The Role of Hemodynamic, Metabolic, and Biomarkers in Predicting Mortality after Coronary Artery Bypass Grafting: Are we there yet?

Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure performed in Brazil and worldwide and has been one of the most studied procedures. Postprocedural aspects have been widely investigated and preoperative risk scores have been developed. Several postoperative markers and indexes, including hemodynamic, metabolic, and biomarkers, have been identified and proposed, aiming to accurately predict poor patient outcomes.^–

Dr. Yamaguti et al. conducted a prospective observational study in which hemodynamic, metabolic, and tissue hypoperfusion biomarkers were analyzed in 183 patients (ages between 35 and 83 years) with left ventricular dysfunction (ejection fraction between 40% and 42,5%) who underwent coronary artery bypass surgery with cardiopulmonary bypass, according to postoperative clinical course (complicated or uncomplicated). Patients with a complicated clinical course (defined as death within 30 days after surgery or more than 4 days of ICU stay) were older (66,3 vs 59,7; p=0.002) and had a higher EuroSCORE (6 vs 3; p<0.001). The authors also found that EuroSCORE, the lactate levels 6 hours after ICU admission, the venoarterial carbon dioxide partial pressure difference (ΔPCO2), and estimated respiratory quotient (eRQ = ΔPCO2/ Ca-vO2) 12 hours after ICU admission were independent predictors of complicated postoperative course, by multivariate logistic regression analysis.

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