ABSTRACT
OBJECTIVES: To assess cognitive impairment after off-pump coronary-artery bypass grafting, with a particular emphasis on long-term follow-up and related risk factors. DESIGN: Prospective study. SETTING: Virgen de la Victoria University Hospital, Málaga, Spain. PARTICIPANTS: Participants were 36 patients undergoing off-pump coronary-artery bypass grafting. MEASUREMENTS: Changes in the neuropsychological test battery administered from before to after surgery (1, 6, and 12 months). Postoperative cognitive impairment was defined by a significant decrease. RESULTS: A significantly multidomain (attention-executive functions, P < .01; immediate and delayed memory, P < .001; and verbal fluency, P < .05) postoperative cognitive impairment was shown, being maximum at 6 months (more than 50% of patients) and still presented at 12 months (more than 30% of patients), but partially recovered. Related risk factors as smoking (P < .01), diabetes mellitus (P < .01), peripheral arteriopathy (P < .01), obesity (P < .05), lower hematocrit (P < .01), and hemoglobin (P < .05) levels and diastolic blood pressure (P < .05) were identified as predictors of cognitive impairment. Better New York Heart Association class (P < .01) and less severity of angina (P < .01) were associated with partial postoperative recovering. CONCLUSION: A multidomain long-term postoperative cognitive impairment and a partial neurocognitive recovering were detected after off-pump coronary-artery bypass grafting and were associated with several nonspecific surgery factors. These findings may be useful when counseling patients before surgery and suggest the importance of long-term neurocognitive evaluation.
Subject(s)
Cognition Disorders/etiology , Coronary Artery Bypass, Off-Pump/adverse effects , Coronary Stenosis/surgery , Elective Surgical Procedures/adverse effects , Aged , Cognition Disorders/epidemiology , Cognition Disorders/physiopathology , Cohort Studies , Confidence Intervals , Coronary Angiography/methods , Coronary Artery Bypass, Off-Pump/methods , Coronary Artery Bypass, Off-Pump/psychology , Coronary Stenosis/diagnostic imaging , Elective Surgical Procedures/methods , Female , Follow-Up Studies , Hospitals, University , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Neuropsychological Tests , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Preoperative Care/methods , Prospective Studies , Risk Assessment , Severity of Illness Index , Spain , Time Factors , Treatment OutcomeABSTRACT
Fundamentos y objetivo: La enfermedad coronaria puede actuar como factor de riesgo cognitivo. Se ha estudiado en pacientes programados para cirugía coronaria la presencia de deterioro cognitivo leve disejecutivo. Pacientes y método: Se ha evaluado en 35 pacientes la función ejecutiva (Trail Making Test). Se clasificaron en grupos con rendimiento normal o con deterioro, estudiándose su relación con otras variables (Mann-Whitney, ji al cuadrado y análisis de regresión múltiple). Resultados: El grupo con deterioro disejecutivo (n = 7; 20%) presentó mayor grado de angina (odds ratio [OR] 1,4, intervalo de confianza del 95% [IC 95%] 1,1-2,6; p = 0,04), enfermedad de 3 vasos (OR 1,3, IC 95% 1,08-3,6; p = 0,04) e índice de masa corporal (OR 1,56, IC 95% 1,16-3,65; p = 0,03), y menor presión arterial diastólica (OR 1,56, IC 95% 1,2-2,98; p = 0,02), hemoglobina (OR 2,03, IC 95% 1,18-4,05; p = 0,02) y hematocrito (OR 2,45, IC 95% 1,67-3,99; p < 0,001); estas variables resultaron significativas del rendimiento en el test como variable dependiente (R2 = 0,62). Conclusiones: Se muestra una importante prevalencia de deterioro cognitivo leve disejecutivo asociado a factores de riesgo cardiovascular. Se recomienda realizar una valoración cognitiva prequirúrgica y un seguimiento posterior por las posibles complicaciones neurológicas posquirúrgicas (AU)
