coronary artery bypass graft

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Preoperative C-reactive protein predicts respiratory infection after coronary artery bypass graft surgery

Agda Mezzomo et al. Odemir L. Bodin Jr. Vera Lucia

BACKGROUND: Increased levels of high-sensitive C-reactive protein (hsCRP) in the preoperative evaluation for coronary artery bypass graft surgery (CABG) have been associated to poor outcomes in the postoperative period. OBJECTIVE: To evaluate the association of high levels of hsCRP with short-term outcomes after cardiac surgery. METHODS: Prospective cohort with 331 patients who underwent CABG surgery with cardiopulmonary bypass (CPB) at our Institution. Patients were assigned to two groups according to hsCRP levels, measured before surgery: normal (N group) with 3 mg/l hsCRP. This cutoff of 3 mg/l had a sensitivity and specificity of 60% for predicting respiratory infection, with a power of 90%. The patients were followed-up during the in-hospital period. RESULTS: The mean age was 60 years, and 71.6% of the patients were male. HsCRP was increased (group A) in 144 patients (43.5%). In-hospital mortality was 4.8% and the most frequent complications in both groups were: overall infections (18%), respiratory infections (16%), atrial fibrillation (15%) and acute myocardial infarction (7.6%). The incidence of postoperative overall infections was 14.4% in the N group and 23.6% in the A group (P=0.046). Respiratory infections were also more frequent in the A group (21.5% vs. 11.8%; p = 0.024). Multivariate analyses showed that hsCRP level represented an independent predictor of postoperative respiratory infection (OR=2.08, 95% IC = 1.14-3.79). CONCLUSION: High preoperative hsCRP level is an independent predictor of respiratory infections in the mid-term postoperative period of elective coronary artery bypass graft surgery.

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Point of view

Angioplasty versus surgery: meta-analyses or registries?

Pedro José Negreiros de Andrade

POINT OF VIEW

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Metabolic syndrome in patients undergoing coronary artery bypass graft: prevalence and a marker of morbidity/mortality during hospitalization and 30 days after hospital discharge

Eduardo Pimenta et al. Oswaldo Passarelli Junior Flávio Borelli Márcio G. Sousa … Carlos Gun Vivian Amato Celso Amodeo Leopoldo Soares Piegas

OBJECTIVES: To compare the morbidity and mortality of patients with and without metabolic syndrome (MS) (according to the First Brazilian Guidelines for Diagnosis and Treatment of MS) undergoing coronary artery bypass graft (CABG) during hospitalization and after 30 days. METHODS: A total of 107 patients who underwent CABG with no associated procedures were assessed between August and October 2005; 74 (69.2%) of them had MS. Criteria of in-hospital outcome were: acute atrial fibrillation (AF), prolonged mechanical ventilation (MV), need for transfusion of blood products, number of hours spent in the ICU, length of hospital stay (days), respiratory and surgical wound infection, and death. For 30 days, the combination of events such as the need for readmission to hospital, surgical wound infection and death was assessed. RESULTS: The mean age was 60.6±9.7 years, and the group with MS presented a higher body mass index and body surface, and a higher prevalence of diabetes. No statistically significant difference was observed in the occurrence of in-hospital events such as AF (15.2% vs. 16.2%), MV (3.0% vs. 2.7%), number of units of blood products used (3.2±2.7 vs. 2.6±2.9), length of ICU stay (53.7±27.3 vs. 58.9±56.5), length of hospital stay (9.2±8.7 x 8.5±8.5), respiratory infection (6.1% vs. 2.7%), surgical wound infection (3.0% vs. 5.4%), and mortality rate (3.0% vs. 0.0%). The occurrence of combined events in 30 days was similar in both groups (12.2% vs. 20.3%, p = NS). CONCLUSION: Patients with MS did not have increased morbidity and mortality when undergoing CABG, however they had a higher trend of occurrence of surgical wound infection.

