Jiayang Wang

Impact of Obstructive Sleep Apnea Syndrome on Endothelial Function, Arterial Stiffening, and Serum Inflammatory Markers: An Updated Meta‐analysis and Metaregression of 18 Studies

Background Obstructive sleep apnea syndrome (OSAS) has been indicated to contribute to the development of cardiovascular disease; however, the underlying mechanism remains unclear. This study aimed to test the hypothesis that OSAS may be associated with cardiovascular disease by elevating serum levels of inflammatory markers and causing arterial stiffening and endothelial dysfunction. Methods and Results Related scientific reports published from January 1, 2006, to June 30, 2015, were searched in the following electronic literature databases: PubMed, Excerpta Medica Database, ISI Web of Science, Directory of Open Access Journals, and the Cochrane Library. The association of OSAS with serum levels of inflammatory markers, endothelial dysfunction, and arterial stiffening were investigated. Overall, 18 eligible articles containing 736 patients with OSAS and 424 healthy persons were included in this meta‐analysis. Flow‐mediated dilation in patients with moderate–severe OSAS was significantly lower than that in controls (standardized mean difference −1.02, 95% CI −1.31 to −0.73, P<0.0001). Carotid‐femoral pulse wave velocity (standardized mean difference 0.45, 95% CI 0.21–0.69, P<0.0001), augmentation index (standardized mean difference 0.57, 95% CI 0.25–0.90, P<0.0001), and serum levels of high‐sensitivity C‐reactive protein and C‐reactive protein (standardized mean difference 0.58, 95% CI 0.42–0.73, P<0.0001) were significantly higher in patients with OSAS than in controls. Conclusion OSAS, particularly moderate–severe OSAS, appeared to reduce endothelial function, increase arterial stiffness, and cause chronic inflammation, leading to the development of cardiovascular disease.

Preoperative Statin Therapy and Renal Outcomes After Cardiac Surgery: A Meta-analysis and Meta-regression of 59,771 Patients

BACKGROUND The purpose of this study was to investigate the effects of preoperative statin therapy (PST) on short- and long-term renal dysfunction after cardiac surgery. METHODS We searched for reports that investigated the effects of PST on renal outcomes after cardiac surgery in the electronic literature databases PubMed, Ovid, and Elsevier. RESULTS Twenty-six reports including 59,771 patients were selected for meta-analysis. The meta-analysis revealed that PST significantly reduced the incidence of postoperative renal dysfunction (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84-0.95; P < 0.0001) without significant heterogeneity (I(2) = 28.1%; P = 0.093). PST also significantly reduced the need for postoperative renal replacement therapy (OR = 0.76; 95% CI, 0.62-0.92; z = 2.77; P = 0.006); particularly in the subgroup of patients who underwent isolated coronary artery bypass grafting, the rate of renal replacement therapy was reduced by 56% (OR, 0.44; 95% CI, 0.30-0.66; z = 4.08; P < 0.0001) with low heterogeneity (I(2) = 18.7%; P = 0.297). Meta-analysis for the outcome of acute kidney injury (AKI) revealed that PST reduced the incidence of postoperative AKI by 13% (OR, 0.87; 95% CI, 0.80-0.94; P = 0.001) and 7% (OR, 0.93; 95% CI, 0.86-0.99; P = 0.031), respectively, for subgroups of patients whose AKI was evaluated using the Acute Kidney Injury Network (AKIN) or the Risk, Injury, Failure, Loss, and End Stage (RIFLE) criteria, without significant heterogeneity for either. CONCLUSIONS PST might be a promising therapy to reduce renal complications after cardiac surgery although large-scaled randomized controlled trials are needed to further verify the conclusion.

Short- and Long-Term Patient Outcomes From Combined Coronary Endarterectomy and Coronary Artery Bypass Grafting: A Meta-Analysis of 63,730 Patients (PRISMA).

