Factors affecting postoperative morbidity and mortality in isolated coronary artery bypass graft surgery.
OBJECTIVE
This study was conducted to investigate predictors of mortality before and after isolated coronary artery bypass grafting (CABG).


METHODS
Single-institutional data on risk factors and mortality were collected for 8890 patients who underwent isolated CABG by the same group of surgeons. The relationship between risk factors and outcome was assessed using univariate and multivariate analyses in two risk models: a preoperative model (model 1) and then a pre-, intra-, and postoperative model (model 2).


RESULTS
The mean age of the patients (25.4% women and 74.6% men) was 58.5 +/- 9.7 years. Fifty-five (0.6%) patients died after surgery. Hypercholesterolemia was the most common comorbidity factor (61.1%), followed by hypertension, a smoking habit, recent myocardial infarction (MI) <21 days, and diabetes. Postoperative tamponade, graft occlusion, and MI (0.01%) were the least common complications. The patients spent 39.7 +/- 33.9 h in the intensive care unit (ICU) postoperatively. Patients were followed up for a minimum of 30 days. The multivariate analysis of our preoperative risk model revealed that the best predictors of operative mortality were a history of diabetes, hypertension, previous CABG, the presence of angina, arrhythmia, Canadian Cardiovascular Society Classification (CCS) of grade III or IV, ejection fraction (EF) < or =30%, three-vessel disease, and left main disease.


CONCLUSIONS
After surgery, and with the inclusion of all the pre-, intra-, and postoperative variables into model two, the following were revealed to be prognostic factors for in-hospital mortality: a history of diabetes, hypertension, the presence of angina, CCS grades III or IV, EF -30%, absence of internal mammary artery (IMA) use, prolonged cardiopulmonary bypass (CPB) time, and prolonged ICU stay.
Karimi
Abbasali
A
Cardiothoracic Surgery Department, University of Tehran, North Kargar Street, Tehran, 1411713138, Iran.
Ahmadi
Hossein
H
Davoodi
Saeed
S
Movahedi
Namvar
N
Marzban
Mehrab
M
Abbasi
Kyomars
K
Omran
Abbas Salehi
AS
Sadeghian
Saeed
S
Yazdanifard
Parin
P
Abbasi
Seyed Hesameddin
SH
Fallah
Nader
N
D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors