in cardiac rehabilitation (CR) reduces the disease burden and the risk of future cardiac events. However, adherence to the health behaviors targeted in CR could be improved. Using data from 1,682 patients included in the THORESCI study, we explored whether psychological factors could predict health behavior adherence and the role of participation in CR. Results revealed that psychological factors were linked to adherence to medical advice, exercise, and diet. Overall, patients with low to moderate optimism levels exhibited more favorable changes in healthy dietary habits than patients with high levels of optimism. Participation in CR made the link between high anxiety, pessimism, low to moderate resilience, and lower adherence to health behaviors less strong. Cardiac rehabilitation programs could use these results to enhance the health behavior adherence of patients who have undergone PCI.

Perceived social support among percutaneous coronary intervention patients over a long-term follow-up period.

AIM: To investigate perceived social support and the associated factors as well as the sources of social support among post-percutaneous intervention patients over a long-term follow-up period. DESIGN: An explanatory and descriptive survey with a six-year follow-up (STROBE Statement: Supplementary file 1). METHODS: Baseline data (n = 416) were collected from Finnish patients in 2013, with follow-up data collected from the same study group in 2019 (n = 154). The research employed the Social Support of Patients with Coronary Heart Disease self-reported questionnaire. Data were analysed using descriptive statistics and multivariate methods. RESULTS: In the acute phase, higher informational support was associated with lower LDL cholesterol and female gender and higher emotional support with working status. In long-term follow-up period, physical activity, younger age, normal cholesterol levels and previous percutaneous coronary intervention predicted higher informational support, regular participation in follow-up sessions and relationship status predicted higher emotional support, and previous coronary artery bypass grafting, smoking, alcohol consumption, normal cholesterol and regular follow-ups predicted higher functional support. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Effects of rehabilitation management on lifestyle and quality of life of patients with coronary heart disease after percutaneous coronary intervention based on behavior change theory.

BACKGROUND: The aim of this study was to assess the effects of rehabilitation management on the lifestyle and quality of life of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) based on the behavior change theory. METHODS: A total of 222 CHD patients admitted from January 2019 to April 2021 were randomly divided into research and control groups (N.=111). Control group was administered with routine postoperative nursing management, while research group received behavior changing nursing intervention. The quality-of-life scores, blood pressure and blood lipid levels before and after surgery, as well as length of hospitalization, treatment duration, symptom relief time, incidence rate of complications and nursing satisfaction were compared. RESULTS: After surgery, the length of hospitalization, treatment duration and symptom relief time were shorter, and the incidence rate of complications, levels of total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower in research group than those in control group, while research group was better in physical function, social function, physiological functioning, physical pain, mental health, emotional functioning, vitality and overall health scores, satisfaction and high-density lipoprotein cholesterol (HDL-C) level than control group (P<0.05). CONCLUSIONS: The application of behavior change theory in the cardiac rehabilitation management of patients with CHD after PCI can improve the lifestyle and quality of life.

Exploration on the Value of Circulation Quality Control Intervention Mode in Percutaneous Coronary Intervention in Patients with Coronary Heart Disease and Chronic Heart Failure.

BACKGROUND: Patients with coronary heart disease (CHD) often have other diseases due to organ dysfunction, among which chronic heart failure (CHF) is the most common. Percutaneous coronary intervention (PCI) is the mainstream method for the treatment of such diseases. Because most of the patients are the elderly and the functions of various organs are declining, it is necessary to implement scientific and efficient management methods. OBJECTIVE: To explore the application value of circulation quality control intervention (CQCI) mode in PCI of patients with CHD and CHF. Time: From June 2021 to June 2023. METHODS: The clinical data of 197 CHD patients with CHF were retrospectively analyzed, and 14 patients who did not meet the inclusion criteria were excluded. According to different perioperative management methods, the remaining cases were divided into the reference group (RG, receiving routine clinical management) and observation group (OG, receiving routine clinical management and CQCI). The cardiac function indexes and emotional state before and after management were compared between the two groups, and the quality of life in two groups was compared. RESULTS: In this study, 100 patients were included in the RG and 83 patients were included in the OG finally. Compared with the RG, the OG had lower levels of left ventricular end systolic diameter and left ventricular end-diastolic diameter after management (p < 0.05), while the OG had significantly higher left ventricular ejection fraction level (p < 0.001). The OG had overtly higher clinical satisfaction than the RG (p < 0.05). After management, the Hospital Anxiety and Depression Scale score in the OG were distinctly lower than those in the RG (p < 0.001). After management, the OG had significantly higher scores of physiological field, psychological field, social relationship and environmental field than the RG (p < 0.001). CONCLUSION: The application of CQCI mode in the perioperative period of PCI has certain benefits for improving the cardiac function of patients. At the same time, this program can also improve the quality of life of patients to a certain extent, which is helpful to accelerate postoperative rehabilitation.

[Evaluation of the metabolic profile and prevalence of cardiovascular disease in former combatants of the Malvinas war]. / Evaluación del perfil metabólico y prevalencia de enfermedad cardiovascular en los ex combatientes de la guerra de Malvinas.

INTRODUCTION: It has been reported in different parts of the world that war veterans are more exposed to cardiovascular risk factors. The objective of this study was to establish the risk factors, the cardiometabolic profile and the prevalence of cardiovascular disease in a group of ex-combatants of the Malvinas War (HdeM). METHODS: In a case-control design, data from 799 HdeM were analyzed and compared with 799 controls matched by age. The sample was selected from the participants of the Cardiovascular Health Prevention Program of the Favaloro Foundation, between January 2017 and December 2019. RESULTS: The average age was 56.9 ± 3.9 years. An increase in weight was observed among the HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). A higher frequency of arterial hypertension (42% vs. 34%; p < 0.001) and diabetes mellitus (15.1% vs. 10.4%; p < 0.005) was observed in HdeM. Metabolic syndrome was also more prevalent in HdeM (49.2% vs. 39.7%; p = 0.0001). It was observed that the history of acute myocardial infarction was more frequent among the HdeM (3.6% vs. 2%; p < 0.05), with a similar prevalence of stroke (1.2% vs. 1%; p = ns), coronary angioplasty (3.2% vs. 2.1%; p = ns) or myocardial revascularization surgery (0.8% vs. 0.4%; p = ns). DISCUSSION: The HdeM showed an increase in the frequency of risk factors, metabolic syndrome and acute myocardial infarction. It is important to take this increased risk into account in order to maximize cardiovascular prevention strategies in ex-combatants.

Introducción: Se ha informado que los veteranos de guerra están más expuestos a factores de riesgo cardiovascular. El objetivo del presente trabajo fue establecer los factores de riesgo, el perfil cardiometabólico y la prevalencia de enfermedad cardiovascular de un grupo de excombatientes de la Guerra de Malvinas (HdeM). Métodos: En un diseño caso-control se analizaron los datos de 799 HdeM y se compararon 799 controles de misma edad. La muestra se seleccionó de los participantes del Programa de Prevención de Salud Cardiovascular de la Fundación Favaloro, entre enero de 2017 y diciembre de 2019. Resultados: La edad promedio fue 56.9 ± 3.9 años. Se observó un aumento del peso entre los HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). Se observó mayor frecuencia de hipertensión arterial en HdeM (42% vs. 34%; p < 0.001) y diabetes mellitus (15.1% vs. 10.4%; p < 0.005). El síndrome metabólico fue más prevalente en HdeM (49.2% vs. 39.7%; p = 0.0001). Se observó que el antecedente de infarto agudo de miocardio fue más frecuente entre los HdeM (3.6% vs. 2%; p < 0.05), con similar prevalencia de ACV (1.2% vs. 1%; p = ns), angioplastia coronaria (3.2% vs. 2.1%; p = ns) o cirugía de revascularización miocárdica (0.8% vs. 0.4%; p = ns). Discusión: Los HdeM mostraron mayor prevalencia de factores de riesgo, síndrome metabólico e infarto agudo de miocardio. Es importante tener en cuenta este aumento de riesgo para maximizar las estrategias de prevención cardiovascular en los excombatientes.

Postoperative Cognitive Behavioral Intervention in Patients with Coronary Heart Disease Based on the Effect of Nursing Process Reengineering.

With the development of society and economy, patients with coronary heart disease increasingly hope to receive more humanized services after surgery, and the reengineering of the nursing process is precisely based on humanized management. In order to create a nursing intervention that helps in boosting total nursing gains and lowering disasters, the primary element of the nursing business process reengineering is to reintegrate or condense the creative work flow that was fragmented by specialization into a whole job. The "patient" is positioned in the center of nursing process reengineering, with service quality as the main guiding principle. It follows the management principles of continuous regulation and innovation, and cultivates and promotes the development of the nursing field from the perspective of "sublation." In the method part, this article introduces and supplements related information on nursing process reengineering, coronary heart disease, and postoperative cognitive behavioral intervention. Algorithmically, this paper proposes 3D RPN structure, loss function, capsule network, and improved activation function algorithm for coronary heart disease region extraction. In the part of experiment and results, this article collects general data of patients and compares memory ability, grades of self-management behaviors of patients treated with coronary heart disease, scores of quality control standards before and after nursing process reengineering, scores of patients' mental state, and comparison of postoperative physical indicators. According to the test results, the test group's diastolic and systolic blood pressure declined by more than 20, their total cholesterol dropped from 6.23 to 5.28, and their triglyceride levels dropped from 1.82 to 1.39 after the stent was implanted. Triglycerides reduced from 1.82 to 1.39, and total cholesterol dropped from 6.15 to 5.98. It indicates postoperative memory in patients with coronary heart disease. Abilities, including recognition, number, touch memory, and associative memory, decline significantly, but it can be improved after receiving the nursing process reengineering. It can be seen that nursing process reengineering can play a positive role in the postoperative cognitive behavior of patients with coronary heart disease.

Impacts of Omaha System-Based Continuing Care on the Medication Compliance, Quality of Life, and Prognosis of Coronary Heart Disease Patients After PCI.

INTRODUCTION: The objective of this study is to explore the impacts of Omaha System-based continuing care on medication compliance, quality of life (QOL), and prognosis of coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI). METHODS: A total of 100 CHD patients who were hospitalized and received PCI were selected and divided into the control group and the observation group, 50 patients per group, according to a random number table method. The control group was given routine care, while the observation group was applied Omaha System-based continuing care on the basis of the control group. RESULTS: Follow-up demonstrated that the Morisky-Green score of the observation group was significantly higher than that of the control group (P<0.001), indicating that the medication compliance of the observation group was significantly better than that of the control group (P<0.001). The short form-36 (SF-36) scores were notably higher after nursing compared with on admission; SF-36 scores of the observation group were significantly increased than those of the control group (P<0.001). The incidence of major adverse cardiac event (MACE) in the observation group was significantly lower than in the control group (P<0.001). The nursing satisfaction of the observation group was considerably higher than that of the control group (P<0.01). CONCLUSION: Omaha System-based continuing care could improve the medication compliance and QOL, reduce the incidence of MACE, and benefit the prognosis of CHD patients after PCI.

Intelligent Algorithm-Based Electrocardiography to Predict Atrial Fibrillation after Coronary Artery Bypass Grafting in the Elderly.

The objective of this study was to explore the predictive value of electrocardiogram (ECG) based on intelligent analysis algorithm for atrial fibrillation (AF) in elderly patients undergoing coronary artery bypass grafting (CABG). Specifically, 106 elderly patients with coronary heart disease who underwent CABG in the hospital were selected, including 52 patients with postoperative AF (AF group) and 54 patients without arrhythmia (control group). Within 1-3 weeks after operation, the dynamic ECG monitoring system based on Gentle AdaBoost algorithm constructed in this study was adopted. After the measurement of the 12-lead P wave duration, the maximum P wave duration (Pmax) and minimum P wave duration (Pmin) were recorded. As for simulation experiments, the same data was used as the back-propagation algorithm. The results showed that for the detection accuracy of the test samples, the Gentle AdaBoost algorithm showed 93.7% accuracy after the first iteration, and the Gentle AdaBoost algorithm was 16.1% higher than the back-propagation algorithm. Compared with the control group, the detection rate of arrhythmia in patients after CABG was significantly lower (P < 0.05). Bivariate logistic regression analysis on Pmax and Pmin showed as follows: Pmax: 95% confidential interval (CI): 1.024-1.081, P < 0.05; Pmin: 95% CI: 1.036-1.117, P < 0.05. The sensitivity of Pmax and Pmin in predicting paroxysmal AF was 78.2% and 73.4%, respectively; the specificity of them was 80.1% and 85.6%, respectively; the positive predictive value was 81.2% and 83.4%, respectively; and the negative predictive value was 79.5% and 75.3%, respectively. In conclusion, the generalization ability of Gentle AdaBoost algorithm was better than that of back-propagation algorithm, and it can identify arrhythmia better. Pmax and Pmin were important indicators of AF after CABG.

