Predictors of operative mortality following primary coronary artery bypass surgery.
BACKGROUND
Although quality assessment of coronary artery patients can be done by 30 days risk-adjusted operative mortality, it is still insufficient to study the outcome after primary coronary artery bypass graft surgery (CABG). In our study, we attempted to determine the factors, which can help predict operative mortality before and after CABG.


METHODS
The study population consisted of 1000 prospective patients who underwent primary isolated CABG. Assessment was done by dividing the patients into two groups, i.e. non-survivors ( n= 12) and survivors ( n= 988). Data were analyzed using both univariate and multivariate models.


RESULTS
On univariate analysis, recent acute myocardial infarction, intra-aortic balloon counterpulsation (IABC), left ventricular ejection fraction (LVEF) <25%, ventilator-associated pneumonia (VAP), tracheostomy, re-exploration, ventricular arrhythmias, low cardiac output (CO), multiple blood transfusions, post-operative renal dysfunction and longer intensive care unit and hospital stay were found as risk factors for mortality. Multivariate analysis showed that LVEF <25%,VAP, ventricular arrhythmias and low CO independently predicted mortality. Prior knowledge of these risk factors can help not only in predicting the outcome and the risks but also helps to plan the surgical and post-operative course of the patients to improve the morbidity and mortality.


CONCLUSIONS
Our data suggest that operative mortality can be predicted prior to and after surgery considering factors such as LVEF, use of IABC, onset of ventricular arrhythmias and low CO.
Wasir
Harpreet
H
Depatment of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India.
Mehta
Yatin
Y
Pawar
Mandakini
M
Choudhary
Anshumali
A
Kohli
Vijay
V
Meharwal
Zile Singh
ZS
Bapna
Ramesh Kumar
RK
Malhotra
Rajneesh
R
Trehan
Naresh
N
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors