title: Long term mortality of deep sternal wound infection after coronary artery bypass surgery.
abstract: BACKGROUND
  Deep sternal wound infection and mediastinitis determine high in-hospital mortality. International studies show that these patients are also at increased cardiovascular mortality risk in long-term follow-up. However, data are scarce and there is no national data.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the mortality and incidence of cardiovascular events in long-term follow-up of patients suffering from deep sternal wound infection and mediastinitis.
  
  
  METHODS
  Case-control study, matched by propensity score in a 1:1 proportion, in patients submitted to coronary artery bypass grafting between 2005 and 2008 at the Institute Dante Pazzanese of Cardiology (São Paulo, SP, Brazil). The primary outcome was death. As a secondary outcome, we analyzed the composite event of myocardial infarction, new revascularization, stroke or death.
  
  
  RESULTS
  Of 1975 patients, 114 developed one of the infections. During the mean follow up of 3.6 years, deep sternal wound infection and mediastinitis increased the risk of death by 8.26 (95% CI 1.88-36.29, P = 0.005) and the incidence of combined end point by 2.61 (95% CI 1.2-5.69, P = 0.015). The Kaplan-Meier curves for both outcomes demonstrated that the greatest risk occurs in the first six months, followed by a period of stabilization and further increase in the incidence of events after 4 years of hospital discharge. The similarity between the curves of primary and secondary outcomes may be consequent to the predominance of death on the combined cardiovascular events.
  
  
  CONCLUSIONS
  The presence of deep sternal wound infection or mediastinitis increased mortality in long-term follow-up in this sample of the Brazilian population according to the same pattern displayed by the developed countries.
authors.affiliation: Institute Dante Pazzanese of Cardiology, São Paulo, SP, Brazil. alineiannoni@gmail.com
authors.forename: Aline Alexandra Iannoni de
authors.initials: AA
authors.lastname: de Moraes
authors.forename: Cely Saad
authors.initials: CS
authors.lastname: Abboud
authors.forename: André Zeraik Limma
authors.initials: AZ
authors.lastname: Chammas
authors.forename: Yara Santos
authors.initials: YS
authors.lastname: Aguiar
authors.forename: Lucas Cronemberger
authors.initials: LC
authors.lastname: Mendes
authors.forename: Jonatas
authors.initials: J
authors.lastname: Melo Neto
authors.forename: Pedro Silvio
authors.initials: PS
authors.lastname: Farsky
mesh_terms: D000328:Adult; D017677:Age Distribution; D001938:Brazil; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000401:mortality*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D012086:Reoperation; D012307:Risk Factors; D017678:Sex Distribution; D013249:Sternum / Q000601:surgery; D013530:Surgical Wound Infection / Q000401:mortality*; D013997:Time Factors; D055815:Young Adult