The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures.

OBJECTIVE: To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. METHODS: A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. RESULTS: Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01). CONCLUSION: Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.

MULTIMODAL LOGIT MODEL FOR PREDICTING THE EFFICIENCY OF MYOCARDIAL REVASCULARIZATION BY THE METHOD OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH CORONARY HEART DISEASE. / MUL'TYMODAL'NA LOGIT-MODEL' PROGNOZUVANNIa EFEKTYVNOSTI REVASKULIaRYZATsIÏ MIOKARDA METODOM AORTO-KORONARNOGO ShUNTUVANNIa U PATsIIeNTIV Z IShEMIChNOIu KhVOROBOIu SERTsIa.

OBJECTIVE: building of a mathematical logit model for possible prediction of the outcome of surgical treatment bythe method of coronary artery bypass grafting (CABG) in patients of different groups with coronary heart disease(CHD) based on myocardial viability (MV) assessment. MATERIAL AND METHODS: To implement the set clinical tasks, 62 patients with coronary heart disease with preservedsystolic function and systolic dysfunction were examined. The mean age of the subjects was (59.6 ± 8.2) years. 35(56 %) patients had a variant of heart failure (HF) with an ejection fraction (EF) of 45 % or less. 27 (44 %) patientshad EF of 46 % or more. 5 (8.0 %) patients denied myocardial infarction (MI). Myocardial scintigraphy (MSG) wasperformed on Infinia Hawkeye combined gamma-camera (GE, USA) with integrated CT. The studies were performedin SPECT and SPECT / CT with ECG synchronization (Gated SPECT) modes. 99mTc-MIBI with an activity of 555-740 MBqwas used. MSG was performed in the dynamics of treatment (before CABG and after CABG) according to One Day Restprotocol. A total of 124 scintigraphic studies were performed. RESULTS: Samples of patients studied «before¼ and «after¼ the treatment were compared using nonparametricWilcoxon test (Wilcoxon Matched Pairs Test). A multivariate regression model, that reflects a statistically significanteffect on the treatment response (MV after treatment) of such cardiac activity indicators as LV EF (%), coronary bedlesion area and MV level (%) before treatment, was built. The above-described regression relationship between thethree above-defined functional factors of cardiac activity before treatment and the therapeutic effect in the formof the change in MV can be construed as a diagnostic model that predicts the treatment outcome. CONCLUSIONS: This scientific study allows to build logit models to predict the expected outcome of coronary heartdisease surgical treatment in patients of different groups. The presented multivariate regression model is characterised by a sufficiently high for biostatistical studies adjusted coefficient of determination (Adjusted R2 = 0,893 (F = 173,4; p < 0,001)).

Comparison between OPCABG and CABG Surgical Revascularization Using Transit Time Flow Measurement (TTFM).

OBJECTIVE: To compare the intraoperative quality of coronary anastomoses performed with or without cardiopulmonary bypass using transit time flow measurement (TTFM) parameters. METHODS: We collected data from 588 consecutive patients who underwent surgical revascularization. We retrospectively reviewed data from two groups: 411 with cardiopulmonary bypass (CABG group) and 177 off-pump (OPCABG group). Transit time flow measurement parameters: mean graft flow (MGF), pulsatile index (PI), and diastolic filing (DF) were measured for each graft and patient. RESULTS: Patients in the OPCABG group had higher EuroSCORE compared with the CABG group (3.53 ± 2.32 versus 2.84 ± 2.15, P = .002). Overall comparison of TTFM parameters showed no statistical difference between the two surgical techniques except for PI in circumflex artery territory, which was higher in the OPCABG group for all types of grafts 3.0 ± 4.9 versus 2.4 ± 2.0 in, P = .026. CONCLUSION: The comparison between OPCABG and CABG in this study showed comparable results with both surgical techniques. PI was higher in the OPCABG group in harder-to-reach vessel territories. Measurement of transit time may improve the quality, safety, and efficacy of coronary artery bypass grafting and should be considered as a routine procedure.

SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta.