AbstractThis meta-analysis aimed to compare the short- and long-term outcomes in patients undergoing combined coronary endarterectomy and coronary artery bypass grafting (CE + CABG) versus isolated CABG, and particularly to examine subgroup patients with high-risk profile and patients with diffuse disease in the left anterior descending artery (LAD).Studies published between January 1, 1970 and May 31, 2015 were searched in the literature databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science.A total of 30 eligible studies including 63,730 patients were analyzed.Five authors extracted data from the included studies independently.Meta-analysis on the total patients revealed that CE + CABG was associated with significantly increased 30-day postoperative all-cause mortality compared with isolated CABG (OR = 1.86, 95% CI: 1.66–2.08, z = 10.99, P < 0.0001). Subgroup analysis on patients with high-risk profile and patients with diffuse disease in the LAD showed that 30-day mortality after CE + CABG was 2.6 folds (OR = 2.60, 95% CI: 1.39–4.86, z = 2.99, P = 0.003) and 3.93 folds (OR = 3.93, 95% CI: 1.40–11.0, z = 2.60, P = 0.009) of that after isolated CABG in the respective subgroup. In contrast, the mortality was comparable in CE + off-pump CABG and CE + on-pump CABG groups (OR = 0.53, 95% CI: 0.18–1.55, z = 1.16, P = 0.248). In addition, the incidences of perioperative myocardial infarction (MI) and 30-day postoperative complications, including low output syndrome (LOS), MI, ventricular tachycardia (VT), and renal dysfunction after CE + CABG were significantly higher than those after isolated CABG (all P < 0.05). In high-risk patient subgroup, CE + CABG significantly increased the incidences of postoperative LOS, MI, and renal function compared with isolated CABG (all P < 0.05). The incidence of perioperative myocardial after CE + CABG was 2.86 and 2.92 times of that after isolated CABG in high-risk patients and patients with diffuse disease in LAD, respectively. Analysis on the recent reports (published later than 2000) showed consistent results as the analysis including all the eligible reports. Long-term survival was comparable in CE + CABG and isolated CABG groups (hazardous ratio = 1.16, 95% CI: 0.32–4.22, z = 0.23, P = 0.819).CE + CABG appears to be associated with poor short-term outcomes, particularly in high-risk patients and patients with diffuse disease in the LAD.

Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow

BackgroundEnd-to-side anastomoses to connect the distal end of the great saphenous vein (GSV) to small target coronary arteries are commonly performed in sequential coronary artery bypass grafting (CABG). However, the oversize diameter ratio between the GSV and small target vessels at end-to-side anastomoses might induce adverse hemodynamic condition. The purpose of this study was to describe a distal end side-to-side anastomosis technique and retrospectively compare the effect of distal end side-to-side versus end-to-side anastomosis on graft flow characteristics.MethodsWe performed side-to-side anastomoses to connect the distal end of the GSV to small target vessels on 30 patients undergoing off-pump sequential CABG in our hospital between October 2012 and July 2013. Among the 30 patients, end-to-side anastomoses at the distal end of the GSV were initially performed on 14 patients; however, due to poor graft flow, those anastomoses were revised into side-to-side anastomoses. We retrospectively compared the intraoperative graft flow characteristics of the end-to-side versus side-to-side anastomoses in the 14 patients. The patient outcomes were also evaluated.ResultsWe found that the side-to-side anastomosis reconstruction improved intraoperative flow and reduced pulsatility index in all the 14 patients significantly. The 16 patients who had the distal end side-to-side anastomoses performed directly also exhibited satisfactory intraoperative graft flow. Three-month postoperative outcomes for all the patients were satisfactory.ConclusionsSide-to-side anastomosis at the distal end of sequential vein grafts might be a promising strategy to connect small target coronary arteries to the GSV.

Independent Risk Factors Contributing to Acute Kidney Injury According to Updated Valve Academic Research Consortium-2 Criteria After Transcatheter Aortic Valve Implantation: A Meta-analysis and Meta-regression of 13 Studies

OBJECTIVES This study aimed to examine the risk factors for transcatheter aortic valve implantation (TAVI)-associated acute kidney injury (AKI) according to the AKI definition from the Valve Academic Research Consortium-2 (VARC-2). SETTING A meta-analysis. PARTICIPANTS A total of 661 patients with post-TAVI AKI according to the VARC-2 definition and 2,012 controls were included in the meta-analysis. INTERVENTIONS Patients undergoing TAVI were included in this meta-analysis. MEASUREMENTS AND MAIN RESULTS Multiple electronic databases were searched using predefined criteria. The diagnosis of AKI was based on the VARC-2 classification. The authors found that preoperative New York Heart Association class IV (odds ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated significantly with an increased risk for post-TAVI AKI. Furthermore, previous peripheral vascular disease (PVD), hypertension, atrial fibrillation, congestive heart failure, diabetes mellitus, and stroke were also risk factors for TAVI-associated AKI. Additionally, transfemoral access significantly correlated with a reduced risk for post-TAVI AKI (OR, 0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of Thoracic Surgeons Score, the logistic European System for Cardiac Operative Risk Evaluation, aortic valve area, mean pressure gradient, left ventricular ejection fraction, age, body mass index, contrast volume, and valve type, had no impact on the association between the risk factors and post-TAVI AKI. Subgroup analysis of the eligible studies presenting multivariate logistic regression analysis on the independent risk factors for post-TAVI AKI revealed that previous CKD, previous PVD, and transapical access were independent risk factors for TAVI-associated AKI. CONCLUSIONS The current meta-analysis suggested that previous CKD, previous PVD, and transapical access may be independent risk factors for TAVI-associated AKI.

Independent risk factors for postoperative AKI and the impact of the AKI on 30-day postoperative outcomes in patients with type A acute aortic dissection: an updated meta-analysis and metaregression

Background This meta-analysis aims to investigate the effects of postoperative acute kidney injury (AKI) on 30-day postoperative outcomes and the independent risk factors for postoperative AKI in patients with type A acute aortic dissection (TAAD). Methods Relevant reports published between January 1, 2011 and May 31, 2017 were searched in multiple electronic literature databases. A total of seven eligible articles were included in the meta-analysis. Results Postoperative AKI was associated with 249% increase in 30-day postoperative mortality [odds ratio (OR): 3.49; 95% confidence interval (CI): 2.17-5.59; P<0.0001]. Subgroup analysis revealed that patients with stage II/III AKI showed 445% increase in 30-day postoperative mortality compared with the control group (OR: 5.45; 95% CI: 2.87-10.36; P<0.0001). Postoperative AKI was also associated with 143%, 432%, and 126% increase in the incidences of 30-day postoperative stroke, bleeding, and respiratory complications, respectively. Notably, high body mass index (BMI), advanced age, and perioperative sepsis were independent risk factors for postoperative AKI in patients with TAAD. Conclusions This meta-analysis firstly provided clinical evidence showing the adverse effects of postoperative AKI on 30-day postoperative outcomes in patients with TAAD and identified high BMI, advanced age, and perioperative sepsis as the independent risk factors for postoperative AKI. These findings suggest that preventive or therapeutic methods to effectively manage postoperative AKI may improve 30-day postoperative outcomes in patients with TAAD.

In-Hospital and Long-Term Mortality in 35,173 Chinese Patients Undergoing Coronary Artery Bypass Grafting in Beijing: Impact of Sex, Age, Myocardial Infarction, and Cardiopulmonary Bypass

OBJECTIVE The purpose of this study was to investigate the independent risk factors for mortality, the correlation between female sex and mortality, and the effects of cardiopulmonary bypass on prognosis in Chinese patients undergoing coronary artery bypass grafting (CABG). SETTING A retrospective, observational study. PARTICIPANTS The study included 26,926 (76.6%) men and 8,247 (23.4%) women. INTERVENTIONS Patients undergoing isolated CABG were included in this study. MEASUREMENTS AND MAIN RESULTS The medical records of patients undergoing CABG between January 1, 2006, and December 31, 2011, in Beijing were reviewed. Multivariate logistic regression and propensity score-matched analyses were performed to analyze the independent risk factors for in-hospital and long-term mortality. A total of 35,173 patients (76.6% men) were included in this study. Women were significantly older than men, and the proportions of women presenting with hypertension and unstable angina at hospital admission were significantly higher than those of men (all p<0.05). Women showed significantly higher in-hospital mortality (1.62% v 1.30%, p = 0.0248) and long-term mortality (3-year mortality, 10.2% v 7.3%, p<0.0001) than did men. Multivariate logistic regression analyses on the total patients and the propensity score-matched group revealed that female sex was not an independent risk factor for in-hospital mortality, whereas age and off-pump CABG were associated significantly with mortality (all p<0.0001). Age, a history of myocardial infarction before CABG, and on-pump CABG were independent risk factors for long-term mortality (all p<0.0001), but female sex was not. CONCLUSIONS These findings suggested that advancing age but not female sex, appeared to be an independent risk factor for post-CABG in-hospital and long-term mortality, and off-pump CABG may be associated with worse in-hospital mortality and better long-term survival compared with on-pump CABG.