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Published on: March 27, 2018
[Coronary artery bypass grafting: evolution of coronary disease characteristics and immediate surgical outcomes over
Roberto González L1, Aleck Stockins L1, Felipe Alarcón O2
1Centro Cardiovascular, Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Concepción, Chile.
Insights
Coronary artery bypass grafting (CABG) patients are older and sicker, with increased surgical risk but stable mortality rates. This evolution reflects changes in patient demographics and comorbidities over time.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Epidemiology of Coronary Artery Disease
Context:
- Coronary artery bypass grafting (CABG) procedures have evolved due to demographic shifts, surgical techniques, and perioperative care.
- Analysis of isolated CABG patients from two distinct periods (2006-2008 and 2016-2018) in Chile.
- Investigating changes in patient characteristics and immediate outcomes following CABG.
Purpose:
- To analyze the evolution of coronary artery disease patient characteristics undergoing CABG.
- To assess the immediate results of CABG procedures over time.
- To identify trends in patient comorbidities, surgical approaches, and risk stratification.
Summary:
- A significant increase in patient age and prevalence of comorbidities like diabetes mellitus, COPD, and acute myocardial infarction (AMI) was observed in the later period.
- The proportion of high-risk patients undergoing CABG increased significantly, alongside a rise in the use of multiple arterial grafts.
- Despite increased surgical risk (Additive EuroSCORE I), in-hospital mortality rates remained statistically unchanged between the two periods.
Impact:
- Highlights the increasing complexity of CABG patient profiles.
- Demonstrates the ability of surgical teams to manage higher-risk patients without compromising survival rates.
- Provides insights into the changing landscape of cardiovascular surgery and patient management.
Introduction:
Several factors intervene in the evolution of the characteristics of Coronary artery bypass grafting (CABG), such as demographic changes, surgical technique, and perioperative care. Our objective was to analyze the evolution of the characteristics of coronary artery disease in patients treated with CABG and its immediate results.
Methods:
In an analytical study, we analyzed a cohort of patients with isolated CABG from January 2006 to December 2008 and from January 2016 to December 2018 in Hospital Clínico Regional Concepción, Chile. After the ethics committee's approval, we reviewed the database and surgical protocols. We used Chi-square and U Mann Whitney tests for statistical analysis (SPSSv25®), considering significant p < 0,05.
Results:
We analyzed 1,400 isolated CABG, 658 from the first period and 742 from the second, with a mean age of 62.0 ± 8.7 and 64.6 ± 9.3 respectively (p < 0.001). The subgroup with ventricular dysfunction in the second period showed a significant increase in diabetes mellitus, chronic obstructive pulmonary disease, acute myocardial infarction (AMI), and severe ventricular dysfunction. The second group decreased off-pump surgery and increased the use of ≥ 2 arterial grafts (p < 0.05). The Additive EuroSCORE I increased from 3.6 ± 2.5 to 4.4 ± 2.7 (p = 0.001). High-risk subgroup: 137 (20.8%) to 236 (31.8%), p < 0.001. Mortality of 13 (1.98%) and 16 (2.2%) in the first and second group respectively, p = 0.813.
Conclusion:
There was a significant increase in the estimated surgical risk; however, mortality remained unchanged. The increase in surgical risk is consistent with the increase in mean age and prevalence of comorbidities, as well as the increase in severe ventricular dysfunction in the group ofpatients with ventricular dysfunction and recent AMI in the second period.
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