Journal of cardiothoracic and vascular anesthesia最新文献

Objectives: Hemolysis is a contributor to CS-AKI. Biochemistry analyzers provide a hemolysis index to quantify in vitro hemolysis, a condition that can, for example, affect the accuracy of potassium concentration measurements. We aimed to assess whether the postoperative plasma level of the hemolysis index (HI_{postoperative}) could aid the early recognition of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) and also to evaluate other hemolysis indicators: plasma carboxyhemoglobin (COHb_{postoperative}) and methemoglobin (MetHb_{postoperative}).

Design: One-year retrospective study.

Setting: University hospital.

Participants: Patients undergoing elective cardiac surgery.

Interventions: None.

Measurements and main results: In 1090 patients, the median HI_{postoperative} was higher in patients who developed CS-AKI compared to patients who did not (11 mg/dL [interquartile range (IQR), 5-38 mg/dL] v 7 mg/dL [IQR, 3-16 mg/dL]; p < 0.001). HI_{postoperative} refined the early recognition of CS-AKI: the area under the precision-recall curve (AUPRC) for HI_{postoperative} was 37% (95% confidence interval [CI], 31%-42%), whereas the AUPRC associated with no discriminative power, equal to the prevalence of CS-AKI in the whole population, was 21%. Among the 611 patients with measurements for all 3 biomarkers, the AUPRC of HI_{postoperative} was higher than that of COHb_{postoperative} or MetHb_{postoperative} (+6.6% and +7.4% respectively; p < 0.0001 for both). Unlike COHb_{postoperative} or MetHb_{postoperative}, the incorporation of HI_{postoperative} into a model (trained on a sample then validated in another sample) of CS-AKI early recognition significantly enhanced its performance, with a +1.9% (95% CI, 1.6%-2.1%) increase in AUPRC (p < 0.0001).

Conclusions: Elevated HI_{postoperative} represents an early alert signal for the development of CS-AKI. Our findings support the incorporation of HI_{postoperative}, a readily available biomarker, into predictive scores of CS-AKI.

Objective: To determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG).

Design: A cohort study was conducted between January 2006 and December 2019, with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27, 2023.

Setting: A single tertiary center in Korea.

Participants: Patients who underwent preoperative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG.

Interventions: None.

Measurements and main results: The primary outcome was the incidence of MACCEs within 30 days of CABG. MACCEs included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. Secondary outcomes included each component of MACCEs and all-cause mortality at 5 years after surgery. Of the 2,476 study patients (median [interquartile range] age: 65 [58-71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCEs after CABG. After performing 1:4 propensity-score matching, 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCEs within 30 days was not significantly different between patients with covert brain infarction and those without (15.1% [32/212] v 15.6% [132/845]; risk difference: -0.5, 95% confidence interval: -5.6 to 4.4; risk ratio: 0.97, 95% confidence interval: 0.66 to 1.32, p = 0.85). There were also no significant differences in each component of MACCEs within 30 days. There was no significant difference between the two groups regarding all-cause mortality at 5 years (18.7% v 17.0%, respectively, p for stratified log-rank test = 0.33).

Conclusions: Among patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCEs within 30 days or long-term mortality after CABG.