The aim was to evaluate 16S rDNA sequencing in heart valves in patients with infective endocarditis undergoing surgery.
Fifty-seven patients with infective endocarditis were examined in this prospective study by analysing heart valves with 16S rDNA sequencing and culturing methods and comparing the results to blood cultures. As controls, heart valves from 61 patients without any signs of endocarditis were examined.
All together 77% of the endocarditis patients were positive for 16S rDNA, 84% had positive blood cultures and 23% had positive cultures from heart valves, whereas only 16% of the cultures from heart valves were concordant with results from blood cultures or 16S rDNA. Concordant results between 16S rDNA sequencing and blood cultures were found in 75% patients. All controls were negative for 16S rDNA. In 4 out of 9 patients with negative blood cultures, the aetiology was established by 16S rDNA alone, i.e. viridans group streptococci.
In this Swedish study, 16S rDNA sequencing of valve material was shown to be a valuable addition in blood culture-negative cases. The value of heart valve culture was low. Molecular diagnosis using 16S rDNA sequencing should be recommended in patients undergoing valve replacement for infective endocarditis.
Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and is associated with adverse outcomes. However, the relationship between AKI after CABG and the long-term risk of end-stage renal disease (ESRD) is unknown.
This study included 29 330 patients who underwent primary isolated CABG in Sweden between 2000 and 2008. AKI was classified according to the Acute Kidney Injury Network (AKIN) classification: stage 1, >0.3 mg/dL (>26 µmol/L) or 50% to 100% increase; stage 2, 100% to 200% increase; and stage 3, >200% increase from the preoperative to postoperative serum creatinine level. Cox proportional hazards regression analysis was used to calculate hazard ratios with 95% confidence intervals for ESRD in AKIN stage 1 and stage 2 to 3. Postoperative AKI occurred in 13% of patients. During a mean follow-up of 4.3±2.4 years, 123 patients (0.4%) developed ESRD, including 50 (1.6%) in AKIN stage 1, 29 (5.2%) in AKIN stage 2 to 3, and 44 (0.2%) without AKI after CABG. After multivariable adjustment, the hazard ratio for ESRD was 2.92 (95% confidence interval, 1.87-4.55) for AKIN stage 1 and 3.81 (95% confidence interval, 2.14-6.79) for AKIN stage 2 to 3.
This nationwide study of patients who underwent CABG found that a small increase in the postoperative serum creatinine level was associated with an almost 3-fold increase in the long-term risk of ESRD after adjustment for a number of confounders, including preoperative renal function.
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with early mortality. Its impact on the risk of myocardial infarction (MI) over time and long-term mortality has not been well described.
We performed a nationwide population-based cohort study in 27,929 patients who underwent a first isolated CABG between 2000 and 2008 in Sweden. Acute kidney injury was divided into three categories based on the absolute increase in postoperative serum creatinine (sCr) concentration compared with the preoperative baseline: stage 1, sCr increase of 0.3 to 0.5mg/dL; stage 2, sCr increase of >0.5 to 1.0mg/dL and stage 3, sCr increase of = 1.0mg/dL.
The overall incidence of postoperative AKI was 13%, 6.3% met the criterion for stage 1, 4.3% for stage 2 and 2.3% for stage 3. During a mean follow-up of 5.0 years, there were 2119 (7.6%) MIs and 4679 (17%) deaths. Multivariable adjusted hazard ratios with 95% confidence intervals for MI were 1.35 (1.15 to 1.57), 1.80 (1.53 to 2.13) and 1.63 (1.29 to 2.07), in AKI stages 1, 2 and 3, respectively. The corresponding hazard ratios for all-cause mortality were 1.30 (1.17 to 1.44), 1.65 (1.48 to 1.83) and 2.68 (2.37 to 3.03), respectively.
Our results show that AKI after CABG is associated with an increased long-term risk of MI and death.
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: email@example.com.
Acute kidney injury (AKI) is associated with death, end-stage renal disease, and heart failure in patients with coronary heart disease. This study investigated the association between AKI and long-term risk of stroke.
