Explore the vast range of titles available.

While coronary artery bypass grafting (CABG) surgery is effective in reducing the risk of myocardial infarction and subsequent cardiac events by improving myocardial perfusion, the risk of sudden cardiac death (SCD) remains notable. This retrospective observational study evaluated the efficacy of dual antiplatelet therapy (DAPT) in preventing sudden cardiac death (SCD) among patients undergoing CABG surgery at a major U.S. cardiac center (2012-2015). Data was manually extracted from electronic medical records between 23/04/2017 to 30/03/ 2018 and verified for accuracy, with patients categorized into DAPT or aspirin monotherapy groups based on discharge prescriptions. Of 2,476 patients followed in this post-CABG study, the analysis included 1,005 patients who received aspirin monotherapy (AMT) and 1,458 patients who received dual antiplatelet therapy (DAPT). AMT group had a significantly higher incidence of SCD compared to those on DAPT (3.1% vs 0.8%; OR = 3.831, 95% CI: 1.961-7.519; p < 0.001). The binary regression model indicated that a higher BMI was associated with an increased risk of SCD (HR = 1.064, 95% CI: 1.012-1.118, p = 0.014). However, patients prescribed P2Y12 antagonists (HR = 0.285, 95% CI: 0.135-0.603, p < 0.001), those with a GFR >  60 ml/min (HR = 0.314, 95% CI: 0.158-0.624, p < 0.001), and those with a higher ejection fraction (HR = 0.962, 95% CI: 0.939-0.986, p = 0.002) were less likely to experience SCD following CABG. A 1 kg/m2 increase in BMI is associated with a 6.4% increase in the risk of SCD. Morbidly obese patients with BMI >  35 were more likely to have experienced SCD than those with BMI < 35 (HR = 2.400, 95% CI: 1.204-4,787; p =  0.013). Similarly, patients with EF > 40% had decreased incidence of SCD compared to those with EF < 40% (HR 0.347, 95% CI:0.158-0.763; p = 0.008). Patients on AMT had higher all-cause (OR = 2.136, 95% CI 1.502-3.038; p < 0.001) and CV mortality (OR = 3.731, 95% CI 2.233-6.235; p < 0.001) but had lower incidence of major bleeding (by drop in hemoglobin criteria) (OR = 0.704, 95% CI: 0.595-0.833; p < 0.001) compared to the DAPT group. DAPT prescription after CABG improves survival and lowers risk of sudden cardiac death.

Background Despite advancements in surgical techniques, interventional procedures, novel pharmacotherapies, and other contemporary treatments, patients after coronary artery bypass graft surgery (CABG) remain at risk for graft failure and progression of native vessel disease progression. Consequently, secondary revascularization is often required. Methods This is a retrospective observational study evaluating the incidence, trends, and predictors of revascularization after CABG surgery. Results Of 2,476 patients followed in this post-CABG study, 1458 patients received dual antiplatelet therapy (DAPT) compared to 1005 patients received aspirin monotherapy (AMT). The overall incidence of revascularization was significantly higher in the DAPT group (14.54%, 212 out of 1458) compared to the AMT group (7.07%, 71 out of 1005), with an odds ratio (OR) of 2.24 (95% CI: 1.69–2.97, p  < 0.001). 770 patients who received DAPT for six months or more after surgery were compared in sub-analysis and were noted to have significantly higher incidence of revascularization compared to AMT (22.08% vs. 6.96%; OR = 3.157, 95% CI: 2.734–4.940; p  < 0.001). The binary regression model revealed that younger patients ( hazard ratio (HR) = 0.964, 95% CI: 0.95–0.97; p  < 0.001), diabetics (HR = 1.50, 95% CI: 1.12-2.00, p  = 0.007), patients who had fewer internal mammary artery grafts (HR = 0.54, 95% CI: 0.36–0.81, p  = 0.003), and patients receiving DAPT of any duration after CABG (HR = 3.47, 95% CI: 2.55–4.72, p  < 0.001) were more likely to receive revascularization after CABG. The model, comprising these four predictors, was able to explain 12.8% of the variance in post-CABG revascularization (Nagelkerke R² = 0.128; p  < 0.001). The survival rates were 96.5% for the DAPT group and 92.0% for AMT (odds ratio (OR) = 0.421, 95% confidence interval (95% CI): 0.269–0.658; p  < 0.001). Conclusion Diabetes mellitus, younger age, fewer Internal mammary artery grafts, and the use of DAPT after CABG were strong predictors of the need for secondary revascularization.

