The arrival of COVID-19 in Brazil and the impact on coronary artery bypass surgery
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Updated: Nov 3, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Omar A V Mejia1,2, Gabrielle B Borgomoni1, Lucas M V Silveira1
1Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil.
Insights
The COVID-19 pandemic significantly increased mortality risk for coronary artery bypass grafting (CABG) surgeries in Brazil. Surgical volumes decreased by 60%, highlighting the pandemic's adverse impact on cardiovascular care.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Public Health
Background:
- The emergence of coronavirus disease 2019 (COVID-19) presented unprecedented challenges to healthcare systems globally.
- Brazil experienced a significant influx of COVID-19 cases, necessitating an analysis of its impact on specialized surgical procedures.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on coronary artery bypass grafting (CABG) surgery in Brazil.
- To compare outcomes and surgical volumes during the pre-COVID-19 period versus the COVID-19 era.
Main Methods:
- A comparative study was conducted on isolated CABG patients across six Brazilian hospitals.
- Data from March-May 2019 (pre-COVID-19) were compared with March-May 2020 (COVID-19 era).
- Logistic regression was used to develop a predictive model for mortality in the COVID-19 era.
Main Results:
- Coronary artery bypass grafting (CABG) surgery showed a 2.8-fold increase in mortality risk in 2020 compared to 2019.
- Patients with COVID-19 experienced an 11-fold increased mortality risk after CABG.
- Surgical volume decreased by 60%, with increased rates of morbidity and intensive care unit readmissions.
Conclusions:
- The COVID-19 pandemic adversely affected mortality rates, morbidity, and the overall volume of CABG surgeries.
- A validated predictive model for CABG mortality during the COVID-19 era demonstrated good calibration and discrimination.
Background And Aim Of The Study:
This study analyzed the arrival of coronavirus disease 2019 (COVID-19) in Brazil and its impact on coronary artery bypass grafting (CABG) surgery.
Methods:
Patients undergoing isolated CABG in six hospitals in Brazil were divided into two periods: pre-COVID-19 (March-May 2019, N = 468) and COVID-19 era (March-May 2020, N = 182). Perioperative data were included on a dedicated REDCap platform. Patients with clinical and tomographic criteria and/or PCR (+) for severe acute respiratory syndrome coronavirus 2 infection were considered COVID-19 (+). Logistic regression analysis was performed to create a multiple predictive model for mortality after CABG in COVID-19 era.
Results:
Compared to 2019, in 2020, CABG surgeries had a 2.8-fold increased mortality risk (95% confidence interval [CI]: 1-7.6, p = .041), patients who evolved with COVID-19 had a 11-fold increased mortality risk (95% CI: 2.2-54.9, p < .003), rates of morbidities and readmission to the intensive care unit. The surgical volume was decreased by 60%. The model to predict mortality after CABG in the COVID-19 era was validated with good calibration (Hosmer-Lemeshow = 1.43) and discrimination (receiver operating characteristic = 0.78).
Conclusion:
The COVID-19 pandemic had an adverse impact on mortality, morbidity and volume of patients undergoing CABG.
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