50,244 patients who underwent coronary artery bypass grafting (CABG) in Sweden between 2000 and 2008 were identified from the SWEDEHEART registry. After exclusions 23,584 patients without prior stroke who underwent elective, primary, isolated, CABG were included. AKI was categorized according to absolute increases in postoperative creatinine values compared with preoperative values: stage 1, 0.3-0.5 mg/dL (26-44 µmol/L); stage 2, 0.5-1.0mg/dL (44-88 µmol/L); and stage 3, >1.0 mg/dL (=88 µmol/L). Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. There were 1156 (4.9%) strokes during a mean follow-up of 4.1 years. After adjustment for confounders, HRs (95% CIs) for stroke in AKI stages 1, 2 and 3 were 1.12 (0.89-1.39), 1.31 (1.04-1.66) and 1.31 (0.92-1.87), respectively, compared with no AKI. This association disappeared after taking death into account in competing risk analysis. There was a significant association between AKI and stroke in men (HR: 1.26 [1.05-1.50]) but not in women (HR: 1.07 [0.75-1.53]), and in younger (
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is common and increases the risk of postoperative complications and mortality. There is little information on the association between AKI after CABG and long-term risk of incident heart failure (HF).
All patients (n=24 018) undergoing primary, isolated CABG in Sweden between 2000 and 2008 with complete information on pre- and postoperative serum creatinine values, and no prior hospitalization for HF were included. The postoperative increase in serum creatinine was used to define different stages of AKI: stage 1, 0.3 to 0.5 mg/dL; stage 2, 0.5 to 1 mg/dL; stage 3, >1 mg/dL. Hazard ratios with 95% confidence intervals were calculated for first hospitalization for HF for each stage of AKI using Cox proportional hazards regression. Twelve percent of the study population developed AKI. During a mean follow-up of 4.1 years, there were 1325 cases (5.5%) of incident HF. Hazard ratios with 95% confidence interval for HF in AKI stage 1, 2, and 3 were 1.60 (1.34-1.92), 1.87 (1.54-2.27), and 1.98 (1.53-2.57), respectively, after multivariable adjustment for age, sex, diabetes mellitus, estimated glomerular filtration rate, left ventricular ejection fraction, and myocardial infarction before surgery or during follow-up.
AKI is associated with increased long-term risk of HF after CABG. Patients with AKI after CABG should be followed closely to detect early changes in cardiac function.
Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine-heparin ratio used for heparin reversal varies widely among institutions (0.7-1.3?mg protamine/100 IU heparin). Excess protamine may impair coagulation. With an empirically developed algorithm, the HeProCalc program, heparin, and protamine doses are calculated during the procedure. The primary aim was to investigate whether HeProCalc-based dosage of heparin could reduce protamine use compared with traditional dosages. The secondary aim was to investigate whether HeProCalc-based dosage of protamine affected postoperative bleeding. Patients and Methods We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine doses, based on body weight alone, were given. In the treatment group, the HeProCalc program was used, which calculated the initial heparin bolus dose from weight, height, and baseline activated clotting time and the protamine dose at termination of CPB. Results We analyzed the results from 37 patients, after exclusion of three patients. Equal doses of heparin were given in both groups, whereas significantly lower mean doses of protamine were given in the treatment group versus control group (211?±?56 vs. 330?±?61?mg, p?
Depression is common in patients with coronary artery disease and is associated with increased cardiovascular morbidity and mortality. Previous reports on the relationship between antidepressant use before coronary artery bypass grafting (CABG) and survival are conflicting. Our aim was to study the association between preoperative antidepressant use and survival following CABG.
We identified all patients who underwent primary isolated non-emergent CABG in Sweden between 2006 and 2008. We used the SWEDEHEART registry and the Swedish National Patient Register to acquire information about baseline characteristics, and the national Prescribed Drug Register to obtain data regarding exposure, defined as at least one antidepressant prescription dispensed before surgery.
Of the 10,884 patients identified, 1171 (11%) were treated with antidepressants before surgery. Unadjusted 4-year survival was 89% in the antidepressant group compared with 92% in the group without antidepressant use (p=0.002). After multivariable adjustment, antidepressant use was associated with increased mortality (hazard ratio [HR] 1.45; 95% confidence interval [CI] 1.18-1.77), compared with non-use of antidepressants. Antidepressant use was also associated with an increased risk of rehospitalization (HR 1.40; 95% CI 1.19-1.65) and the composite endpoint rehospitalization or death (HR 1.44; 95% CI 1.26-1.65).
Among patients who underwent contemporary primary isolated CABG on a nonemergency basis in Sweden, there was a strong and statistically significant association between antidepressant use prior to surgery and long-term survival.
Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting.
To study the association of donor age and sex with survival of patients receiving transfusions.
