Lower mortality following coronary arterial revascularization in patients taking statins.

OBJECTIVES: Numerous studies have suggested that statins have beneficial non-lipid-lowering effects, including reduction of systemic inflammatory response following surgery. We wanted to evaluate the effect of preoperative statin treatment on complications and operative mortality after coronary arterial revascularization. DESIGN: We performed a retrospective study of 720 consecutive patients who underwent on-pump coronary artery bypass grafting (CABG) (n = 513) or off-pump (OPCAB) (n = 207) in Iceland from 2002-2006. Patients taking statins preoperatively (n = 529) were compared with those not taking statins (n = 191). Predictors of complications and operative mortality were evaluated by univariate and multivariate analysis. RESULTS: Cardiovascular risk profiles were similar. However, hypertension was more common in the statin group but EuroSCORE was slightly lower. Operative mortality was significantly lower in patients taking statins (1.7% vs. 5.8%, p < 0.001). There were no significant differences in the incidence of major complications. Multivariate analysis showed that preoperative statin treatment was an independent predictor of lower operative mortality (OR = 0.33, p = 0.043), even after adjusting for EuroSCORE, acute operations, advanced age, or other medications. CONCLUSIONS: In this non- randomized study, patients taking statins had lower operative mortality than the controls after adjusting for multiple confounders. The reason for this might be linked to pleiotropic effects of statins.

Improving outpatient care for heart failure through digital innovation: a feasibility study.

BACKGROUND: Heart failure (HF) affects over 26 million people worldwide. Multidisciplinary management strategies that include symptom monitoring and patient self-care support reduce HF hospitalization and mortality rates. Ideally, HF follow-up and self-care support includes lifestyle-change recommendations and remote monitoring of weight and HF symptoms. Providing these via a digital solution may be ideal for improving HF disease outcomes and reducing the burden on providers and healthcare systems. This study's main objective was to assess the feasibility of a digital solution including remote monitoring, lifestyle-change, and self-care support for HF outpatients in Iceland. METHODS: Twenty HF patients (mean age 57.5 years, 80% males) participated in an 8-week study. They were provided with a digital solution (SK-141), including lifestyle-change and disease self-care support, a remote symptom monitoring system, and a secure messaging platform between healthcare providers and patients. This feasibility study aimed to assess patient acceptability of this new intervention, retention rate, and to evaluate trends in clinical outcomes. To assess the acceptability of SK-141, participants completed a questionnaire about their experience after the 8-week study. Participants performed daily assigned activities (missions), including self-reporting symptoms. Clinical outcomes were assessed with the Hospital Anxiety and Depression Scale and the Kansas City Cardiomyopathy Questionnaire at the study's beginning and end with an online survey. RESULTS: Of the 24 patients invited, 20 were elected to participate. The retention rate of participants throughout the 8-week period was high (80%). At the end of the 8 weeks, thirteen participants completed a questionnaire about their experience and acceptability of the SK-141. They rated their experience positively including on questions whether they would recommend the solution to others (6.8 on a scale of 1-7), whether the solution had improved their life and well-being (5.7 on a scale of 1-7), and whether it was user friendly (5.5 on a scale of 1-7). Many of the clinical parameters studied exhibited a promising trend towards improvement over the 8-week period. CONCLUSION: The digital solution, SK-141, was very acceptable to patients and also showed promising clinical results in this small feasibility study. These results encourage us to conduct a longer, more extensive, adequately powered, randomized-controlled study to assess whether this digital solution can improve the quality of life and clinical outcomes among HF patients.

[Outcome of myocardial revascularisation in Iceland]. / Árangur kransaedahjáveituadgerda á Íslandi 2002-2006.

