TITLE:
Long-Term Outcomes after Coronary Artery Bypass Grafting with Risk Stratification
AUTHORS:
Ayman R. Abdelrehim, Ibraheem H. Al Harbi, Hasan I. Sandogji, Faisal A. Alnasser, Mohammad Nizam S. H. Uddin, Fatma A. Taha, Fareed A. Alnozaha, Fath A. Alabsi, Shakir Ahmed, Waheed M. Fouda, Amir A. El Said, Tousif Khan, Ahmed M. Shabaan
KEYWORDS:
Coronary Artery Bypass Graft, Long-Term Mortality, Risk Prediction Model, Risk Stratification
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.13 No.8,
August
25,
2023
ABSTRACT: Background: Risk stratification of long-term outcomes for
patients undergoing
Coronary artery bypass grafting has enormous potential clinical importance. Aim: To develop risk stratification models for predicting long-term outcomes
following coronary artery bypass graft (CABG) surgery. Methods: We
retrospectively revised the electronic medical records of 2330 patients who
underwent adult Cardiac surgery between August 2016 and December 2022 at
Madinah Cardiac Center, Saudi Arabia. Three hundred patients fulfilled the
eligibility criteria of CABG operations with a complete follow-up period of at
least 24 months, and data reporting. The collected data included patient demographics, comorbidities, laboratory
data, pharmacotherapy, echocardiographic parameters, procedural details,
postoperative data, in-hospital outcomes, and follow-up data. Our follow-up was depending on the
clinical status (NYHA class), chest
pain recurrence, medication
dependence and echo follow-up. A
univariate analysis was performed between each patient risk factor and the
long-term outcome to determine the preoperative, operative, and postoperative
factors significantly associated with each long-term outcome. Then a
multivariable logistic regression analysis was performed with a stepwise,
forward selection procedure. Significant (p Results: The incidence of all-cause mortality during
hospital admission or follow-up period was 2.3%. Other long-term outcomes
included all-cause recurrent hospitalization (9.8%), recurrent chest pain
(2.4%), and the need for revascularization by using a stent in 5 (3.0%)
patients. Thirteen (4.4%) patients suffered heart failure and they were on the
maximum anti-failure medications. The model for predicting all-cause mortality
included the preoperative EF ≤ 35% (AOR: 30.757, p = 0.061), the bypass time (AOR: 1.029, p = 0.003), and the duration of ventilation following
the operation (AOR: 1.237, p = 0.021). The model for risk
stratification of recurrent hospitalization comprised the preoperative EF ≤ 35%
(AOR: 6.198, p p = 0.023), low postoperative
cardiac output (AOR: 3.622, p = 0.007), and the development of postoperative atrial fibrillation (AOR:
2.787, p = 0.038). Low postoperative
cardiac output was the only predictor that significantly contributed to
recurrent chest pain (AOR: 11.66, p = 0.004). Finally, the model consisted of low postoperative cardiac
output (AOR: 5.976, p p = 0.019) was significantly
associated with an increased likelihood of the future need for
revascularization using a stent. Conclusions: A risk prediction model
was developed in a Saudi cohort for predicting all-cause mortality risk during
both hospital admission and the follow-up period of at least 24 months after
isolated CABG surgery. A set of models were also developed for predicting long-term
risks of all-cause recurrent hospitalization, recurrent chest pain, heart
failure, and the need for revascularization by using stents.