Predictive value of varying degrees of delirium on the occurrence of perioperative myocardial infarction following off-pump coronary aortic bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Hailong , WANG Xugang , SU Zhenyu ,  ZHANG Huijun

Department of Cardiac Surgery, First Hospital of Hebei Medical University, Shijiazhuang, 050000, P. R. China;

Corresponding?author：

ZHANG Huijun, Email: 2683292687@qq.com

Keywords：

Delirium; coronary artery bypass grafting; myocardial infarction; independent risk factors; brain-heart syndrome

DOI：

10.7507/1007-4848.202406020

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the predictive value of different degrees of delirium after off-pump coronary aortic bypass grafting (OPCABG) for perioperative myocardial infarction (MI). Methods A retrospective analysis was conducted on the clinical data of patients who underwent OPCABG in the First Department of Cardiac Surgery at the First Hospital of Hebei Medical University between April 2018 and March 2024. Patients were divided into a mild delirium group, a moderate delirium group, and a severe delirium group based on the degree of delirium, and into a MI group and a non-MI group based on the occurrence of perioperative MI. Binary logistic regression analysis was used to investigate the predictive factors for secondary MI during OPCABG. The predictive value of different degrees of postoperative delirium for secondary perioperative MI was assessed using receiver operating characteristic (ROC) curves. Results A total of 436 patients were included, with 211 males and 225 females, and a median age of 51 (44.0, 57.75) years. Delirium occurred in 139 patients, with 52 in the mild delirium group, 29 in the moderate delirium group, and 58 in the severe delirium group. MI occurred in 101 patients, with 101 in the MI group and 335 in the non-MI group. Binary logistic regression analysis showed that severe delirium was an independent predictor of secondary MI during OPCABG [OR=23.979, 95% CI (11.572, 49.691), P=0.000]. ROC curve analysis revealed that the area under the ROC curve for predicting perioperative MI by severe postoperative delirium was 0.709, with a sensitivity of 0.546 and a specificity of 0.964. Conclusion Severe postoperative delirium can be used as an indicator to predict secondary MI during OPCABG.

1.	Thielmann M, Sharma V, Al-Attar N, et al. ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J, 2017, 38(31): 2392-2407.
2.	Abdullah AS, Salama A, Ibrahim H, et al. Palliative care in myocardial infarction: Patient characteristics and trends of service utilization in a national inpatient sample. Am J Hosp Palliat Care, 2019, 36(8): 722-726.
3.	Gaebel W, Zielasek J, Reed GM. Mental and behavioural disorders in the ICD-11: Concepts, methodologies, and current status. Psychiatr Pol, 2017, 51(2): 169-195.
4.	Li T, Li J, Yuan L, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: The RAGA randomized trial. JAMA, 2022, 327(1): 50-58.
5.	Devlin JW, Skrobik Y, Gélinas C, et al. Executive summary: Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): 1532-1548.
6.	J?ckel M, Zotzmann V, Wengenmayer T, et al. Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry. Catheter Cardiovasc Interv, 2021, 98(6): 1072-1081.
7.	Patil S, Gonuguntala K, Rojulpote C, et al. Delirium is an important predictor of mortality in elderly patients with ST-elevation myocardial infarction: Insight from National Inpatient Sample database. Coron Artery Dis, 2020, 31(8): 665-670.
8.	Li S, Zhang XH, Zhou GD, et al. Delirium after primary percutaneous coronary intervention in aged individuals with acute ST-segment elevation myocardial infarction: A retrospective study. Exp Ther Med, 2019, 17(5): 3807-3813.
9.	Wei LA, Fearing MA, Sternberg EJ, et al. The confusion assessment method: A systematic review of current usage. J Am Geriatr Soc, 2008, 56(5): 823-830.
10.	Inouye SK, Kosar CM, Tommet D, et al. The CAM-S: Development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med, 2014, 160(8): 526-533.
11.	丁曉航, 高銘鑫, 于洋. 冠狀動脈旁路移植術后圍術期心肌梗死發生機制及預測的研究進展. 心肺血管病雜志, 2022, 41(8): 942-946.Ding XH, Gao M, Xin YY. Research progress on pathogenesis and prediction of perioperative myocardial infarction after coronary artery bypass transplantation. J Cardiovasc Pulm Dis, 2022, 41(8): 942-946.
12.	王鳳華, 魏茂提, 徐寧, 等. 不同來院方式急性ST段抬高心肌梗死患者再灌注時間及院內死亡危險因素分析. 臨床心血管病雜志, 2022, 38(4): 298-303.Wang FH, Wei MT, Xu N, et al. Effects of different admission modes on reperfusion time and risk factors of in-hospital death in patients with acute ST-segment elevation myocardial infarction. J Clin Cardiol (China), 2022, 38(4): 298-303.
13.	Melendez E, Whitney JE, Norton JS, et al. A pilot study of the association of amino-terminal pro-b-type natriuretic peptide and severity of illness in pediatric septic shock. Pediatr Crit Care Med, 2019, 20(2): e55-e60.
14.	李末寒, 陸士奇, 肖卓韜, 等. 白細胞/血小板平均體積聯合Gensini 積分評估急性心肌梗死患者住院期間預后的研究. 臨床急診雜志, 2020, 21(4): 282-286.Li MH, Lu SQ, Xiao ZT, et al. White blood cell/mean platelet volume combined with Gensini score for in-hospital prognosis in patients with acyte myocardial infarction. J Clin Emerg (China), 2020, 21(4): 282-286.
15.	Zhao D, Liu J, Wang M, et al. Epidemiology of cardiovascular disease in China: Current features and implications. Nat Rev Cardiol, 2019, 16(4): 203-212.
16.	Wang J, Gu C, Yu W, et al. Short- and long-term patient outcomes from combined coronary endarterectomy and coronary artery bypass grafting: A meta-analysis of 63, 730 patients (PRISMA). Medicine (Baltimore), 2015, 94(41): e1781.
17.	馬小龍, 李溫斌, 王堅剛, 等. 冠狀動脈旁路移植術后1年內接受經皮冠狀動脈介入治療的臨床特征與隨訪結果研究. 心肺血管病雜志, 2022, 41(2): 152-157.Ma XL, Li WB, Wang JG, et al. Clinical characteristics and follow-up outcomes of 121 patients who received percutaneous coronary intervention within 1 year after coronary artery bypass grafting. J Cardiovasc Pulm Dis, 2022, 41(2): 152-157.
18.	田麗曉, 秦歷杰, 王龍安, 等. 糖化血紅蛋白聯合腦鈉肽對老年急性心肌梗死住院患者臨床預后的評估價值. 中華老年醫學雜志, 2020, 39(10): 1174-1177.Tian LX, Qin LJ, Wang LA, et al. Clinical value of glycated hemoglobin combined with brain natriuretic peptide in predicting the prognosis of elderly hospitalized patients with acute myocardial infarction. Chin J Geriatrics, 2020, 39(10): 1174-1177.
19.	林玉萍, 黃錦杭, 張海林, 等. 冠心病患者發生心肌梗死的獨立危險因素分析. 心血管病防治知識, 2021, 11(32): 11-14.Lin YP, Huang JH, Zhang HL, et al. Analysis of independent risk factors for myocardial infarction in patients with coronary heart disease. Cardiovasc Dis Pre Know, 2021, 11(32): 11-14.
20.	Mart MF, Williams Roberson S, Salas B, et al. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med, 2021, 42(1): 112-126.
21.	Sanjanwala RM, Hiebert B, Kent D, et al. A Quality improvement initiative to reduce postoperative delirium among cardiac surgery patients. Geriatrics (Basel), 2021, 6(4): 111.
22.	甘文欣, 馬晶, 彭曉紅, 等. ICU 心臟手術患者術后譫妄發生現況及影響因素. 河北醫藥, 2023, 45(4): 518-521.Gan WX, Ma J, Peng XH, et al. Current situation and influencing factors of postoperative delirium in intensive care unit patients undergoing cardiac surgery. Hebei Med J, 2023, 45(4): 518-521.
23.	Wang M, Peng Y. Advances in brain-heart syndrome: Attention to cardiac complications after ischemic stroke. Front Mol Neurosci, 2022, 15: 1053478.
24.	Scheitz JF, Nolte CH, Doehner W, et al. Stroke-heart syndrome: Clinical presentation and underlying mechanisms. Lancet Neurol, 2018, 17(12): 1109-1120.
25.	Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers, 2020, 6(1): 90.
26.	Sposato LA, Hilz MJ, Aspberg S, et al. Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review. J Am Coll Cardiol, 2020, 76(23): 2768-2785.

1. Thielmann M, Sharma V, Al-Attar N, et al. ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J, 2017, 38(31): 2392-2407.
2. Abdullah AS, Salama A, Ibrahim H, et al. Palliative care in myocardial infarction: Patient characteristics and trends of service utilization in a national inpatient sample. Am J Hosp Palliat Care, 2019, 36(8): 722-726.
3. Gaebel W, Zielasek J, Reed GM. Mental and behavioural disorders in the ICD-11: Concepts, methodologies, and current status. Psychiatr Pol, 2017, 51(2): 169-195.
4. Li T, Li J, Yuan L, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: The RAGA randomized trial. JAMA, 2022, 327(1): 50-58.
5. Devlin JW, Skrobik Y, Gélinas C, et al. Executive summary: Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): 1532-1548.
6. J?ckel M, Zotzmann V, Wengenmayer T, et al. Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry. Catheter Cardiovasc Interv, 2021, 98(6): 1072-1081.
7. Patil S, Gonuguntala K, Rojulpote C, et al. Delirium is an important predictor of mortality in elderly patients with ST-elevation myocardial infarction: Insight from National Inpatient Sample database. Coron Artery Dis, 2020, 31(8): 665-670.
8. Li S, Zhang XH, Zhou GD, et al. Delirium after primary percutaneous coronary intervention in aged individuals with acute ST-segment elevation myocardial infarction: A retrospective study. Exp Ther Med, 2019, 17(5): 3807-3813.
9. Wei LA, Fearing MA, Sternberg EJ, et al. The confusion assessment method: A systematic review of current usage. J Am Geriatr Soc, 2008, 56(5): 823-830.
10. Inouye SK, Kosar CM, Tommet D, et al. The CAM-S: Development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med, 2014, 160(8): 526-533.
11. 丁曉航, 高銘鑫, 于洋. 冠狀動脈旁路移植術后圍術期心肌梗死發生機制及預測的研究進展. 心肺血管病雜志, 2022, 41(8): 942-946.Ding XH, Gao M, Xin YY. Research progress on pathogenesis and prediction of perioperative myocardial infarction after coronary artery bypass transplantation. J Cardiovasc Pulm Dis, 2022, 41(8): 942-946.
12. 王鳳華, 魏茂提, 徐寧, 等. 不同來院方式急性ST段抬高心肌梗死患者再灌注時間及院內死亡危險因素分析. 臨床心血管病雜志, 2022, 38(4): 298-303.Wang FH, Wei MT, Xu N, et al. Effects of different admission modes on reperfusion time and risk factors of in-hospital death in patients with acute ST-segment elevation myocardial infarction. J Clin Cardiol (China), 2022, 38(4): 298-303.
13. Melendez E, Whitney JE, Norton JS, et al. A pilot study of the association of amino-terminal pro-b-type natriuretic peptide and severity of illness in pediatric septic shock. Pediatr Crit Care Med, 2019, 20(2): e55-e60.
14. 李末寒, 陸士奇, 肖卓韜, 等. 白細胞/血小板平均體積聯合Gensini 積分評估急性心肌梗死患者住院期間預后的研究. 臨床急診雜志, 2020, 21(4): 282-286.Li MH, Lu SQ, Xiao ZT, et al. White blood cell/mean platelet volume combined with Gensini score for in-hospital prognosis in patients with acyte myocardial infarction. J Clin Emerg (China), 2020, 21(4): 282-286.
15. Zhao D, Liu J, Wang M, et al. Epidemiology of cardiovascular disease in China: Current features and implications. Nat Rev Cardiol, 2019, 16(4): 203-212.
16. Wang J, Gu C, Yu W, et al. Short- and long-term patient outcomes from combined coronary endarterectomy and coronary artery bypass grafting: A meta-analysis of 63, 730 patients (PRISMA). Medicine (Baltimore), 2015, 94(41): e1781.
17. 馬小龍, 李溫斌, 王堅剛, 等. 冠狀動脈旁路移植術后1年內接受經皮冠狀動脈介入治療的臨床特征與隨訪結果研究. 心肺血管病雜志, 2022, 41(2): 152-157.Ma XL, Li WB, Wang JG, et al. Clinical characteristics and follow-up outcomes of 121 patients who received percutaneous coronary intervention within 1 year after coronary artery bypass grafting. J Cardiovasc Pulm Dis, 2022, 41(2): 152-157.
18. 田麗曉, 秦歷杰, 王龍安, 等. 糖化血紅蛋白聯合腦鈉肽對老年急性心肌梗死住院患者臨床預后的評估價值. 中華老年醫學雜志, 2020, 39(10): 1174-1177.Tian LX, Qin LJ, Wang LA, et al. Clinical value of glycated hemoglobin combined with brain natriuretic peptide in predicting the prognosis of elderly hospitalized patients with acute myocardial infarction. Chin J Geriatrics, 2020, 39(10): 1174-1177.
19. 林玉萍, 黃錦杭, 張海林, 等. 冠心病患者發生心肌梗死的獨立危險因素分析. 心血管病防治知識, 2021, 11(32): 11-14.Lin YP, Huang JH, Zhang HL, et al. Analysis of independent risk factors for myocardial infarction in patients with coronary heart disease. Cardiovasc Dis Pre Know, 2021, 11(32): 11-14.
20. Mart MF, Williams Roberson S, Salas B, et al. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med, 2021, 42(1): 112-126.
21. Sanjanwala RM, Hiebert B, Kent D, et al. A Quality improvement initiative to reduce postoperative delirium among cardiac surgery patients. Geriatrics (Basel), 2021, 6(4): 111.
22. 甘文欣, 馬晶, 彭曉紅, 等. ICU 心臟手術患者術后譫妄發生現況及影響因素. 河北醫藥, 2023, 45(4): 518-521.Gan WX, Ma J, Peng XH, et al. Current situation and influencing factors of postoperative delirium in intensive care unit patients undergoing cardiac surgery. Hebei Med J, 2023, 45(4): 518-521.
23. Wang M, Peng Y. Advances in brain-heart syndrome: Attention to cardiac complications after ischemic stroke. Front Mol Neurosci, 2022, 15: 1053478.
24. Scheitz JF, Nolte CH, Doehner W, et al. Stroke-heart syndrome: Clinical presentation and underlying mechanisms. Lancet Neurol, 2018, 17(12): 1109-1120.
25. Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers, 2020, 6(1): 90.
26. Sposato LA, Hilz MJ, Aspberg S, et al. Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review. J Am Coll Cardiol, 2020, 76(23): 2768-2785.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesPredictive value of varying degrees of delirium on the occurrence of perioperative myocardial infarction following off-pump coronary aortic bypass grafting

Abstract Full text Figures/Tables Video References Cited by

Format

Content