open access

Ahead of print
Original articles
Published online: 2017-06-01
Submitted: 2017-01-06
Accepted: 2017-05-25
Get Citation

How to predict the risk of postoperative complications after coronary artery bypass grafting in patients under 50 and over 80 years old? A retrospective cross-sectional study

Jacek Piątek, Anna Kędziora, Grzegorz Kiełbasa, Marta Olszewska, Dorota Sobczyk, Bryan HyoChan Song, Janusz Konstanty-Kalandyk, Tomasz Darocha, Karol Wierzbicki, Irena Milaniak, Krzysztof Wróbel, Bogusław Kapelak
DOI: 10.5603/KP.a2017.0120

open access

Ahead of print
Original articles
Published online: 2017-06-01
Submitted: 2017-01-06
Accepted: 2017-05-25

Abstract

Background. Coronary artery disease (CAD) remains the leading cause of death in developed countries and there is an increasing number of both young and elderly patients requiring surgical treatment. Despite improvement of conventional risk stratification scores (EuroSCORE II, STS risk score), all of the calculations are estimated based on the typical population and the studies emphasize that the scales may need further investigation and modernization, as demographic changes of the population suffering from CAD are unavoidable.

Aim. To characterize two increasing and challenging cohorts of patients undergoing coronary artery bypass grafting (CABG), and to identify preoperative risk factors for postoperative complications.

Methods. In the retrospective cross-sectional study we analyzed 388 patients ≥ 80 yo and 190 patients ≤ 50 yo, who underwent CABG consecutively at our Institution. Data was obtained from medical records.

Results. The vast majority of studied patients had commonly described risk factors for cardiovascular diseases, regardless the age group. Diabetes was present in almost twice as many individuals in the older cohort, when compared to EuroSCORE population. Similar observation was made for hypertension, which was more frequent in both age groups. Summarizing all of the postoperative complications, at least one occurred significantly more frequently among the older group (10% vs. 20.9%, P=0.001). The vast majority of major adverse cardiac and cerebrovascular events (MACCE) in older group led to death (79.4%). Among patients ≥ 80 yo, higher NYHA class (P=0.001, OR 2.05, [1.34 – 3.12] for every next class) and renal failure (P=0.02, OR 2.47, [1.16 – 5.25]) increased the MACCE rate, whereas higher left ventricular ejection fraction (LVEF) (P=0.002, OR 0.81, [0.7 – 0.93] for every 5%) decreased the risk. Emergent admission was the only factor increasing the occurrence of any postoperative complications among patients ≤ 50 yo (P=0.007, OR 3.63, 95% CI [1.37 - 9.62]). On the other hand, among patients ≥ 80 yo emergent admission was not associated with any postoperative complications.

Conclusions. Young and old patients requiring CABG differ from the standard EuroSCORE population. Postoperative complications are more common among elder patients and MACCE is usually fatal in this age group. Individuals with risk factors for MACCE (higher NYHA class, renal failure, lower LVEF) should be carefully evaluated and qualified, and closely monitored post-surgery.

Abstract

Background. Coronary artery disease (CAD) remains the leading cause of death in developed countries and there is an increasing number of both young and elderly patients requiring surgical treatment. Despite improvement of conventional risk stratification scores (EuroSCORE II, STS risk score), all of the calculations are estimated based on the typical population and the studies emphasize that the scales may need further investigation and modernization, as demographic changes of the population suffering from CAD are unavoidable.

Aim. To characterize two increasing and challenging cohorts of patients undergoing coronary artery bypass grafting (CABG), and to identify preoperative risk factors for postoperative complications.

Methods. In the retrospective cross-sectional study we analyzed 388 patients ≥ 80 yo and 190 patients ≤ 50 yo, who underwent CABG consecutively at our Institution. Data was obtained from medical records.

Results. The vast majority of studied patients had commonly described risk factors for cardiovascular diseases, regardless the age group. Diabetes was present in almost twice as many individuals in the older cohort, when compared to EuroSCORE population. Similar observation was made for hypertension, which was more frequent in both age groups. Summarizing all of the postoperative complications, at least one occurred significantly more frequently among the older group (10% vs. 20.9%, P=0.001). The vast majority of major adverse cardiac and cerebrovascular events (MACCE) in older group led to death (79.4%). Among patients ≥ 80 yo, higher NYHA class (P=0.001, OR 2.05, [1.34 – 3.12] for every next class) and renal failure (P=0.02, OR 2.47, [1.16 – 5.25]) increased the MACCE rate, whereas higher left ventricular ejection fraction (LVEF) (P=0.002, OR 0.81, [0.7 – 0.93] for every 5%) decreased the risk. Emergent admission was the only factor increasing the occurrence of any postoperative complications among patients ≤ 50 yo (P=0.007, OR 3.63, 95% CI [1.37 - 9.62]). On the other hand, among patients ≥ 80 yo emergent admission was not associated with any postoperative complications.

Conclusions. Young and old patients requiring CABG differ from the standard EuroSCORE population. Postoperative complications are more common among elder patients and MACCE is usually fatal in this age group. Individuals with risk factors for MACCE (higher NYHA class, renal failure, lower LVEF) should be carefully evaluated and qualified, and closely monitored post-surgery.

Get Citation

Keywords

coronary artery disease; coronary artery bypass grafting; risk stratification; postoperative complications; major adverse cardiac and cerebrovascular events

About this article
Title

How to predict the risk of postoperative complications after coronary artery bypass grafting in patients under 50 and over 80 years old? A retrospective cross-sectional study

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Ahead of print

Published online

2017-06-01

DOI

10.5603/KP.a2017.0120

Keywords

coronary artery disease
coronary artery bypass grafting
risk stratification
postoperative complications
major adverse cardiac and cerebrovascular events

Authors

Jacek Piątek
Anna Kędziora
Grzegorz Kiełbasa
Marta Olszewska
Dorota Sobczyk
Bryan HyoChan Song
Janusz Konstanty-Kalandyk
Tomasz Darocha
Karol Wierzbicki
Irena Milaniak
Krzysztof Wróbel
Bogusław Kapelak

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl