Postoperative atrial fibrillation (POAF) is the most common arrhythmia that occurs after coronary artery bypass grafting (CABG), contributing to increased mortality, morbidity, longer hospital stays, and higher healthcare costs. Total coronary revascularization via anterior thoracotomy (TCRAT) has recently emerged as a minimally invasive alternative to the traditional median sternotomy (MS). In this multicenter retrospective cohort study, 424 patients who underwent elective CABG between 1 January 2022 and 31 December 2024 at three centers were analyzed. Of these, 221 patients received TCRAT and 203 underwent MS. To minimize baseline differences, a propensity score matching of 1:1 was performed based on age, sex, left ventricular ejection fraction (LVEF), left atrial diameter, CHA ₂ DS ₂ -VASc score, systolic pulmonary artery pressure, and baseline β-blocker use. POAF was defined as an episode of atrial fibrillation lasting a minimum of 5 min and confirmed by electrocardiography. Independent risk factors were identified using a multivariate logistic regression analysis. The rate of incidence of POAF was 16.7% in the TCRAT group and 25.1% in the MS group ( p = 0.045). After matching, a multivariate analysis showed that the traditional surgical approach, MS, was an independent risk factor for POAF [odds ratio (OR), 6.12; 95% confidence interval (CI), 2.48–15.09; p < 0.001]. Advanced age (OR 1.04, p = 0.019), reduced LVEF (OR 0.95, p = 0.019), longer cross-clamp time (OR 1.07, p < 0.001), higher blood transfusion requirements (OR 1.48, p = 0.004), and diabetes (OR 1.91, p = 0.048) were all identified as independent predictors. Despite longer operative and cross-clamp times, TCRAT was associated with a lower incidence of POAF compared with MS.

Background: Cancer patients face a high risk of thromboembolic complications due to disease-, treatment-, and patient-related factors. Chemotherapy regimens such as anthracyclines and alkylating agents can increase both venous and arterial thrombosis, leading to significant morbidity. Case summary: A 44-year-old woman with invasive ductal carcinoma of the right breast underwent right mastectomy and received adjuvant chemotherapy with doxorubicin (60 mg/m²) and cyclophosphamide (600 mg/m²). Five days after her second treatment cycle, she presented with chest pain. Electrocardiography showed inferolateral ST-segment elevation, and echocardiography revealed a left ventricular ejection fraction (LVEF) of 38%. Coronary angiography demonstrated total occlusion of the distal left anterior descending and circumflex arteries. She was treated with dual antiplatelet therapy, low-molecular-weight heparin, and a glycoprotein IIb/IIIa inhibitor. Follow-up angiography on day five showed complete thrombus resolution and restoration of TIMI III flow. During long-term follow-up, her left ventricular function recovered (LVEF 50%) and her cancer remained in complete remission. Conclusion: This case illustrates a rare but clinically important complication of adjuvant doxorubicin–cyclophosphamide therapy, presenting as subacute inferolateral myocardial infarction secondary to coronary thrombosis. Awareness of this potential adverse effect and early management are crucial for improved outcomes.

Objective: The aim of this study was to determine the relationship between the neutrophil/lymphocyte ratio (NLR) measured before coronary angiography and coronary collateral (CC) development. Method: This retrospective descriptive study was carried out between January 2012 and June 2013 in the cardiology outpatient clinic of a university hospital in Aydın, with 165 patients who were diagnosed with acute coronary syndrome or stable angina pectoris and who had 95% or more stenosis in at least one coronary artery according to angiography. Coronary artery stenosis was determined by Gensini scoring. The classification of CC was performed by the Rentrop method, and patients were divided into two groups: Rentrop stages 0 and 1 (poor CC filling (group 1)) and Rentrop stages 2 and 3 (good CC filling (group 2)). The data were analyzed using appropriate statistical analyses. Multivariate logistic regression was used to determine the predictors of CC level, and receiver operating characteristic (ROC) curve analysis was performed to calculate the predictive value of predictors. Results: When the groups were compared, the mean age (p=0.023), Gensini score (p<0.001), smoking status (p=0.012), creatinine level (p=0.032), and aspartate aminotransferase level (p=0.032) of the patients in group 1 were significantly lower than those in group 2, while their total cholesterol (p=0.006) and low-density lipoprotein (LDL) levels (p=0.020) were higher. Neutrophils (p=0.016) and NLR (p<0.001) were significantly higher in group 2 patients. A significant positive correlation was found between CC level and neutrophils (p=0.035) and NLR (p=0.011). In regression analysis, high NLR, high Gensini score, and smoking were predictors of good CC filling. According to ROC curve analysis, the sensitivity and specificity of NLR ≥3.53 at the time of presentation to the clinic for predicting good CC filling were 37.6% and 85%, respectively. Conclusion: This study showed that NLR was significantly associated with the development of good CC filling; as NLR increased, the development of good CC filling increased in patients.