Observational studies and randomised controlled trials (RCTs) have yielded conflicting results regarding the outcomes of multiple arterial grafts (MAG) vs. single arterial grafts (SAG) in coronary artery bypass graft (CABG) surgery. We conducted a comprehensive search across multiple databases for RCTs that directly compared MAG and SAG. The clinical outcomes assessed included all-cause mortality, cardiac-specific mortality, myocardial infarction (MI), repeat revascularization, stroke, sternal wound complications, and major bleeding. Outcomes were measured using hazard ratios (HR), relative risks (RR), and the corresponding 95% confidence intervals (CI). Eighteen RCTs involving 10,143 patients were included in the analysis. The follow-up period ranged from 6 months to 12.6 years, and the average age of the patients across the studies ranged between 56.3 and 77.3 years. MAG and SAG did not differ significantly in terms of the incidence of sternal wound complications, major bleeding, or stroke following CABG. However, the MAG group demonstrated a lower risk of all-cause mortality, cardiac mortality, MI, and repeat revascularization compared with the SAG group. MAG was associated with higher survival, lower risk of MI, and fewer repeat revascularization. Nonetheless, there were no significant differences in the incidence of sternal wound infections, major bleeding, and stroke between MAG and SAG.

Background: Myocardial injury-related cardiogenic shock (MICS) is significantly associated with poor outcomes in patients after cardiac surgery. Herein, we aimed to investigate the risk factor for postoperative MICS. Methods: We performed a case-control study on 792 patients undergoing cardiac surgery from 2016 to 2019, including 172 patients with postoperative MICS and 620 age- and sex-matched controls. MICS was defined as composite criteria: a cardiac index of < 2.2 L/m²/min, arterial lactate levels of > 5 mmol/L at the end of the surgery, a vasoactive-inotropic score of > 40 at the end of the surgery, and a cardiac troponin T (cTnT) level of > 0.8 µg/L on postoperative day 1 (POD1) with an increase of > 10% on POD 2. Results: A total of 4671 patients who underwent cardiac surgery in our hospital between 2016 and 2019 were included; of these, 172 (3.68%) had MICS and the remaining 4499 did not. For investigating the risk factors, we selected 620 age- and sex-matched controls. In the univariate analysis, MICS was significantly associated with death (P < 0.05), extracorporeal membrane oxygenation (P < 0.05), continuous renal replacement therapy (P < 0.01), and ventricular arrhythmias (P < 0.05). Multivariable logistic regression analysis revealed that diabetes mellitus (OR:8.11, 95% CI: 3.52–18.66, P < 0.05) and a cardiopulmonary bypass (CPB) time of > 2 h (OR: 3.16, 95% CI: 1.94–5.15, P < 0.05) were associated with postoperative MICS. Moreover, long-time administration of preoperative calcium channel blocker (CCB) was associated with a less incidence of MICS (OR: 0.11, 95% CI: 0.05–0.27, P < 0.05). Conclusions: Postoperative MICS is significantly associated with poor outcomes. Diabetes mellitus and long CPB time are associated with MICS. Preoperative CCB administration is associated with less incidence of MICS.

Objective: Multiple arterial grafting (MAG) has been suggested to confer long-term survival benefits for patients undergoing coronary artery bypass grafting (CABG), yet its short-term benefits remain uncertain. This study aims to analyze the impact of MAG on in-hospital outcomes and identify potential risk factors. Methods: A retrospective analysis was conducted from all patients who underwent CABG surgery in our development from January 2022 to December 2024. A generalized mixed-effects model and sensitivity analysis were employed to evaluate the influence of the type of CABG bypass graft on in-hospital major adverse cardiac and cerebrovascular events (MACCEs), postoperative dialysis, intra-aortic balloon pump (IABP) use, re-thoracotomy for bleeding and sternal wound infection (SWI). Results: A total of 960 patients were included in this study. Patients who received MAG surgeries had more coronary artery lesions observed preoperatively. Compared with patients who underwent single arterial grafting (SAG), those who received MAG surgery did not show significant differences in the incidence of in-hospital MACCEs, postoperative dialysis, IABP use, re-thoracotomy or SWI. Interestingly, good left ventricular function was associated with a reduced occurrence of postoperative dialysis, MACCEs, and IABP application. Chronic renal insufficiency emerged as a risk predictor of major in-hospital adverse events. Conclusion: This single-center study did not find significant differences in short-term outcomes between MAG and SAG groups. However, caution should be exercised when applying these findings to other clinical environments and patient populations. Further multi-center, prospective randomized controlled trials (RCTs) are needed to validate and extend our results.