Background and objectives: Coronary disease has been associated with cognitive disorders. We studied the presence of dysexecutive mild cognitive impairment in patients scheduled for coronary surgery. Patients and methods: The executive function of 35 patients was evaluated (Trail Making Test). They were classified into 2 groups: normal performance or cognitive impairment, and we assessed the relationship with others variables (Mann-Whitney, chi-square and multiple regression analysis). Results: The dysexecutive cognitive impairment group (n = 7; 20%) showed greater degree of angina (odds ratio [OR] 1.4, 95% confidence interval [95% CI] 1.1-2.6; P = .04), 3-vessels coronary artery disease (OR 1.3, 95% CI 1.08-3.6; P = .04) and body mass index (OR 1.56, 95% CI 1.16-3.65; P = .03) and lower diastolic blood pressure (OR 1.56, 95% CI 1.2-2.98; P = .02), hemoglobin (OR 2.03, 95% CI 1.18-4.05; P = .02) and hematocrit (OR 2.45, 95% CI 1.67-3.99; P < .001); these variables proved to be significant in the test performance considered as a dependent variable (R2 = 0.62). Conclusions: We found a significant prevalence of dysexecutive mild cognitive impairment, which was associated with cardiovascular risk factors. We recommend assessment and monitoring of cognitive performance for probable neurological complications after cardiac surgery (AU)
Subject(s)
Humans , Coronary Disease/complications , Cognition Disorders/epidemiology , Cognitive Dysfunction/epidemiology , Executive Function , Risk Factors , Cross-Sectional StudiesABSTRACT
BACKGROUND AND OBJECTIVES: Coronary disease has been associated with cognitive disorders. We studied the presence of dysexecutive mild cognitive impairment in patients scheduled for coronary surgery. PATIENTS AND METHODS: The executive function of 35 patients was evaluated (Trail Making Test). They were classified into 2 groups: normal performance or cognitive impairment, and we assessed the relationship with others variables (Mann-Whitney, chi-square and multiple regression analysis). RESULTS: The dysexecutive cognitive impairment group (n=7; 20%) showed greater degree of angina (odds ratio [OR] 1.4, 95% confidence interval [95% CI] 1.1-2.6; P=.04), 3-vessels coronary artery disease (OR 1.3, 95% CI 1.08-3.6; P=.04) and body mass index (OR 1.56, 95% CI 1.16-3.65; P=.03) and lower diastolic blood pressure (OR 1.56, 95% CI 1.2-2.98; P=.02), hemoglobin (OR 2.03, 95% CI 1.18-4.05; P=.02) and hematocrit (OR 2.45, 95% CI 1.67-3.99; P<.001); these variables proved to be significant in the test performance considered as a dependent variable (R(2)=0.62). CONCLUSIONS: We found a significant prevalence of dysexecutive mild cognitive impairment, which was associated with cardiovascular risk factors. We recommend assessment and monitoring of cognitive performance for probable neurological complications after cardiac surgery.
Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/etiology , Coronary Disease/complications , Aged , Cross-Sectional Studies , Female , Humans , Male , Neuropsychological TestsABSTRACT
The results of epidemiological studies of venous thromboembolic disease (VTD) vary widely, depending both on the geographical area and study type. In Spain, there are no data on the incidence and distribution of VTD. To determine the incidence and distribution of this disease, we analyzed the hospital discharges codified by the Spanish national health system. The results of the analysis showed that VTD represented 0.82% (0.69%-0.92%) of all hospital discharges in Spain between 1999 and 2005. The rate of diagnoses for all hospital discharges in 2005 was 103/100,000 inhabitants, with an estimated number of total diagnoses in Spain (hospitalized or not) of 154/100,000. Fifty-three percent were pulmonary embolisms (PE), which showed a tendency to increase, and 47% were deep venous thrombosis (DVT), which showed a tendency to decrease. The mean age was 65 years in men (51% of cases) and 68 years in women, with the incidence increasing exponentially with age. The mean age in patients with PE was 70 years vs 64 years in DVT. Mortality associated with PE was 11.6% vs 2.3% with DVT. DVT occurred during admission in 4% (3-4.7) of persons hospitalized for any cause, 74% of patients being admitted for medical problems. These data reveal that DVT is a serious health problem in Spain, with high morbidity and mortality. The incidence of this disease seems to be increasing and is particularly associated with medical problems, despite improved diagnosis and the accumulated evidence on thromboprophylaxis. Therefore, greater efforts should be made both to improve identification of at-risk patients and the application of prevention protocols.
Subject(s)
Venous Thromboembolism/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Diagnosis-Related Groups , Female , Hospitalization , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Patient Discharge , Pulmonary Embolism/epidemiology , Sex Factors , Spain/epidemiology , Venous Thrombosis/epidemiologyABSTRACT
Hay gran variabilidad en los resultados de los estudios epidemiológicos sobre enfermedad tromboembólica venosa (ETV) dependiendo tanto del área geográfica como del tipo de estudio. En España no hay datos sobre su incidencia y su distribución. Para conocerlos, realizamos un análisis de las altas hospitalarias codificadas por el Sistema Nacional de Salud. Según este estudio, en España, entre 1999 y 2005, la ETV representó el 0,82% (0,69%-0,92%) del total de altas hospitalarias. La tasa calculada de diagnósticos para el total de altas hospitalarias en 2005 fue 103/100.000 habitantes, con una estimación de diagnósticos totales en España (hospitalizados o no) de 154/100.000. El 53% fueron embolias pulmonares (EP), con una tendencia ascendente, y el 47%, trombosis venosa profunda (TVP), con una tendencia descendente. La media de edad fue de 65 años los varones (el 51% de los casos) y 68 años las mujeres, y la incidencia aumenta exponencialmente con la edad. La media de edad en las EP fue 70 años, frente a 64 años en las TVP. La mortalidad por EP fue el 11,6%, frente al 2,3% por TVP. El 4¿ (3¿-4,7¿) de los hospitalizados por cualquier causa sufrieron una ETV durante su ingreso, y el 74% de los pacientes estaban ingresados por problemas médicos. Estos datos ponen de manifiesto que la ETV representa también en España un serio problema de salud ¿con alta morbimortalidad¿ cuya incidencia parece estar aumentando, particularmente en relación con afecciones médicas a pesar del mejor diagnóstico y las evidencias acumuladas en tromboprofilaxis. Por lo tanto, parece necesario intensificar el esfuerzo en mejorar tanto la identificación de los pacientes en riesgo como la aplicación de protocolos de prevención
The results of epidemiological studies of venous thromboembolic disease (VTD) vary widely, depending both on the geographical area and study type. In Spain, there are no data on the incidence and distribution of VTD. To determine the incidence and distribution of this disease,we analyzed the hospital discharges codified by the Spanish national health system.The results of the analysis showed that VTD represented 0.82% (0.69%-0.92%) of all hospital discharges in Spain between 1999 and 2005. The rate of diagnoses for all hospital discharges in 2005 was 103/100,000 inhabitants, with an estimated number of total diagnoses in Spain (hospitalized or not) of 154/100,000. Fifty-threepercent were pulmonary embolisms (PE), which showed a tendency to increase, and 47% were deep venous thrombosis (DVT), which showed a tendency to decrease. The mean age was 65 years in men (51% of cases) and 68 years in women, with the incidence increasingexponentially with age. The mean age in patients with PE was 70 years vs 64 years in DVT. Mortality associated with PE was 11.6% vs 2.3% with DVT. DVT occurred during admission in 4% (3-4.7) of persons hospitalized for any cause, 74% of patients being admitted for medicalproblems.These data reveal that DVT is a serious health problem in Spain, with high morbidity and mortality. The incidence of this disease seems to be increasing and is particularly associated with medical problems, despite improved diagnosis and the accumulated evidence on thromboprophylaxis. Therefore, greater efforts should be made both to improve identification of at-risk patients and the application of prevention protocols
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Venous Thrombosis/epidemiology , Pulmonary Embolism/epidemiology , Spain/epidemiology , IncidenceABSTRACT
BACKGROUND AND OBJECTIVE: To analyze the trends in the utilization of ventilation/perfusion pulmonary scintigraphy (V/QSc), spiral CT (sCT) and pulmonary angiography for diagnosis of pulmonary embolism (PE) in Spain, taking in account the information from the National System of Health (NSH) and RIETE Registry. To examine the diagnostic conformities of V/QSc and sCT in RIETE, with special reference to V/QSc of intermediate/indeterminate probability (V/QScIP). MATERIAL AND METHOD: We examined annual trends of diagnostic imaging for PE in 5,678 Spanish patients included in RIETE (period 2001-2005) and in those of the NHS Databases (1999-2003 period). In RIETE the agreement between diagnostics was compared in cases with both V/QSc and sCT and angiography and V/QSc or sCT. RESULTS: We observed an increasing trend in sTC use, which overcame to V/QSc in 2002 (RIETE) and 2003 (NHS). In 732 cases with both techniques there was a diagnostic conformity of 53%. In 116 cases with V/QScIP a concomitant sTC was + for PE in 87%. If clinical signs of PE were present, then sTC was + in 95% of cases. In 29 cases with sCT and angiography agreement was 83% and in 31 cases with angiography and V/QSc was 77%. CONCLUSIONS: Nowadays in Spain the sTC is the most utilized method to diagnose EP. However, V/QSc studies are also broadly used. In studies V/QScIP it is advisable to look for deep venous thrombosis and, if present, the results of RIETE allow to assure EP coexistence in 87-95% of cases.
Subject(s)
Pulmonary Embolism/diagnosis , Tomography, Spiral Computed , Ventilation-Perfusion Ratio , Aged , Female , Humans , Male , Registries , SpainABSTRACT
Fundamento y objetivo: Analizar las tendencias de utilización de gammagrafía de ventilación-perfusión (gammaV/Q), tomografía computarizada helicoidal (TCH) y arteriografía pulmonar para el diagnóstico de embolia pulmonar (EP) en España, considerando los datos del Sistema Nacional de Salud (SNS) y el Registro RIETE y examinar las analogías diagnósticas de la gammaV/Q y la TCH en RIETE, con especial referencia a la gammaV/Q de probabilidad intermedia/indeterminada (GV/QPI). Material y método: Se examinaron las tendencias anuales en pruebas de imagen para diagnosticar EP en 5.678 pacientes españoles incluidos en el Registro RIETE (2001 a 2005) y se compararon con los pertenecientes al SNS (período 1999-2003). En el RIETE se compararon los resultados análogos entre los casos con gammaV/Q y TCH concomitantes y arteriografía y gammaV/Q o TCH. Resultados: Hubo una tendencia creciente en la utilización de TCH, que superó en 2002 (RIETE) y en 2003 (SNS) a la gammaV/Q. En 732 casos con ambas pruebas, se obtuvieron resultados análogos en el 53%. En 116 casos con gammaV/QPI, la TCH disponible fue positiva a EP en un 87%. Cuando además había signos clínicos de EP, la TCH fue positiva en un 95%. En 29 casos con angiografía pulmonar (AP) y TCH, los resultados fueron análogos en un 83% y en 31 casos con arteriografía y gammaV/Q, en un 77%. Conclusiones: Actualmente, en España, la TCH es el método más utilizado para el diagnóstico de EP, aunque siguen realizándose numerosos estudios con gammaV/Q. En los resultados de gammaV/QPI es aconsejable estudiar la posible trombosis venosa profunda y, si la hay, los resultados del RIETE permiten asegurar la coexistencia de EP en un 87-95% de casos
Background and objective: To analyze the trends in the utilization of ventilation/perfusion pulmonary scintigraphy (V/QSc), spiral CT (sCT) and pulmonary angiography for diagnosis of pulmonary embolism (PE) in Spain, taking in account the information from the National System of Health (NSH) and RIETE Registry. To examine the diagnostic conformities of V/QSc and sCT in RIETE, with special reference to V/QSc of intermediate/indeterminate probability (V/QScIP). Material and method: We examined annual trends of diagnostic imaging for PE in 5,678 Spanish patients included in RIETE (period 2001-2005) and in those of the NHS Databases (1999-2003 period). In RIETE the agreement between diagnostics was compared in cases with both V/QSc and sCT and angiography and V/QSc or sCT. Results: We observed an increasing trend in sTC use, which overcame to V/QSc in 2002 (RIETE) and 2003 (NHS). In 732 cases with both techniques there was a diagnostic conformity of 53%. In 116 cases with V/QScIP a concomitant sTC was + for PE in 87%. If clinical signs of PE were present, then sTC was + in 95% of cases. In 29 cases with sCT and angiography agreement was 83% and in 31 cases with angiography and V/QSc was 77%. Conclusions: Nowadays in Spain the sTC is the most utilized method to diagnose EP. However, V/QSc studies are also broadly used. In studies V/QScIP it is advisable to look for deep venous thombosis and, if present, the results of RIETE allow to assure EP coexistence in 87-95% of cases
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pulmonary Embolism , Pulmonary Embolism , Tomography, Spiral Computed , Angiography , SpainSubject(s)
Internal Medicine/statistics & numerical data , Chronic Disease , Comorbidity , Humans , SpainABSTRACT
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