[Impact of renal dysfunction on early outcomes of coronary artery bypass grafting surgery].

INTRODUCTION: Impaired renal function as seen in chronic kidney disease (CKD) is a known risk factor for coronary artery diseases and has been linked to inferior outcome after myocardial revascularization. Studies on the outcome of coronary bypass grafting (CABG) in CKD-patients are scarce. We aimed to study this subgroup of patients following CABG in a well defined whole-nation cohort, focusing on short term complications and 30 day mortality. MATERIALS AND METHODS: A retrospective study on 2300 consecutive patients that underwent CABG at Landspítali University Hospital 2001-2020. Patients were divided into four groups according to preoperative estimated glomerular filtration rate (GFR), and the groups compared. GFR 45-59 mL/mín/1.73m2, GFR 30-44 mL/mín/1.73m2, GFR <30 mL/mín/1.73m2 and controls with normal GFR (≥60 mL/mín/1.73m2). Clinical information was gathered from medical records and logistic regression used to estimate risk factors of 30-day mortality. RESULTS: Altogether 429 (18.7%) patients had impaired kidney function; these patients being more than six years older, having more cardiac symptoms and a higher mean EuroSCORE II (5.0 vs. 1.9, p<0.001) compared to controls. Furthermore, their left ventricular ejection fraction was also lower, their median hospital stay extended by two days and major short-term complications more common, as was 30 day mortality (24.4% vs. 1.4%, p<0.001). In multivariate analysis advanced age, ejection fraction <30% and GFR <30 mL/min/1.73m2 were independent predictors of higher 30-day mortality (OR=10.4; 95% CI: 3.98-25.46). CONCLUSIONS: Patients with impaired renal function are older and more often have severe coronary artery disease. Early complications and 30-day mortality were much higher in these patients compared to controls and advanced renal failure and the strongest predictor of 30-day mortality.

[Incidence and predictors of prolonged intensive care unit stay after coronary artery bypass in Iceland].

INTRODUCTION: To maximize the use of intensive care unit (ICU) re--sources, it is important to estimate the prevalence and risk factors for prolonged ICU unit stay after coronary artery bypass grafting (CABG) surgery. MATERIAL AND METHODS: This retrospective cohort study included all patients who underwent primary isolated CABG at Landspitali between 2001 and 2018. Patient information was collected from hospital charts and death registries. Patients who stayed in the ICU for the conventional one night postoperatively were compared with those who needed longer stays in the ICU. Survival rate was estimated with the Kaplan-Meier method. Predictors for prolonged ICU stay were calculated with logistic regression and the outcome used to create a calculator that estimates the probability of prolonged ICU stay. RESULTS: Out of 2177 patients, 20% required prolonged ICU stay. Patients with prolonged stay were more frequently female (23% vs 16%, p=0.001), had a higher rate of cardiovascular risk factors and higher EuroSCORE II (4.7 vs. 1.9, p<0.001). They also had a higher rate of impaired renal function before surgery (14% vs. 4%, p<0.001) and emergent surgery (18% vs. 2%, p<0.001). Furthermore, these patients had higher rates of both short-term and long-term complications, and lower long-term survival (85% vs 68% five-year survival rate, p<0.0001). Independent risk factors for prolonged ICU stay were advanced age, female gender, EuroSCORE II, history of heart diseases, impaired renal function and emergent surgery.  Conclusions: Every fifth patient had a prolonged ICU stay after CABG. Several risk factors predicted prolonged ICU stay after CABG, in particular patients' medical condition before surgery, EuroSCORE II and emergent surgery. A better understanding of the risk factors for prolonged ICU stay will hopefully aid in scheduling CABG surgeries at Landspitali.

[The use of Intra Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery].

INTRODUCTION: Intra-aortic balloon pump (IABP) is a mechanical device that increases cardiac output by increasing diastolic blood flow to the coronary arteries and lowers the afterload of the left ventricle in systole. IABP is primarily used in acute heart failure, that includes patients that have to undergo coronary artery bypass grafting (CABG). Its usage, however, in cardiac surgery has been declining with ongoing controversy regarding its benefits. The aim of this study was to assess the use and indications and outcome of IABP related to CABG surgery. MATERIAL AND METHODS: The study was retrospective and included 2177 patients that underwent CABG at Landspítali during 2001-2018. We compared those who received an IABP with controls, using uni- and multivariate analysis. Long term survival and complications (major adverse cardiovascular and cerebral events, MACCE) was estimated with Kaplan-Meier method. RESULTS: A total of 99 (4.5%) patients received an IABP. The incidence was highest in 2006 (8.9%) and lowest in 2001 (1.7%), but the incidence did not change during the study period (p=0.90). Most patients received the pump before (58.6%) or during (34.3%) CABG, but only 6.1% after surgery. Complication rate was 14.1%, with bleeding from the insertion site in the groin being the most common complication. Thirty day mortality was higher in the IABP group compared with controls (22.2% vs 1.3%, p<0.001) and both 5-year survival (56.4% vs 91.5%, 95% CI: 0.47-0.67) and 5-year MACCE-free survival (46.9% vs 83.0%, 95% CI: 0.38-0.58) were inferior. CONCLUSIONS: Less than 5% of patients received IABP in relation to CABG in Iceland and the rate hasn't changed much for the last 18 years. Both the complication rate and 30-day mortality was higher in patients in IABP group and both the long term and MACCE-free survival was much worse, probably mostly related to worse overall clinical condition of the patient that received IABP.

[No significant association between obesity and long-term outcome of coronary artery bypass grafting].

OBJECTIVES:  Our objective was to investigate long-term outcomes of obese patients undergoing coronary artery bypass grafting (CABG) in Iceland. MATERIALS AND METHODS:  A retrospective analysis on 1698 patients that underwent isolated CABG in Iceland between 2001-2013. Patients were divided into four groups according to body mass index (BMI); Normal=18.5-24.9kg/m2 (n=393), ii) overweight=25-29.9 kg/m2 (n=811), iii) obese=30-34.9 kg/m2 (n=388) and iv) severely obese ≥35kg/m2 (n=113). Thirty-day mortality and short-term complications were documented as well as long-term complications that were pooled into major adverse cardiac and cerebrovascular events (MACCE) and included myocardial infarction, stroke, repeated CABG, percutaneous coronary intervention with or without stenting, and death. After pooling the study groups, survival and freedom from MACCE plots (Kaplan- Meier) were generated and Cox regression analysis used to identify predictive factors of survival. Average follow-up time was 5.6 years. RESULTS:  Severely obese and obese patients were significantly younger than those with a normal BMI, more often males with identifiable risk factors of coronary artery disease (CAD) and a lower EuroSCORE II (1.6 vs. 2.7, p=0.002). The incidence of major early complications, 30-day mortality (2%), long-term survival (90% at 5 years, log-rank test p=0.088) and MACCE-free survival (81% at 5 years, log-rank test p=0.7) was similar for obese and non-obese patients. BMI was neither an independent predictor for long-term (OR: 0.98 95%-CI: 0.95-1.01) nor MACCE-free survival (OR: 1.0 95%-CI: 0.98-1.02).  Conclusions: Obese patients that undergo CABG in Iceland are younger and have an increased number of risk factors for coronary disease when compared to non-obese patients. However, BMI neither predicted long-term survival or long-term complications. The outcomes following CABG in obese patients are good in Iceland.

Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries.

BACKGROUND: Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. MATERIALS AND METHODS: This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. RESULTS: Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). CONCLUSION: Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.