Related Experiment Videos
Morbidity and mortality in patients waiting for coronary artery bypass surgery
E M Koomen1, B A Hutten, J C Kelder
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. koomen.em@net.hcc.nl
Insights
Patients awaiting coronary artery bypass graft (CABG) surgery face early risks of cardiac events and death. Reducing waiting times is crucial to lower complication rates for coronary heart disease patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Public Health
Background:
- Patients awaiting coronary artery bypass graft (CABG) surgery are at risk of adverse cardiac events.
- Understanding morbidity and mortality during the waiting period is essential for optimizing patient care.
Purpose of the Study:
- To describe morbidity and mortality in patients awaiting CABG surgery.
- To identify determinants of complications during the waiting period for CABG.
Main Methods:
- A prospective cohort study involving 360 patients accepted for CABG surgery.
- Follow-up assessed cardiac death, myocardial infarction, and unstable angina requiring hospitalization.
Main Results:
- Median waiting times were 100 days (routine) and 69 days (urgent).
- Eight deaths, seven myocardial infarctions, and 33 episodes of unstable angina occurred, predominantly within 30 days.
- Unstable angina prior to acceptance independently predicted complications.
Conclusions:
- Cardiac complications occur early in the waiting period for CABG surgery.
- Reducing waiting times is the most effective strategy to decrease complication rates in the absence of improved prediction models.
Objectives:
To describe morbidity and mortality in patients waiting for coronary artery bypass graft (CABG) surgery and to assess determinants for the occurrence of these complications.
Methods:
A prospective cohort study was carried out in a tertiary referral general teaching hospital. Three hundred and sixty consecutive patients with a priority of routine or urgent who were accepted for CABG or CABG with additional valve surgery were evaluated. Follow-up began from the moment of acceptance until the procedure took place for cardiac death, myocardial infarction and unstable angina requiring hospital admission.
Results:
The median (25-75th percentile) waiting time in the two priority groups was 100 (79-119) days for the routine group and 69 (38-91) days for the urgent group. Overall, eight patients died, seven suffered a myocardial infarction, and 33 episodes of unstable angina requiring immediate hospitalization occurred. The majority of events took place during the first 30 days on the waiting list. Unstable angina less than 3 months before acceptance was identified as an independent predictor (hazard ratio 2.5, 95% confidence interval 1.2-5.1) for complications during the wait. The prognostic value of smoking and familial cardiovascular disease was found to vary depending on the priority assigned to the patient.
Conclusions:
Complications occur relatively early during the time on the waiting list. If complications in coronary heart disease cannot be predicted more accurately, the only way to diminish the complication rate is drastic reduction of waiting times.