Background/Objectives: Coronary artery disease (CAD) remains the leading cause of mortality worldwide, with South Asia bearing a disproportionately high and rising burden, particularly at younger ages. The present study aimed to investigate genetic variants associated with premature coronary artery disease (PCAD) using whole-genome sequencing (WGS). Methods: WGS was conducted on 12 people (five PCAD cases, seven matched controls) to assess feasibility and methodology for future large-scale research. High-quality genomic DNA was sequenced at a minimum read depth of 10× with a quality threshold of Q30. Variant calling with stringent quality control identified single-nucleotide polymorphisms (SNPs), followed by annotation against gnomAD for allele frequencies and ClinVar for pathogenicity. Protein-coding variants were filtered, and candidate genes were prioritized for comparative analysis between cases and controls. Results: An average of over 8.8 million SNPs per individual was identified, with comparable overall variant distributions between cases and controls. Initial analyses revealed 120 SNPs exclusively present in PCAD cases. All protein-coding variants were rare (allele frequency < 0.0001), and none were previously classified as pathogenic in ClinVar. After filtration, 87 candidate genes were prioritized. Enriched or unique variants in PCAD cases are mapped to genes involved in lipid metabolism, endothelial dysfunction, inflammatory signaling, immune regulation, thrombosis, vascular remodeling, and metabolic processes. Additional variants were identified in genes related to smooth muscle proliferation, oxidative stress, and other biological pathways. Conclusions: This WGS pilot study provides an initial overview of the genomic landscape of PCAD in a South Asian cohort, highlighting rare variants across multiple biological pathways implicated in atherosclerosis that need validation in a large-scale study.

Premature coronary artery disease (PCAD) is a growing public health concern, especially in South Asia, where traditional risk factors fail to fully explain the increasing incidence of early-onset myocardial infarction. To explore its molecular underpinnings, we conducted a pilot study analyzing plasma proteins and lipids to identify potential biomarkers and dysregulated pathways associated with PCAD. Label-free quantitative proteomics revealed distinct molecular signatures separating PCAD patients from age- and sex-matched healthy controls. Key alterations included upregulation of GALE, immunoglobulin genes, and KIF20B, suggesting enhanced inflammatory responses and proliferative activity associated with post-myocardial infarction cellular repair. Similarly, down regulations of various proteins linked to multiple functions, such as myocardial infarction, hemoglobinopathy, complement and coagulation cascade, and fatty acid and lipoprotein transport in hepatocytes, were observed. Untargeted lipidomics further revealed significant elevations in several phosphatidylcholine species (PC 42:5, PC 40:3, and PC 42:7), highlighting disruption of highly unsaturated phospholipid metabolism. Overall, these findings indicate that PCAD is a multifactorial disorder involving metabolic, immune, and vascular dysfunction beyond conventional lipid abnormalities, underscoring the need for larger cohort studies to validate these biomarkers and uncover novel therapeutic targets.

Background High‐intensity statins are recommended for patients with chronic coronary artery disease, with reports suggesting improved clinical outcomes. However, recent findings in coronary artery bypass graft (CABG) patients question whether a treat‐to‐target low density lipoprotein (LDL) approach is non‐inferior to high‐intensity statin therapy. Methods This single‐center observational study analyzed all CABG only (n = 1854) procedures performed between 2013 and 2015. Patients were divided into three groups based on statin prescription: high‐intensity statin therapy (atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg), low/moderate‐intensity statin therapy, and a no‐statin group. The primary outcome measured was major adverse cardiovascular events (MACE), a composite of post‐CABG acute coronary syndrome, cerebrovascular accident and cardiovascular mortality. Results No‐Statin group had significantly higher incidence of MACE compared to statin group (14.2% vs 8.9%; odds ratio (OR) 1.60, 95% confidence interval (CI) 1.055–2.427, p = 0.029). Low/moderate‐intensity therapy (n = 1301) was associated with a numerically higher overall rate of MACE compared to high‐intensity therapy (n = 397) but was not statistically significant (9.6% vs 6.6%; OR 1.45, CI 0.961–2.172, p = 0.073). Beyond 2 years post‐CABG, low/moderate intensity statin use was associated with a significant higher incidence of MACE (9.1% vs 5.3%; OR 1.72, 95% CI 0.993–2.978, p = 0.047) compared to high intensity statins. Patients who received high‐intensity statin therapy had the lowest LDL levels (82.21 ± 41.85 mg/dL), compared to those on low/moderate‐intensity statins (90.84 ± 45.89 mg/dL) and no‐statin group (104.83 ± 38.93 mg/dL, p < 0.001). Conclusion High‐intensity statin therapy following CABG is associated with improved long‐term clinical outcomes compared to low‐ or moderate‐intensity statin regimens. Summary What's New? While statin use overall was associated with a significant reduction in major adverse cardiovascular events compared to no statin therapy, high‐intensity statins demonstrated a trend toward superior outcomes compared to low/moderate‐intensity statins, achieving statistical significance in the later follow‐up period. The study provides real‐world evidence from a large, single‐center cohort, supporting the sustained benefit of intensive lipid‐lowering therapy in post‐CABG patients. What Are the Clinical Implications? Statin therapy should be strongly considered in all patients undergoing CABG to reduce the risk of long‐term cardiovascular events. Among statin users, high‐intensity statins may offer additional long‐term benefit, particularly after the second year following surgery, and should be prioritized when clinically tolerated. Patients who are unable to tolerate statin therapy may benefit from alternative lipid‐lowering agents, as this study demonstrated that individuals not receiving statins experienced worse clinical outcomes and had significantly higher levels of total cholesterol and LDL.