BACKGROUND: There is no study about the relationship between the complexity of coronary artery disease (SYNTAX SCORE; SS), and coronary artery calcium (CAC) score, accompanied with aortic calcium score (ACS) levels. The objective of this study was to investigate the relationship between the preoperative SS and CAC scores accompanying ACS in isolated CABG patients and their postoperative clinical results. METHODS: This study included 130 consecutive CABG patients. The mean age of the patients was 62.3 ± 8.62 years (range: 47-84 years). SS was measured using coronary angiography by an experienced cardiologist. We investigated the ACS accompanied with CAC scores using a multidetector computed tomography (MDCT) in the same session, preoperatively. Measurements of the CAC score and ACS were measured by an experienced radiologist, who was unaware of the study in the same session. In order to investigate aortic wall pathology in patients with positive aortic calcification, we provided aortic tissue samples prior to the proximal anastomosis of bypass grafts using No:11 scalpel. RESULTS: Overall median SS was 39 ± 7.2 (range: 15-41). CAC score was zero in 34 patients (26.1%). For the patients with a CAC score of zero, the median SS was 32 ± 9.4. There was no evidence of aortic calcification or plaque formation in 62 patients (47.6%). In these patients, the median SS was 35.6 ± 11.3. No significant difference was found when both groups were compared and for those patients with a calcific score of zero (P = .85). The median CAC score and ACS were 238 ± 122 AU (range: 0-1238 AU) and 112 ± 40 AU (range: 0-730 AU), respectively (P = .0033). For patients with a CAC score and ACS ≥400 AU, the mean SYNTAX score was ≥ 37. SS was correlated with CAC score (R:0.585; P < .0001). SYNTAX was correlated with ACS (R:0.557; P < .001). In multivariate analysis of SS (OR 1.053, 95% CI: 1.003-1.106, P = .039), gender (OR 0.189, 95% CI: 0.053-0.678, P = 0.011), age (OR 1.454, 95% CI: 1.256-1.632, P = .012), and diabetes mellitus (OR 0.341, 95% CI: 1.006-1.124, P = .014) were independent predictors for CAC score and aortic calcification. CONCLUSIONS: CAC score and ACS are strongly correlated with the complexity of coronary arteries in CABG patients. The total CAC score (≥ 400 AU) was independently associated with the degree of SS (>37). To prevent MACCE and mortality in CABG patients, we suggest the measurement of CAC score accompanied with ACS using MDCT as a non-invasive method. Highlight points: • Atherosclerotic plaque formation in aorta and coronary arteries are the main risk factors for stroke and infarction in CABG operations. •SYNTAX score value and aortic atherosclerosis levels are directly correlated. •SYNTAX score may predict the complications due to atherosclerosis during heart surgery.

The Importance of Selecting Permanent Pacemaker, Evaluating the Heart and Assessing Quality of Life in Cardiac Patient.

The use of pacemakers is necessary for patients with symptomatic bradycardia. Pacemaker implantation also acts as a life-saving procedure. However, there are several reports that patients with a pacemaker (the most widely used pacemaker is on the right ventricle, known as single chamber pacemaker) had disturbances in left ventricle contraction lead to left ventricular systolic dysfunction. Global Longitudinal Strain (GLS) Echocardiography can confirm these left ventricular disturbances. Echocardiography examination is best carried out before and after single-chamber PPM implantation. This study compares PPM placement in apical Right Ventricle (RV) and Right Ventricular Outflow Tract (RVOT) and compares paced QRS duration 150 ms and > 150 ms. Pacing burden >40% causes subclinical left ventricular systolic dysfunction after a month of PPM implantation with decreased GLS in apical RV pacing.This study gives additional information that PPM placement is preferably in RVOT with some specific settings. However, there are many ways to reduce the effects of impaired left ventricular function due to lead installation on the PPM single-chamber device. By using the PPM device which has a dual chamber, the leads will be placed in RVOT and also in the right atrium with atrial-ventricle synchronization. The aim is to avoid impaired left ventricular pump function as supported by a systematic review which states the superiority of dual-chamber PPM over single-chamber PPM in reducing atrial fibrillation and pacemaker syndrome. In the importance of quality of life related to heart disease, the Indonesian version of the MacNew questionnaire can be used. This questionnaire seeks the quality of life of patients with coronary heart disease after revascularization surgery and has undergone rehabilitation. Another important thing is the suitability of the adaptation to the original English version.

Risk Factors Associated with an Increased Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery.

BACKGROUND: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. METHODS: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher's exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of < 0.05 was considered to be statistically significant. SPSS 26.0 was used for calculations. RESULTS: Logistic regression analysis revealed that independent risk factors for sternal wound infection were high BMI (odds ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16), long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03), intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP concentration (OR 1.10; CI 1.05-1.16). CONCLUSIONS: Preoperative assessment to identify obese individuals as being at risk and techniques to minimize the duration of surgery and intraoperative blood loss may help reduce postoperative deep sternal wound infections.

Cardioplegia Application with A Hand-Squeezed Cardioplegia Bag. Is It Safe?

OBJECTIVES: Cardioplegia solutions have a role not only in arresting the heart but also in protecting the myocardium from ischemia. While antegrade cardioplegia is given by the heart-lung machine in many centers, it is given by a hand-squeezed bag in very few centers. The pressure of cardioplegia given antegrade from the heart-lung machine is certain (60-90 mmHg). The pressure applied in the cardioplegia method, which is given antegrade with a hand-squeezed bag, is uncertain and variable. We compared the antegrade cardioplegia method applied with a hand-squeezed bag with the antegrade cardioplegia method applied with a roller pump from the heart-lung machine in terms of protecting the myocardium from ischemia. METHODS: Seventy-six patients who did not have an acute myocardial infarction, had normal preoperative cardiac marker (troponin and CK-MB) values, did not undergo redo open heart surgery, had an ejection fraction of 50% and above, and underwent elective two or three-vessel isolated coronary artery bypass surgery were evaluated. While tepid (30-32°C) blood cardioplegia was administered antegrade to 33 patients (Group A) with a hand-squeezed bag, the other 34 patients (Group B) received tepid (30-32°C) antegrade blood cardioplegia from the heart-lung machine. The perioperative and postoperative data of the patients were recorded and compared. To evaluate myocardial damage, postoperative cardiac markers and echocardiography data were evaluated and compared at the fourth hour after the cross-clamp was removed in both groups. RESULTS: When evaluated in terms of preoperative demographic data, preoperative mean EF values and intraoperative data, there was no statistical difference between both groups. When we evaluated in terms of myocardial protection, the mean TnT level was 4.31 ± 1.95 at the 4th hour in Group A and 3.91 ± 1.69 in Group B. Mean 4th hour CK-MB level was 40.84 ± 9.07 in Group A and 38.56 ± 8.07 in Group B. Mean change in EF (%) was -4.09 ± 4.41 in Group A and 3.53 ± 4.53 in Group B. In line with the current data when we evaluated in terms of myocardial protection, we found that there is no statistical difference between the two groups (P = 0.373; P = 0.158; P = 0.523). There was no statistical difference between both groups, in terms of postoperative arrhythmias. None of the patients died, and no patients required an intra-aortic balloon pump. RESULTS: As a result of our study, cardioplegia administration with a certain constant pressure from the roller pump and hand-squeezed bag with uncertain pressure does not make a difference, in terms of myocardial protection. We think that the content and amount of cardioplegia and the preferred time for repeated cardioplegia applications are more important for the protection of the myocardium. METHODS: 76 patients who did not have an acute myocardial infarction, had normal preoperative cardiac marker (troponin and CK-MB) values, did not undergo redo open heart surgery, had an ejection fraction of 50% and above, and underwent elective two or three-vessel isolated coronary artery bypass surgery were evaluated. While tepid(30-32 ° C) blood cardioplegia was administered antegrade to 33 patients(Group A) with a hand-squeezed bag, the other 34 patients(Group B) received tepid(30-32 °C) antegrade blood cardioplegia from the heart-lung machine. The perioperative and postoperative data of the patients were recorded and compared. To evaluate myocardial damage, postoperative cardiac markers and echocardiography data were evaluated and compared at the fourth hour after the cross-clamp was removed in both groups. RESULTS: When evaluated in terms of preoperative demographic data, preoperative mean EF values and intraoperative data there was no statistical difference between both groups. When we evaluated in terms of myocardial protection, the mean TnT level was 4.31 ± 1.95 at the 4th hour in group A and 3.91 ± 1.69 in group B. Mean 4th hour CK-MB level was 40.84 ± 9.07 in group A and 38.56 ± 8.07 in group B. Mean change in EF (%) was -4.09 ± 4.41 in group A and 3.53 ± 4.53 in group B. In line with the current data when we evaluated in terms of myocardial protection; we found that there is no statistical difference between the two groups (p = 0.373; p = 0.158; p = 0.523). There was no statistical difference between both groups in terms of postoperative arrhythmia's. None of the patients died and none of the patients required an intra-aortic balloon pump.