Predictors and outcomes of cardiac complications following elective coronary bypass grafting.

Our objective was to determine the predictors of cardiac complications among a cohort of elective coronary artery bypass graft (CABG) surgery patients and to determine the relationship of such complications to subsequent quality of life and symptoms. A total of 248 patients were enrolled and 237 completed 6 month follow-up. The combined rate of both major and minor cardiac complications was 9.7% (n = 24). Patients in this study were evaluated preoperatively, monitored intraoperatively, followed immediately postoperatively and at 6 months. Major cardiac complications accounted for 3.6% (n = 9) and minor complications for 6% (n = 15). Using multivariable logistic regression analysis, the predictors of major cardiac complications were receiving diuretics preoperatively (p = .01) and increased time during cross-clamping (p = .006). At 6 months after surgery, 19% of the patients with postoperative cardiac complications experienced worsening of symptoms, in contrast to only 8% of those without cardiac complications (p = .03). We concluded that patients who were on preoperative diuretics and those who had longer cross-clamp times were at higher risk of cardiac complications. The majority of patients who had acute cardiac complications had improved function and symptoms at 6 months postoperatively.

[1]  J. Passchier,et al.  Prediction of Quality of Life after Coronary Artery Bypass Graft Surgery: A Review and Evaluation of Multiple, Recent Studies , 1997, Psychosomatic medicine.

[2]  W. Ghali,et al.  Statewide quality improvement initiatives and mortality after cardiac surgery. , 1997, JAMA.

[3]  J. Concato,et al.  A simulation study of the number of events per variable in logistic regression analysis. , 1996, Journal of clinical epidemiology.

[4]  G. Wahl,et al.  Long-term outcome when major complications follow coronary artery bypass graft surgery. Recovery after complicated coronary artery bypass graft surgery. , 1996, Chest.

[5]  E. Guadagnoli,et al.  Physical and psychosocial functioning of women and men after coronary artery bypass surgery. , 1995, JAMA.

[6]  J. Hollenberg,et al.  Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. , 1995, The Journal of thoracic and cardiovascular surgery.

[7]  D. Pryor,et al.  Changes in Mortality after Myocardial Revascularization in the Elderly: The National Medicare Experience , 1994, Annals of Internal Medicine.

[8]  J. Gold,et al.  Long-term prognosis after peri-operative cardiac complications. , 1994, Journal of clinical epidemiology.

[9]  E L Hannan,et al.  Improving the outcomes of coronary artery bypass surgery in New York State. , 1994, JAMA.

[10]  A. Rosen,et al.  Predicting the Occurrence of Adverse Events after Coronary Artery Bypass Surgery , 1993, Annals of Internal Medicine.

[11]  R. McCarthy,et al.  Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. , 1992, The Journal of thoracic and cardiovascular surgery.

[12]  G. Beck,et al.  Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. , 1992, JAMA.

[13]  W. Browner,et al.  Postoperative Myocardial Ischemia: Therapeutic Trials Using Intensive Analgesia Following Surgery , 1992 .

[14]  Allen J. Taylor,et al.  Current status of coronary artery operation in septuagenarians. , 1991, The Annals of thoracic surgery.

[15]  J. Copeland,et al.  Comparison of postoperative comlications between saphenous vein and IMA grafts to left anterior descending coronary artery. , 1991, The Annals of thoracic surgery.

[16]  R C Smith,et al.  Postoperative myocardial ischemia in patients undergoing coronary artery bypass graft surgery. S.P.I. Research Group. , 1991, Anesthesiology.

[17]  M. Metzdorff,et al.  Coronary artery bypass grafting in elderly patients. Comparative results in a consecutive series of 469 patients older than 75 years. , 1991, The Journal of thoracic and cardiovascular surgery.

[18]  S. Khuri,et al.  Perioperative myocardial infarction after coronary artery bypass surgery. Clinical significance and approach to risk stratification. , 1990, Circulation.

[19]  F. Grover,et al.  Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. , 1990, The Annals of thoracic surgery.

[20]  E. Cameron,et al.  Coronary artery bypass surgery. , 1990, BMJ.

[21]  A. Stewart,et al.  Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. , 1989, JAMA.

[22]  B. Spiess,et al.  Does choice of anesthetic agent significantly affect outcome after coronary artery surgery , 1989 .

[23]  A. Keats,et al.  Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations. , 1989, Anesthesiology.

[24]  M. Rich,et al.  Morbidity and mortality of coronary bypass surgery in patients 75 years of age or older. , 1988, The Annals of thoracic surgery.

[25]  T. David,et al.  Calcium Channel Blockade Does Not Offer Adequate Protection from Perioperative Myocardial Ischemia , 1988, Anesthesiology.

[26]  J F Murray,et al.  An expanded definition of the adult respiratory distress syndrome. , 1988, The American review of respiratory disease.

[27]  Edmunds Lh,et al.  Open-Heart Surgery in Octogenarians , 1988 .

[28]  A. Keats,et al.  Does Chronic Treatment with Calcium Entry Blocking Drugs Reduce Perioperative Myocardial Ischemia? , 1988, Anesthesiology.

[29]  G. Lawrie,et al.  Determinants of survival 10 to 14 years after coronary bypass: analysis of preoperative variables in 1,448 patients. , 1987, The Annals of thoracic surgery.

[30]  A. Keats,et al.  Further observations on perioperative myocardial ischemia. , 1986, Anesthesiology.

[31]  W. C. Sheldon,et al.  Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. , 1986, The New England journal of medicine.

[32]  A. Keats,et al.  Does Perioperative Myocardial Ischemia Lead to Postoperative Myocardial Infarction? , 1985, Anesthesiology.

[33]  W. Kannel,et al.  Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. , 1984, The New England journal of medicine.

[34]  Cass Principal Investigators and Their Associates Myocardial infarction and mortality in the coronary artery surgery study (CASS) randomized trial. , 1984, The New England journal of medicine.

[35]  P. Clayton,et al.  Association between early graft patency and late outcome for patients undergoing artery bypass graft surgery. , 1984, Circulation.

[36]  B. Chaitman,et al.  Diagnostic criteria and prognosis of perioperative myocardial infarction following coronary bypass. , 1983, The Journal of thoracic and cardiovascular surgery.

[37]  L. T. Sheffield,et al.  Use of Survival Analysis to Determine the Clinical Significance of New Q Waves After Coronary Bypass Surgery , 1983, Circulation.

[38]  H. Swan,et al.  Perioperative Myocardial Infarction: Late Clinical Course After Coronary Artery Bypass Surgery , 1982, Circulation.

[39]  K. Hammermeister,et al.  Effect of Perioperative Myocardial Infarction on Late Survival in Patients Undergoing Coronary Artery Bypass Surgery , 1982, Circulation.

[40]  E F Cook,et al.  Comparative Reproducibility and Validity of Systems for Assessing Cardiovascular Functional Class: Advantages of a New Specific Activity Scale , 1981, Circulation.

[41]  W. Keon,et al.  Perioperative myocardial infarction complicating coronary bypass. Clinical and angiographic correlations and prognosis. , 1981, The Journal of thoracic and cardiovascular surgery.

[42]  T. Ryan,et al.  Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). , 1980, The Journal of thoracic and cardiovascular surgery.

[43]  J. Morgan,et al.  Detection, prediction, and significance of perioperative myocardial infarction following aorta-coronary bypass. , 1979, The Journal of thoracic and cardiovascular surgery.

[44]  V. Willman,et al.  Late sequelae of perioperative myocardial infarction. , 1978, The Annals of thoracic surgery.

[45]  M. Bourassa,et al.  Evaluation of myocardial damage during coronary artery grafting with serial determinations of serum CPK MB isoenzyme. , 1978, The Journal of thoracic and cardiovascular surgery.

[46]  L Goldman,et al.  Multifactorial index of cardiac risk in noncardiac surgical procedures. , 1977, The New England journal of medicine.

[47]  M. Weissman,et al.  Assessing depressive symptoms in five psychiatric populations: a validation study. , 1977, American journal of epidemiology.

[48]  J. Ross,et al.  Detection of Perioperative Myocardial Damage after Coronary Artery Bypass Graft Surgery , 1977, Circulation.

[49]  M. Rose,et al.  Electrocardiographic and serum enzyme changes of myocardial infarction after coronary artery bypass surgery. , 1974, American Journal of Cardiology.

[50]  A. Bartel,et al.  Myocardial Infarction as a Complication of Coronary Bypass Surgery , 1973, Circulation.

[51]  E. Plass THE UNDERGRADUATE TEACHING OF OBSTETRICS , 1938 .

[52]  P. Heath POSSESSIONS, FUNCTIONS AND NEEDS OF A SCIENTIFIC SOCIETY: CHAIRMAN'S ADDRESS , 1938 .

[53]  B. Brown Extension in the Treatment of Diseased Vertebræ , 1884 .

[54]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[55]  E. Sivertssen,et al.  Myocardial infarction after aortocoronary bypass surgery. The incidence in 187 consecutive patients and the late postoperative significance. , 1980, Scandinavian journal of thoracic and cardiovascular surgery.