A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden and Denmark who received at least 1 red blood cell transfusion of autologous blood or blood from unknown donors between January 1, 2003, and December 31, 2012. Patients were followed up from the first transfusion until death, emigration, or end of follow-up. Data analysis was performed from September 15 to November 15, 2016.
The number of transfusions from blood donors of different age and sex. Exposure was treated time dependently throughout follow-up.
Hazard ratios (HRs) for death and adjusted cumulative mortality differences, both estimated using Cox proportional hazards regression.
Results of a crude analysis including 968?264 transfusion recipients (550?257 women and 418?007 men; median age at first transfusion, 73.0 years [interquartile range, 59.8-82.4 years]) showed a U-shaped association between age of the blood donor and recipient mortality, with a nadir in recipients for the most common donor age group (40-49 years) and significant and increasing HRs among recipients of blood from donors of successively more extreme age groups (
Cites: Cell. 2013 May 9;153(4):828-3923663781
Cites: JAMA. 2012 Oct 10;308(14):1443-5123045213
Cites: Science. 2014 May 9;344(6184):630-424797482
Cites: N Engl J Med. 2015 Apr 9;372(15):1419-2925853746
Cites: Science. 2014 May 9;344(6184):649-5224797481
Cites: Transfusion. 2015 Jul;55(7):1600-625573303
Cites: Epidemiol Perspect Innov. 2008 Nov 14;5:719014582
Cites: Circulation. 2016 Nov 22;134(21):1692-169427881511
Prior observational studies have suggested better outcomes in patients who receive bilateral internal mammary arteries (BIMA) during coronary artery bypass grafting (CABG) compared with patients who receive a single internal mammary artery (SIMA). The aim of this study was to analyze the association between BIMA use and long-term survival in patients who underwent primary isolated CABG.
Patients who underwent primary isolated non-emergent CABG in Sweden between 1997 and 2008 were identified. The SWEDEHEART registry and other national Swedish registers were used to acquire information about patient characteristics and outcomes. Unadjusted and multivariable adjusted regression models were used to estimate the association between BIMA use and early mortality, long-term survival, and a composite of death from any cause or rehospitalization for myocardial infarction, heart failure, or stroke in the overall cohort and in a propensity score-matched cohort. The study population consisted of 49702 patients who underwent CABG with at least one internal mammary artery, and 559 (1%) of those had BIMA grafting. In the adjusted analyses, BIMA use was not associated with better survival compared with SIMA use in the overall cohort (hazard ratio (HR) for death: 1.16, 95% confidence interval (CI): 0.97 to 1.37) or in the matched cohort (HR: 1.04, 95% CI: 0.78 to 1.40). The results were similar for early mortality and the composite endpoint. Reoperation for sternal wound complications was more common among BIMA patients (odds ratio: 1.71, 95% CI: 1.01 to 2.88).
BIMA grafting was performed infrequently and was not associated with better outcomes compared with SIMA grafting in patients undergoing non-emergent primary isolated CABG in Sweden during 1997-2008.
Cites: Ann Thorac Surg. 2003 Dec;76(6):2017-2214667633
Cites: Ann Thorac Surg. 2001 Nov;72(5):1535-4111722039
Cites: Ann Thorac Surg. 1996 Nov;62(5):1289-948893559
Cites: Ann Thorac Surg. 1997 Sep;64(3):599-6059307445
Cites: Ann Intern Med. 1999 Mar 16;130(6):461-7010075613
Guidelines for recommended medication use for the secondary prevention of coronary heart disease are exceedingly important in patients with chronic kidney disease. Despite a high risk for recurrent cardiovascular events, these patients are less likely to use evidence-based recommended medications. The objective of the current study was to analyze the association between renal function and guideline-recommended drug therapy in patients with coronary heart disease.
In this nationwide population-based cohort study, we included 12,332 patients with established coronary heart disease who underwent primary isolated coronary artery bypass grafting in Sweden between 2005 and 2008. Medication use was retrieved from the national Prescribed Drug Register.
During the first year after coronary surgery, 94% of patients had at least two dispensed prescriptions for an antiplatelet agent, 68% for an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, 92% for a beta-blocker, and 93% for a statin. Only 57% of all patients had prescriptions for all four medication classes. Reduced renal function (estimated glomerular filtration rate (eGFR) of 30 to 45 mL/min per 1.73 m(2) and 60 mL/min per 1.73 m(2)).
In patients with established coronary heart disease, moderate to severe renal dysfunction was associated with significantly lower use of guideline-recommend medications as compared to normal renal function.