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Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery.

ABSTRACT: This study retrospectively investigated the effect of dexmedetomidine on outcomes of patients undergoing coronary artery bypass graft (CABG) surgery.Retrospective investigation.Patients from a single tertiary medical center.A total of 724 patients undergoing CABG surgery met the inclusion criteria and were categorized into 2 groups: 345 in the dexmedetomidine group (DEX) and 379 in the nondexmedetomidine group (Non-DEX).Perioperative dexmedetomidine was used as an intravenous infusion (0.24 to 0.6 µg/kg/hour) initiated after cardiopulmonary bypass and continued for less than 24 hours postoperatively in the intensive care unit.Major outcome measures of this study were in-hospital, 30-day and 1-year all-cause mortality, delirium and major adverse cardiocerebral events. Perioperative dexmedetomidine infusion was associated with significant reductions in in-hospital, 30-day, and 1-year mortalities, compared with the patients who did not received dexmedetomidine. In-hospital, 30-day, and 1-year mortalities were 1.5% and 4.0% (adjusted odds ratio [OR], 0.332; 95% CI, 0.155 to 0.708; p = 0.0044), 2.0% and 4.5% (adjusted OR, 0.487; 95% CI, 0.253 to 0.985; p = 0.0305), and 3.2% and 6.9% (adjusted OR 0.421; 95% CI, 0.247 to 0.718, p = 0.0015), respectively. Perioperative dexmedetomidine infusion was associated with a reduced risk of delirium from 7.9% to 4.6% (adjusted OR, 0.431; 95% CI, 0.265-0.701; p = 0.0007).Dexmedetomidine infusion during CABG surgery was more likely to achieve improved in-hospital, 30-day, and 1-year survival rates, and a significantly lower incidence of delirium.

SUBMITTER: Ji F

PROVIDER: S-EPMC4402998 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery.

Ji Fuhai F Li Zhongmin Z Young Nilas N Moore Peter P Liu Hong H

Journal of cardiothoracic and vascular anesthesia 20131029 2

<h4>Objective</h4>This study retrospectively investigated the effect of dexmedetomidine on outcomes of patients undergoing coronary artery bypass graft (CABG) surgery.<h4>Design</h4>Retrospective investigation.<h4>Setting</h4>Patients from a single tertiary medical center.<h4>Participants</h4>A total of 724 patients undergoing CABG surgery met the inclusion criteria and were categorized into 2 groups: 345 in the dexmedetomidine group (DEX) and 379 in the nondexmedetomidine group (Non-DEX).<h4>In ...[more]

PMID: 24182835

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Project description:Background Coronary artery bypass graft (CABG) surgery represents the preferred revascularization strategy for most patients with diabetes and multivessel disease. We aimed to evaluate the role of optimized, perioperative cardiometabolic targets on long-term survival in patients who underwent CABG. Methods and Results Single-institution retrospective study was conducted in patients with diabetes who underwent CABG between January 2010 and June 2018. Demographic, surgical, and cardiometabolic determinants were identified during the perioperative period. Clinical characteristics and longitudinal survival outcomes data were obtained. A total of 1534 patients with CABG were considered for analysis and 1273 met inclusion criteria. The mean age of patients was 63.3 years (95% CI, 62.7-63.8 years), and most were men (65%) and Hispanic or Latino (47%). Comorbidities included hypertension (95%) and dyslipidemia (88%). In total, 490 patients (52%) had a low-density lipoprotein cholesterol level >70 mg/dL. Furthermore, 390 patients (31%) had uncontrolled systolic blood pressure >130 mm Hg. Last, only 386 patients (29%) had a hemoglobin A1c level between 6% and 7%. At 5 years, 121 patients (10%) died. Failure to achieve goal systolic blood pressure was associated with all-cause (hazard ratio [HR], 1.573; 95% CI, 1.048-2.362 [P=0.029]) and cardiovascular (HR, 2.023; 95% CI, 1.196-3.422 [P=0.009]) mortality at 5 years post-CABG. In contrast, prescription of a statin during the perioperative interval demonstrated a protective effect for all-cause (HR, 0.484; 95% CI, 0.286-0.819 [P=0.007]) and cardiovascular (HR, 0.459; 95% CI, 0.229-0.920 [P=0.028]) mortality. There was no association between achievement of low-density lipoprotein cholesterol, triglycerides, non-high-density lipoprotein cholesterol, or hemoglobin A1c level goals and mortality risk at 5 years. Conclusions Among patients with diabetes, blood pressure control and statin therapy were the most important perioperative cardiometabolic survival determinants 5 years after CABG.

Project description:BackgroundDecreased graft patency after off-pump coronary artery bypass grafting (OPCAB) leads to substantial increases in cardiac events. However, there is paucity of data on efficacy and safety of perioperative statin therapy for OPCAB populations.Methods582 patients undergoing OPCAB in a single-institution database (October 1, 2009-September 30, 2012) were stratified by perioperative continuation of statin therapy (CS group, n=398) or not (DS group, n=184). Inverse probability weighted propensity adjustment was used to account for treatment assignment bias, resulting in a well-matched cohort. Primary outcomes were graft patency at an average of five days after operation and in-hospital mortality. Secondary outcomes included intraoperative blood loss, liver, and renal functions.ResultsNo in-hospital death occurred in this study. Early graft patency rates after OPCAB were 98.4% (1255 of 1275 grafts) in the CS group and 98.0% (583 of 595 grafts, P=0.486) in the DS group. Secondary outcomes showed a reduction in blood loss during operation (438.53 mL versus 480.47 mL, P=0.01). Continuation of statin therapy is associated with alanine transaminase (ALT) elevation (49.67 U/L versus 34.52 U/L, P<0.001), as well as aspartate transaminase (33.54 U/L versus 28.10 U/L, P<0.001). Abnormal ALT elevation was observed in 8.9% of the CS group and 3.1% in DS (odds ratio 3.06, 95% confidence interval, 1.77 to 5.29, P<0.001). There was no significant difference in estimated glomerular filtration rate (76.28 mL/min/1.73m2 versus 76.13 mL/min/1.73m2, P=0.90). Subgroup analyses suggested that graft occlusion was less common in CS than in DS group among smoking patients (odds ratio 0.41, 95% confidence interval, 0.20 to 0.86, P=0.026).ConclusionsPerioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. A lower risk of graft occlusion was observed among smoking patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT01268917).

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Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery.

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Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery.

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