Coronary artery bypass grafting in acute myocardial infarction: analysis of predictors of in-hospital mortality.
OBJECTIVE
Coronary artery bypass grafting (CABG) during the acute phase of infarction (AMI) is associated with increased operative risk. The aim of this study was to determine predictors of in-hospital mortality in patients undergoing CABG in AMI.


METHODS
During three years, all patients undergoing CABG in AMI were retrospectively analyzed of the institutional database. Sixty variables per patient were evaluated: 49 preoperative variables from the 2000 Bernstein-Parsonnet and EuroSCORE models, 4 preoperative variables not considered in these models (time between AMI and CABG, maximum CKMB, Troponin maximum and ST-segment elevation) and 7 intraoperative variables [(cardiopulmonary bypass (CPB), CPB time, type of cardioplegia, endarterectomy, number of grafts, use of internal thoracic artery and complete revascularization]. Univariate and multivariate analysis for the outcome of in hospital mortality were performed.


RESULTS
The mean time between AMI and CABG was 3.8 ± 3 days. The overall mortality was 19%. In the multivariate analysis: age > 65 years OR [16.5 (CI 1.8 to 152), P= 0.013]; CPB > 108 minutes [OR 40 (CI 2.7 to 578), P= 0.007], creatinine> 2 mg/dl [OR 35.5 (CI 1.7 to 740), P= 0.021] and systolic pulmonary pressure > 60 mmHg [OR 31 (CI 1.6 to 591), P= 0.022] were predictors of in-hospital mortality.


CONCLUSIONS
Conventional preoperative variables such as age > 65 years, creatinine > 2 mg/dl and systolic pulmonary pressure > 60 mmHg were predictive of in-hospital mortality in patients underwent CABG in AMI.
Heart Institution, Clinics Hospital of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil. omarvilca@incor.usp.br
Omar Asdrúbal Vilca
OA
Mejía
Luiz A Ferreira
LA
Lisboa
Marcos Gradim
MG
Tiveron
José Augusto Duncan
JA
Santiago
Rafael Angelo
RA
Tineli
Luis Alberto Oliveira
LA
Dallan
Fabio Biscegli
FB
Jatene
Noedir Antonio Groppo
NA
Stolf
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001026:Coronary Artery Bypass / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery; D012016:Reference Values; D012307:Risk Factors; D014336:Troponin / Q000097:blood
D014336:Troponin; D003404:Creatinine