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：

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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.

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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.	Jäckel 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.	丁晓航, 高铭鑫, 于洋. 冠状动脉旁路移植术后围术期心肌梗死发生机制及预测的研究进展. 心肺血管病杂志, 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.	王凤华, 魏茂提, 徐宁, 等. 不同来院方式急性ST段抬高心肌梗死患者再灌注时间及院内死亡危险因素分析. 临床心血管病杂志, 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, 陆士奇, 肖卓韬, 等. 白细胞/血小板平均体积联合Gensini 积分评估急性心肌梗死患者住院期间预后的研究. 临床急诊杂志, 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.	马小龙, 李温斌, 王坚刚, 等. 冠状动脉旁路移植术后1年内接受经皮冠状动脉介入治疗的临床特征与随访结果研究. 心肺血管病杂志, 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.	田丽晓, 秦历杰, 王龙安, 等. 糖化血红蛋白联合脑钠肽对老年急性心肌梗死住院患者临床预后的评估价值. 中华老年医学杂志, 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, 黄锦杭, 张海林, 等. 冠心病患者发生心肌梗死的独立危险因素分析. 心血管病防治知识, 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, 马晶, 彭晓红, 等. ICU 心脏手术患者术后谵妄发生现况及影响因素. 河北医药, 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. Jäckel 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. 丁晓航, 高铭鑫, 于洋. 冠状动脉旁路移植术后围术期心肌梗死发生机制及预测的研究进展. 心肺血管病杂志, 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. 王凤华, 魏茂提, 徐宁, 等. 不同来院方式急性ST段抬高心肌梗死患者再灌注时间及院内死亡危险因素分析. 临床心血管病杂志, 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, 陆士奇, 肖卓韬, 等. 白细胞/血小板平均体积联合Gensini 积分评估急性心肌梗死患者住院期间预后的研究. 临床急诊杂志, 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. 马小龙, 李温斌, 王坚刚, 等. 冠状动脉旁路移植术后1年内接受经皮冠状动脉介入治疗的临床特征与随访结果研究. 心肺血管病杂志, 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. 田丽晓, 秦历杰, 王龙安, 等. 糖化血红蛋白联合脑钠肽对老年急性心肌梗死住院患者临床预后的评估价值. 中华老年医学杂志, 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, 黄锦杭, 张海林, 等. 冠心病患者发生心肌梗死的独立危险因素分析. 心血管病防治知识, 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, 马晶, 彭晓红, 等. ICU 心脏手术患者术后谵妄发生现况及影响因素. 河北医药, 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

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