ABSTRACT
Objective: The aim of this study was to investigate the association between platelet-to-lymphocyte ratio [PLR] and atrial fibrillation [AF] after coronary artery bypass graft [CABG] surgery
Subjects and Methods: A total of 125 patients were retrospectively analyzed. AF was diagnosed using standard clinical criteria, and PLR was calculated as the ratio of the platelets to lymphocytes, obtained from the blood samples that were taken in the fasting state before CABG surgery. The association of different variables with postoperative AF and PLR was calculated using univariate and multivariate analysis. The receiver operating characteristics curve was used to determine the sensitivity and specificity of PLR and the optimal cutoff value for predicting post-CABG AF
Results: Of the 125 patients, 50 with AF [mean age: 67.0 +/- 9.5 years, 38 males and 12 females] and 75 patients without AF [mean age: 61.1 +/- 9.1 years, 58 males and 17 females] were identified, and the difference in the mean age was statistically significant [p = 0.01]. PLR was also significantly higher in those with AF [152.8 +/- 82.2] than those without AF [118.2 +/- 32.9] [p = 0.012]. Univariate analysis showed that age and PLR were associated with AF after CABG surgery [p < 0.001 and p = 0.005, respectively]. Using a multivariate logistic regression model with the backward elimination method, age and PLR remained as independent predictors of AF after CABG surgery [p < 0.001 and p = 0.005, respectively]. PLR levels >119.3 predicted postoperative AF with 64% sensitivity and 56% specificity [AUC: 0.634, p = 0.012]
Conclusion: In this study, age and PLR level were independent predictors of AF after CABG surgery. Patients with an elevated preoperative PLR were at higher risk of AF after CABG surgery
ABSTRACT
<p><b>BACKGROUND</b>Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP). Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD). We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.</p><p><b>METHODS</b>Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.</p><p><b>RESULTS</b>Twenty-seven patients had poor CCC and 28 patients had good CCC. In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs. 4 (13%), P = 0.013). Preoperative hemoglobin level (OR: 0.752; 95% CI, 0.571-0.991, P = 0.043), chronic obstructive pulmonary disease (OR: 6.731; 95% CI, 1.159-39.085, P = 0.034) and poor CCC grade (OR: 5.750; 95% CI, 1.575±20.986, P = 0.008) were associated with post-CABG in-hospital mortality. Poor CCC grade (OR: 4.853; 95% CI, 1.124-20.952, P = 0.034) and preoperative hemoglobin level (OR: 0.624; 95% CI, 0.476-0.954, P = 0.026) were independent predictors of in-hospital mortality after CABG.</p><p><b>CONCLUSION</b>Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Collateral Circulation , Physiology , Coronary Artery Bypass , Mortality , Hospital Mortality , Intra-Aortic Balloon Pumping , MortalityABSTRACT
To determine the effects of combined in-patient rehabilitation with a home-based program on function and quality of life. Tertiary care, university teaching hospital, randomized controlled trial. Thirty admitted patients with congestive heart failure with New York Heart Association class II -IV. A five step individualised phase-1 cardiac rehabilitation program followed by a structured home based rehabilitation for eight weeks was given to the experimental group while the control group only received physician directed advice. Six minute walk distance was assessed at discharge and follow-up, while quality of life [SF36] was assessed at admission, discharge, and follow-up. Independent t-test, paired t-test and repeated measures ANOVA with Bonferroni post-hoc analysis. At admission patients in both the groups were comparable. After the phase-1 cardiac rehabilitation, there was a change in the six minute walk distance between control and experimental group [310 m vs. 357 m, respectively; P = 0.001]. Following the eight week home-based program, there was a greater increase in six minute walk distance in the experimental group when compared to the control group [514 m vs. 429 m; P < 0.001]. Quality of life as measured by the SF-36 at the end of 8-weeks showed a statistically significant difference [P < 0.05] in the experimental group for both the mental and physical components. Early in-patient rehabilitation followed by an eight week home based exercise program improves function and quality of life in patients with congestive heart failure
Subject(s)
Humans , Male , Female , Inpatients , Home Care Services , Quality of Life , WalkingABSTRACT
Phase-1 Cardia Rehabilitation [CR] is an important part in the treatment of patients with ST-Elevation Myocardial Infarction [STEMI]. Lac of literature in the rural Indian setting led to the design of this study. Secondary care rural hospital, non-randomized experimental study. Fifteen historical controls and 15 prospectively enrolled patients between January 2007 and December 2007. The prospectively enrolled patients received the phase-1, exercise-based, protocol-guided CR. At discharge, the six-minute walk test [6MWT] distance, Borg's Rating of Perceived Exertion [RPE] after the 6MWT, time to return to baseline parameters after the 6MWT, and complications were assessed. Independent t-test and the Mann Whitney test. Statistically significant [P< 0.01] differences in rating of perceived exertion [RPE] and time to return to baseline parameters post the 6MWT were seen in the experimental group [2 vs. 4 and 5.47 vs. 7.93 minutes, respectively]. No significant changes in the 6MWT distance between the groups were noticed [470+151.76 m and 379 +170.70 m, respectively]. No adverse events during the 6MWT and the phase-1 CR were observed. Protocol-guided, phase-1 CR produces a much faster return of heart rate and blood pressure to baseline following the 6MWT, without producing a great rise in the RPE during the 6MWT, which suggests a training benefit among these patients. The 6MWT can be safely administered in this rural population. However, larger studies will be required to validate these results