Preoperative frontal QRS-T angle is an independent correlate of hospital length of stay and predictor of haemodynamic support requirement following off-pump coronary artery bypass graft surgery.
OBJECTIVE
With the adoption of novel operative techniques and aggressive care protocols that facilitate earlier extubation and mobilization of patients, postoperative length of stay (LOS) following coronary artery bypass graft surgery (CABG) has declined. However, there is paucity of information regarding preoperative electrocardiographic predictors of LOS following CABG. In this study, we investigated whether frontal QRS-T angle, which is an abnormal repolarization marker in prediction of various cardiovascular events, was an independent correlate of postoperative hospital LOS for off-pump CABG. Furthermore, we evaluated independent predictors of vasopressor agent/intra-aortic balloon pump (IABP) support requirement following off-pump CABG.


METHODS
In this observational study, 78 patients with stable angina, who were scheduled for elective coronary artery bypass surgery following diagnosis of obstructive coronary artery disease by conventional angiography, were enrolled.


RESULTS
Left ventricular ejection fraction (LVEF) was significantly lower and vasopressor agent/IABP support requirement and incidence of sustained atrial or ventricular arrhythmias was higher in patients with wide QRS-T angle (P < 0.05). Postoperative hospital LOS was also longer in this group. From the preoperative characteristics, wide frontal QRS-T angle was found to be an independent correlate of postoperative hospital LOS (B ± SD: 11.97 ± 0.62, P ≤ 0.01). Wide frontal QRS-T angle was also found to be an independent predictor of vasopressor agent/IABP support requirement postoperatively (OR: 7.87, P ≤ 0.01).


CONCLUSIONS
Prediction of the hospital LOS and patient outcome following CABG is of great importance. Being easily obtainable via standard 12-lead electrocardiogram and its low cost may make frontal QRS-T angle a beneficial marker for reducing both patient-based morbidity and economic burden.
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey erkankaya76@yahoo.com.
Erkan
E
Kaya
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Kubilay
K
Karabacak
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Murat
M
Kadan
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Kadri Murat
KM
Gurses
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Duygu
D
Kocyigit
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Suat
S
Doganci
Department of Anaesthesiology and Reanimation, Gulhane Military Medical Academy, Ankara, Turkey.
Vedat
V
Yildirim
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Ufuk
U
Demirkilic
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects
D014662:Vasoconstrictor Agents
Coronary artery bypass graft surgery; Hospital length of stay; Inotropic support; QRS-T angle