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Patients undergoing dialysis treatment have long been recognized as having an elevated risk of developing coronary artery disease necessitating coronary artery bypass grafting (CABG). However, the prognostic implications of CABG in dialysis-dependent patients remain underexplored. This study aimed to comprehensively assess both short- and long-term outcomes in dialysis-dependent patients undergoing CABG. In this retrospective analysis, we meticulously matched 55 dialysis-dependent patients with 55 non-dialysis patients, controlling for baseline characteristics including age, sex, etiology, and date of surgery. All patients underwent CABG treatment at our institution between January 2014 and June 2022. We conducted a comparative analysis of postoperative complications and survival rates between the two groups. Our findings revealed that the dialysis-dependent group exhibited a significantly higher incidence of postoperative complications compared to the non-dialysis group (92.7% vs. 61.8%; p < 0.001). Furthermore, the 5-year survival rates were notably diminished among dialysis patients relative to their non-dialysis counterparts (46.2 ± 7.9% vs. 58.2 ± 12.1%, p = 0.045). Consistently, dialysis patients exhibited decreased 5-year cardiac-event-free rates in contrast to non-dialysis patients (31.6 ± 7.6% vs. 58.8 ± 11.3%, p = 0.041). Predictably, several baseline parameters were identified as significant risk factors contributing to adverse outcomes among dialysis patients, including a history of smoking, diabetes mellitus, congestive heart failure upon admission, and the requirement for intraoperative concomitant surgery (p = 0.006, p = 0.043, p = 0.017, p = 0.003, respectively). This study underscores the poorer prognosis associated with CABG treatment in dialysis-dependent patients. Notably, baseline factors such as a smoking history, diabetes mellitus, congestive heart failure upon admission, and the need for intraoperative concomitant surgery were all independently linked to increased mortality in this patient population.

TRNA-derived small RNAs (tsRNAs) represent a novel class of highly conserved non-coding RNAs that play crucial roles in various cellular processes, including cell proliferation and the initiation of viral reverse transcription. Despite their significant biological functions, studies exploring the role of tsRNAs in infectious diseases remain limited. Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne hemorrhagic fever caused by SFTS virus (SFTSV), which is associated with a high fatality rate. This study investigates the potential diagnostic value of serum tsRNAs in SFTS. Using tsRNA sequencing, we analyzed the differential expression of serum tsRNAs between SFTS patients and healthy controls, followed by validation using quantitative real-time PCR (qRT-PCR) in individual samples. Our findings revealed that the expression levels of tsRNA-3002a, tsRNA-5007a, tsRNA-5013c, tsRNA-5017b, tsRNA-5027b, and tsRNA-5030c were significantly altered in the serum of SFTS patients compared to healthy controls. Among these, tsRNA-5017b showed the most pronounced upregulation, with its expression progressively increasing in parallel with the severity of the disease. Further analysis demonstrated that tsRNA-5017b alone could predict SFTS severity at admission with a specificity of 93%. When combined with conventional laboratory markers such as platelet count (PLT) and aspartate aminotransferase (AST), the sensitivity reached 91.7%. Bioinformatics analysis suggested that tsRNA-5017b may be involved in the regulation of immune responses, apoptosis, and inflammatory pathways. In conclusion, this study is the first to identify the expression of tsRNA in the serum of SFTS patients and proposes tsRNA-5017b as a promising biomarker for predicting disease severity at admission. IMPORTANCE: Severe fever with thrombocytopenia syndrome (SFTS) is a fatal tick-borne disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV), with limited early diagnostic tools available. This study identifies serum tRNA-derived small RNAs (tsRNAs) as potential biomarkers for SFTS, revealing that tsRNA-5017b, in particular, correlates with disease severity. Our findings show that tsRNA-5017b is associated with SFTS severity at admission, with high specificity alone and improved sensitivity when combined with conventional markers. This research highlights the potential of tsRNA-based biomarkers in diagnosing and assessing disease severity in SFTS, advancing our understanding of viral pathogenesis and immune regulation in infectious diseases.