Predictors of early postoperative complications in patients with stable coronary artery disease after coronary artery bypass grafting
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Abstract
The aim – to establish predictors of major early postoperative complications (EPOC) in patients (pts) with stable coronary artery disease (CAD) after coronary artery bypass grafting (CABG).
Material and methods. A retrospective observational single-center study included 576 consecutive pts with stable CAD (mean age 61±9 years, 491 (85.2 %) males, 85 (14.8 %) females), undergoing isolated CABG. We analyzed demographic, clinical, laboratory, echocardiographic, coronary angiographic, intra- and postoperative data, and assessed health-related quality of life. In total, EPOC were registered in 112 (19.4 %) cases. Acute kidney injury (n=55) and acute heart failure (n=49) were the most frequent major EPOC (9.5 % and 8.5 %, respectively). Two patients (0.4 %) died early after CABG.
Results. At univariate analysis, EPOC were related to the following baseline parameters: age; body mass index (BMI); heart failure NYHA class; permanent AF; severe diabetes mellitus (DM); poor kidney function (by estimated glomerular filtration rate (eGFR)); left atrium and left ventricular (LV) end-diastolic volume index; LV systolic dysfunction; LV hypertrophy; aortic and mitral valve regurgitation; three-vessel CAD. At multivariate analysis, the independent predictors of EPOC were as follows: BMI (per 5 kg/m2 increase vs < 25.0 kg/m2 as reference (r): OR 1.38 (95 % CI 1.06–1.79); Р=0.017); DM severity (per each severity category increase vs no DM (r): OR 1.75 (95 % CI 1.47–2.10); Р<0.001); eGFR (per each 30 ml/min/1.73 m2 decrease vs ≥ 90 ml/min/1.73 m2 (r): OR 2.29 (95 % CI 1.58–3.31); Р<0.001); and LV ejection fraction (EF) (< 40 % vs. 40–49 % vs. ≥ 50 % (r): OR 1.92 (95 % CI 1.49–2.49); Р<0.001).
Conclusions. Multiple characteristics related to EPOC reflected comorbidity burden in the study cohort. Independent predictive value of baseline BMI, DM severity, eGFR and LV EF should be taken into account for risk stratification before CABG.
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