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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Association Between Infection and Thrombosis After Coronary Artery Bypass Grafting: A Cohort Study
Xiaojie Liu1, Lijuan Wang1, Sudena Wang1
1Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Postoperative infection after coronary artery bypass grafting (CABG) significantly increases the risk of perioperative thrombosis. While infection did not elevate major adverse cardiovascular and cerebral events (MACCEs), it highlights a critical area for quality improvement in cardiac surgery care.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Epidemiology
- Thrombosis Research
Background:
- Surgery-related infection is a significant complication in cardiac surgery.
- The relationship between postoperative infection and thrombosis after coronary artery bypass grafting (CABG) requires further investigation.
Purpose of the Study:
- To investigate the association between postoperative infection and thrombosis.
- To examine the link between postoperative infection and major adverse cardiovascular and cerebral events (MACCEs) in CABG patients.
Main Methods:
- Retrospective cohort study including 75 infected patients and 2,926 controls undergoing CABG.
- Analysis of perioperative and postoperative data using multivariable regression.
Main Results:
- Postoperative infection was associated with a 5.13-fold increased odds of perioperative thrombosis (p < 0.0001).
- No significant association was found between infection and 5-year MACCEs (p = 0.080).
- Older age was a significant risk factor for MACCEs (HR 1.040, p < 0.0001).
Conclusions:
- A clear association exists between postoperative infection and perioperative thrombosis following CABG.
- Identifying and managing infection risk factors can improve patient outcomes and reduce thrombosis complications.
Objective:
Surgery-related infection remains a major complication for patients undergoing cardiac surgery, and its association with thrombosis is unclear. This study aimed to examine the association of postoperative infection with thrombosis and major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing coronary artery bypass grafting (CABG).
Design:
Retrospective cohort study. Multiple variable regression analyses were performed.
Setting:
The study was performed at a single institution.
Participants:
All patients underwent CABG.
Intervention:
None.
Measurements And Main Results:
Perioperative and postoperative follow-up data relating to all CABG patients from January 2001 to August 2006 were queried from institutional electronic medical records of Fuwai Hospital, Beijing, China. Patients were divided into 2 groups according to whether they experienced infection. The study population comprised 75 patients who experienced infection and 2,926 control patients. Primary outcomes were a composite outcome of perioperative thrombosis and long-term thrombosis-related complications. Secondary outcomes were 5-year MACCEs postoperatively, including death, myocardial infarction, target vessel revascularization, and stroke. Risk factors for infection included older age, higher level of creatinine, chronic lung disease, cardiopulmonary bypass time, aortic cross-clamp time, history of renal failure, cardiopulmonary bypass, left ventricular assist device or intra-aortic balloon pump, length of stay in the intensive care unit, and duration of tracheal intubation. Infection increased the odds of perioperative thrombosis by 5.132-fold (95% confidence interval [CI] 2.040-12.911; p < 0.0001) compared with control. However, infection was not associated with a significant increase in MACCEs (hazard ratio 1.855, 95% CI 0.929-3.704; p = 0.080). Age was associated with a significant increase in MACCEs (hazard ratio 1.040, 95% CI 1.026-1.054; p < 0.0001).
Conclusion:
There is an association between postoperative infection and perioperative thrombosis after CABG. Several specific management modalities were associated with controlling infection risk, which offers targets for future quality improvement.
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