Carl-Johan Jakobsen

Ischemic heart disease (IHD) is, despite improvement last decades, still a leading cause of death globally. Clinical IHD guidelines do not distinguish betw

Background and Objectives: Despite huge reductions in the incidence and mortality of cardiovascular disease (CVD) during the last decades, ischemic heart disease (IHD) is globally still a leading cause of death. Although females experience higher mortality, the clinical IHD guidelines do not distinguish between sexes, and despite added diagnostic procedures after introduction of computed coronary arteriography (CTA) the differences remain. This study aimed to describe and evaluate the effect, outcomes and sex disparities of the large number of diagnostic procedures not leading to invasive treatments. Materials and Methods: The study included 274,617 first-entry patients submitted to invasive coronary arteriography (ICA) or CTA 2000–2020, from the mandatory Western Denmark Heart Registry. Mortality was evaluated with Kaplan–Meier curves and further compared to background population. Results: Females constituted 34.1% of all first-entry diagnostic procedures but only 25.5% of those who subsequently underwent invasive treatment, demonstrating a substantially lower treatment rate compared to males. All-cause 10-year mortality was higher in females after treatment 1.26 (1.23–1.30) but lower in the non-treated patients 0.71 (0.67–0.72) at all time points. Comparing to the background population, all non-treated patients revealed lower mortality in all indications, except valves. Conclusions: Despite being referred for coronary diagnostication according to their CVD prevalence, females received less invasive treatments than males and presented with substantially higher mortality after invasive treatments. In variance, non-invasive treated females demonstrated significantly better survival than men both in intra-study comparisons and in assessment with background population mortality.

OBJECTIVES: Previous studies indicated higher long-term mortality after the transfusion of allogeneic red blood cells (RBC); newer recommendations emphasize lower transfusion rates. The consequences of the transfusion of RBCs in cardiac surgery are unclear because later studies focused on transfusion triggers and short-term outcomes. Reports on long-term complications after cardiac surgery are few.MATERIAL AND METHODS: The mandatory Western Denmark Heart Registry was used to identify all adult cardiac operations performed in 4 centres from 2000 to 2019. Patients with multiple entries or previous cardiac operations, special/complex procedures, dying within 30 days and not eligible for follow-up were excluded.RESULTS: A total of 32,581 adult cardiac operations performed in 4 centres from 2000 to 2019 were included. The Kaplan–Meier survival plot for low-risk patients undergoing simple cardiac operations showed a significantly lower 15-year survival (0.384 vs 0.661) of patients who received perioperative RBC transfusions [odds ratio 2.43 (confidence level 2.23–2.66)]. The risk decreased with increasing comorbidity or age. No difference was found in high-risk patients. The adjusted risk ratio after an RBC transfusion, including age, sex, comorbidity and surgery, was 1.62 (1.48–1.77).CONCLUSIONS: Despite reduced transfusion rates, long-term follow-up on especially low-risk patients undergoing comparable cardiac operations still demonstrates substantially more deaths of patients receiving perioperative RBC transfusions. Even transfusion of 1–2 units is associated with increased long-term mortality.

Objectives. The goal of this study was to examine whether the use of free arterial grafts could reduce the need for repeated revascularization and all-cause mortality in patients undergoing coronary artery grafting. Design. The cohort study included 17,354 consecutive adults with isolated coronary artery grafting from 2000 to 2016 in three cardiac surgery centers. Data were obtained from the Western Denmark Heart Registry. Propensity matching with 24 factors was used to establish comparable groups of patients receiving either vein grafts (n = 1019) or free arterial grafts (n = 1019) for outcome analysis. Results. The need for repeated revascularization and all-cause mortality was similar in both graft groups at 10 years of follow-up. Creatine-Kinase MB Isoenzyme >100 μg/L increased the risk of repeated revascularization rate after 1, 5 and 10 years. Conclusions. Long-term outcomes in revascularization and survival are comparable after free arterial or saphenous vein grafting.

Background: The quest for methods expediting rapid postoperative patient turnover has triggered implementation of various fast-track cardiac anaesthesia protocols. Using three different fast-track protocols in randomized controlled studies (RCT) conducted 2010-2016 we found minimal achievements in ventilation time together with actual and eligible length of stay in cardiac recovery unit. The comparable control group patients were evaluated in this retrospective post hoc analysis, for an association between above mentioned parameters and quality parameters, to assess whether the marginal gains have been at the expense of quality of recovery and patient comfort. Method: 90 control patients from three RCT with comparable demographic parameters and receiving standard department treatment were evaluated using time parameters and an objective/semi-objective Intensive Care Unit (ICU) score system (IDS score). Results: Ventilation time was statistical significant lower in latest study (C) than the early (A) and intermedium (B) studies (A=293, B=261, C=205 minutes; P=0.04). The IDS was lower at extubation and all time points in the early study compared to other studies (P < 0.001;). The average IDS in latest study were the double of previous studies at the end of observations, and marginally above the acceptable score for discharge. The postoperative morphine requirement A=15.0, B=10.0 and C=26.5 mg; P=0.002) was statistical significant higher in the latest study compared to previous studies. Conclusion: The implementation of strict fast-track protocols resulting in shorter ventilation time did not convert to earlier eligibility to discharge from the ICU. However, the quality of recovery appears challenged.