ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 February;63(1):78-84

DOI: 10.23736/S0021-9509.21.11829-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Risk factors for in-hospital mortality after coronary artery bypass grafting in Colombia

Heiler LOZADA-RAMOS ^{1, 2} ✉, Jorge E. DAZA-ARANA ^{3, 4}, Mauricio ZÁRATE GONZÁLEZ ⁵, Luis F. MEDINA GALLO ⁵, Fernando LANAS ⁶

¹ Medicine Program, University of Santiago de Cali, Santiago de Cali, Colombia; ² Biomedical Research Institute Group, University of Santiago de Cali, Santiago de Cali, Colombia; ³ Physiotherapy Program, University of Santiago de Cali, Santiago de Cali, Colombia; ⁴ Health and Movement Research Group, University of Santiago de Cali, Santiago de Cali, Colombia; ⁵ Cardiovascular Surgery Service, Clínica de Occidente, Santiago de Cali, Colombia; ⁶ Faculty of Medicine, Universidad de la Frontera, Temuco, Chile

BACKGROUND: The aim of this study was to determine the factors associated with in-hospital mortality after a coronary artery bypass (CABG) in a high-complexity clinic in the city of Santiago de Cali, Colombia.
METHODS: A retrospective case-control analytical study was performed. Cases were defined as adult patients that had undergone CABG and died within 30 days of the surgery. Patients aged ≥18 years that had undergone isolated surgeries were included, i.e. procedures without other interventions combined. Patients were excluded from this study if: 1) they had missing data in their medical records; 2) they had previously been in a state of coma; or 3) they had previously undergone cardiac surgery other than a bypass procedure. Exposure variables were measured at three stages: preoperative, intraoperative, and postoperative.
RESULTS: The study included 77 cases and 308 controls. The most common cause of death was cardiogenic shock (53.2%), followed by sepsis (27.3%). The multinomial logistic regression model revealed an association of in-hospital mortality with preoperative variables of age >75 years (odds ratio [OR] 2.5, 95% confidence interval [95% CI]: 1.1-5.8, P=0.032), low socioeconomic status (OR=2.3, 95% CI: 1.1-5.2, P=0.034), heart failure (HF) (OR=3.2, 95% CI: 1.5-7.0, P=0.002), unstable angina (OR=4.2, 95% CI: 1.9-9.0, P=0.000), acute myocardial infarction (AMI)≤7 days (OR=3.9, 95% CI: 1.1-13.7, P=0.037), chronic kidney insufficiency (CKI) (OR=2.9, 95% CI: 1.2-7.0, P=0.018), peripheral vascular disease (PVD) (OR=2.8, 95% CI: 1.2-6.8, P=0.019), and urgent/emergent surgery (OR=8.2, 95% CI: 2.0-34.5, P=0.004). Of the intraoperative variables, the model showed an association between the use of inotropic agents (OR=2.8, 95% CI: 1.3-6.4, P=0.011) and cardiogenic shock (OR=50.6, 95% CI: 7.5-339, P=0.000).
CONCLUSIONS: This study identifies the factors during preoperative and intraoperative periods that are associated with in-hospital mortality in patients that have undergone CABG.

KEY WORDS: Coronary artery bypass; Mortality; Risk factors; Social class