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Long term mortality of deep sternal wound infection after coronary artery bypass surgery
Aline Alexandra Iannoni de de Moraes1, Cely Saad Abboud, André Zeraik Limma Chammas
1Institute Dante Pazzanese of Cardiology, São Paulo, SP, Brazil. alineiannoni@gmail.com
Insights
Deep sternal wound infection and mediastinitis significantly increase long-term mortality and cardiovascular events after coronary artery bypass grafting. This risk is evident early and persists years after hospital discharge.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Deep sternal wound infection and mediastinitis are associated with high in-hospital mortality.
- International data suggest increased long-term cardiovascular mortality for these patients, but national data are lacking.
Purpose of the Study:
- To evaluate long-term mortality and cardiovascular event incidence in patients with deep sternal wound infection and mediastinitis.
- To provide national data on the long-term outcomes of these infections post-cardiac surgery.
Main Methods:
- A case-control study matched by propensity score (1:1 ratio) was conducted.
- Patients undergoing coronary artery bypass grafting between 2005-2008 were included.
- Primary outcome was death; secondary outcome was a composite of myocardial infarction, new revascularization, stroke, or death.
Main Results:
- Out of 1975 patients, 114 developed deep sternal wound infection or mediastinitis.
- These infections increased the risk of death by 8.26 times (P = 0.005) and combined endpoints by 2.61 times (P = 0.015) over a mean 3.6-year follow-up.
- The highest risk for both outcomes was observed within the first six months post-discharge, with a subsequent increase after four years.
Conclusions:
- Deep sternal wound infection or mediastinitis significantly increases long-term mortality.
- The observed mortality and cardiovascular event patterns in Brazil mirror those in developed countries.
- These findings highlight the critical need for effective management and prevention strategies for these infections.
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.
Objectives:
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.
Conclusion:
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.
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