INTRODUCTION: In Iceland over 3500 coronary artery bypass operations have been performed, both On-Pump, using cardiopulmonary bypass and Off-Pump, surgery on a beating heart. The aim was to study their outcome. MATERIAL AND METHODS: This was a retrospective study on 720 consecutive patients who underwent surgical revascularisation at Landspítali-The National University Hospital of Iceland between 2002-2006; 513 On-Pump and 207 Off-Pump patients. Complications and operative mortality (<30 days) were compared between the groups and predictors of survival identified using multivariate analysis. RESULTS: The number of males was significantly higher in the On-Pump group, but other risk factors of coronary artery disease, including age and high body mass index, were comparable, as were the number of distal anastomoses and EuroSCORE. The Off-Pump procedure took 25 minutes longer on average and chest tube output was significantly increased, but the amount of transfusions administered was similar. The rate of minor complications was higher in the On-Pump group. Of the major complications, stroke rates were similar in both groups (2%) but the rate of reoperation for bleeding was higher in the On-Pump group. Mean length of hospital stay was one day longer for On-Pump patients but operative mortality was similar for both groups (4% vs. 3%, p=0.68) as was 5 year survival (92% in both groups). In multivariate analysis both EuroSCORE and age predicted outcome of operative mortality and long term survival but type of surgery (On-Pump vs. Off-Pump) was not a predictive variant. CONCLUSIONS: Outcome of myocardial revascularisation in Iceland is good as regards operative mortality and long term survival. This applies to both conventional On-Pump and Off-Pump procedures.

[Impact of obesity on surgical outcomes following coronary artery bypass graft surgery]. / Tengsl offitu við árangur kransæðahjáveituaðgerða.

INTRODUCTION: Obesity has been related to increased postoperative morbidity and mortality following open-heart surgery. However, recent studies have shown no association or even a more favourable outcome in obese patients. This relationship was investigated in a well-defined cohort of patients that underwent myocardial revascularisation in Iceland. MATERIAL AND METHODS: A retrospective study including all patients that underwent isolated myocardial revascularisation in Iceland from 2002 to 2006. Altogether 720 patients were divided into two groups, an obese group, with BMI >30 kg/m2 (n=207, 29%), and a non-obese group with BMI ≤30 kg/m2 (n=513, 71%). Patient demographics, complications, operative mortality and long term survival of both groups were compared. RESULTS: Demographics were comparable between the groups. Obese patients were 2.4 years younger, more likely to use statins (83,3% vs. 71,2%, had a significantly lower EuroSCORE (4.3 vs. 5.0) but a slightly longer operation time. Pleural fluid was less often drained in obese patients (8.2 vs. 15.0%) but rates for other complications were similar in both groups, as was operative mortality ≤30 days (2.0% vs. 3.7%), 1 and 5 year survival. In a multivariate analysis obesity was not an independent risk factor for minor or major complications, operative mortality or long term survival. CONCLUSION: The rate of complications and operative mortality after myocardial revascularisation is not significantly higher in obese patients and the same applies to long term survival. This is true even after correcting for confounding factors in a multivariate analysis.

[Pulmonary sequestration in Iceland - two case reports]. / Adskilinn lungnahluti (pulmonary sequestration) med tengsl vid meltingarveg. Tvö sjúkratilfelli sem rökstydja ad um medfaeddan galla sé ad raeda.

Pulmonary sequestration (PS) is a rare disease where non-functioning lung tissue is separated from the normal bronchopulmonary tree and vasularized by an aberrant systemic artery. The origin of PS is not fully understood. Here we describe two unique cases of PS that support the hypothesis that PS is a congenital malformation rather than an acquired one. These are also the first Icelandic cases of PS reported.

Bilateral extralobar pulmonary sequestration communicating with the upper gastrointestinal system in a newborn with duodenal atresia.

We report a rare form of bilateral pulmonary sequestration (PS) that was directly connected to the gastroesophageal junction with a well-formed aberrant bronchus-like structure. An upper gastrointestinal contrast series was performed directly after birth, and a unique PS bronchogram was identified, along with duodenal atresia. The PS was successfully resected and the duodenal atresia was corrected.

[Desmoid tumor of chest wall--an important differential diagnosis to malignancies]. / Desmoid-aexli í brjóstvegg--mikilvaeg mismunagreining vieth illkynja mein.

Desmoid tumors are rare solid tumors that arise from musculoaponeurotic tissues. They are classified as benign as they do not metastasize. Desmoid tumors can, however, exhibit rapid local growth and clinically they can mimic sarcomas. Their histological appearance can also resemble some malignant neoplasms such as low grade sarcomas, rendering the differential diagnosis difficult. The present report describes a 60-year-old woman with a history of left mastectomy, performed for a lymph node negative adenocarcinoma. At follow-up 4 years later, a solid nodule was palpated below the right breast. The tumor increased in size over several weeks and caused local radiating chest pain. Clinically a breast cancer metastasis was suspected. Open biopsy revealed a desmoid tumor. The tumor was resected together with a part of the anterior hemithorax, and the defect in the chest wall covered with a Goretex-patch. Six months postoperatively, the patient is doing well with no signs of locally recurrent disease.