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Prognostic value of the doppler index of myocardial performance in postoperative of coronary artery bypass surgery

Karina Oliveira Azzolin et al. Iran Castro Flávia Feier Fernanda Pandolfo Carolina Oderich

OBJECTIVE: Myocardial Performance Index (MPI) obtained by Doppler echocardiography for the non-geometrical evaluation of systolic and diastolic function has been described as a method for prognostic evaluation in patients with acute myocardial infarction (AMI). Using the same condition, the objective of this study was to evaluate the predictive value of MPI for cardiovascular complications in patients at low risk during the postoperative period of CABG. METHODS: Eighty patients submitted to CABG with adequate left ventricular function in the preoperative period were studied, with MPI measured during the first hours postoperatively. Patients were followed until hospital discharge. Statistical analysis included Chi-Square test, Student t test, Mann-Whitney test, and estimation of relative risks with 95% confidence intervals, sensitivity and specificity plus a ROC curve. RESULTS: The data were evaluated by two independent observers blinded to the clinical data with non-significant intra and interobserver variability. MPI=0.43 was found as the cutoff point, considering patients with a higher probability of postoperative events those who had MPI above 0.43. The relevant events for analysis were AMI (RR 0.87 ci 0.21-3.65), atrial fibrillation (RR 0.65 ci 0.24 – 1.76), other arrhythmias (RR 1.51 ci 0.36-6.33), LV dysfunction (RR 1.74 ci 0.32-9.88), with no association between patients with MPI>0.43 and the occurrence of these events. CONCLUSION: No association was found between MPI and cardiovascular complications and longer hospital stay in this group of patients, and this index was considered not adequate as an isolated predictive method.

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Ischemic heart disease lethalities in the state of Rio de Janeiro between 1999 and 2003

Gláucia Maria Moraes de Oliveira et al. Carlos Henrique Klein Nelson Albuquerque de Souza e Silva Paulo Henrique Godoy Tânia Maria Peixoto Fonseca

OBJECTIVE: To estimate the lethality rate of acute and chronic ischemic heart disease (IHD) procedures, coronary artery bypass graft (CABG) procedures and percutaneous transluminal coronary angioplasty (PTCA) procedures in the hospitals that are registered as service providers for the Hospital Information System / Single Healthcare System (SIH/SUS) plan in the state of Rio de Janeiro (RJ) between 1999 and 2003. METHODS: The procedures considered as CABGs and PTCAs were provided by Datasus (SUS databank). The rates were standardized in accordance with gender, age, and disease severity. The common factors among these procedures are that they are highly complex cardiovascular procedures performed in RJ in the year 2000. The IHD groups are: angina, acute myocardial infarction, other acute IHDs and chronic IHDs. RESULTS: Lethality rates for angina, acute myocardial infarction (AMI), other acute and chronic IHDs were 2.8%, 16.2%, 2.9% and 3.9%, respectively, in the RJ. The lethality rates for CABG and PTCA, adjusted by age, sex and diagnostic groups, were elevated ranging from 1.9% to 12.8% for CABG procedures and as high as 3.2% for PTCA. When medical therapy was performed the rates were 2.3% for CABG and 11.1% for PTCA. CONCLUSION: There has been a progressive increase in the number of CABG and PTCA procedures to treat IHDs in the RJ. Lethality rates were above the desirable level, mainly for chronic IHD hospital admissions (5.4% and 1.7%, respectively). Optimized medical therapy appears to be a worthwhile therapeutic option, reserving CABG and PTCA procedures for the cases with the worst prognoses. Lethality rates for AMI with medical therapy was comparable to current rates when thrombolytics were not used (16.7%).

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Preoperative C-reactive protein predicts respiratory infection after coronary artery bypass graft surgery

Angioplasty versus surgery: meta-analyses or registries?

Metabolic syndrome in patients undergoing coronary artery bypass graft: prevalence and a marker of morbidity/mortality during hospitalization and 30 days after hospital discharge

Prognostic value of the doppler index of myocardial performance in postoperative of coronary artery bypass surgery

Ischemic heart disease lethalities in the state of Rio de Janeiro between 1999 and 2003

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