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The Journal of Cardiovascular Surgery 2021 Aug 02

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


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BACKGROUND: 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.
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, i.e. procedures without other interventions combined, were included. This study excluded patients that had missing data in their medical records, had previously been in a state of coma, or 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 [CI95%]: 1.1-5.8, p = 0.032), low socioeconomic status (OR 2.3, CI95%: 1.1-5.2, p = 0.034), heart failure (HF) (OR 3.2, CI95%: 1.5-7.0, p = 0.002), unstable angina (OR 4.2, CI95%: 1.9-9.0, p = 0.000), acute myocardial infarction (AMI) ≤7 days (OR 3.9, CI95%: 1.1-13.7, p = 0.037), chronic kidney insufficiency (CKI) (OR 2.9, CI95%: 1.2-7.0, p = 0.018), peripheral vascular disease (PVD) (OR 2.8, CI95%: 1.2-6.8, p = 0.019), and urgent/emergent surgery (OR 8.2, CI95%: 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, CI95%: 1.3-6.4, p = 0.011) and cardiogenic shock (OR 50.6, CI95%: 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 bypass; Mortality; Risk factor; Socioeconomic status; EuroSCORE (MeSH)

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