ПРЕДИКТОРЫ ГОСПИТАЛЬНЫХ ОСЛОЖНЕНИЙ КОРОНАРНОГО ШУНТИРОВАНИЯ: РОЛЬ МУЛЬТИФОКАЛЬНОГО АТЕРОСКЛЕРОЗА

Abstract

Aim: The aim of the study was to determine the factors associated with in­hospital complications of coronary artery bypass grafting (CABG) and to investigate the impact of multifocal atherosclerosis (MFA) on short­term results of coronary artery bypass. Materials and Methods: A total of 708 consecutive patients (564 men; median age of 59 years) underwent CABG from May 22, 2011 to March 22, 2012. Three groups were assigned based on the presence of one­ (n=350), two­ (n=241), and three­vessel disease (n=117). Groups were comparable in clinical characteristics, medical­history parameters, data of laboratory and instrumental examination, and incidence of post­operative complications. Predictors of unfavorable outcomes after CABG were determined based on logistic regression. Results: Patients with MFA were older than patients with one­vessel disease (p<0.001). Time of cardiopulmonary bypass and total duration of surgery were significantly longer in group with two­vessel disease compared with other patient groups (p<0.010 and p<0.001). In one­way logistic regression, the probability of complications increased along with MDRD glomerular filtration rate decrease (GFR) (OR 1.014 for decrease by every mL/min*1.73 м2, 95%CI 1.006­1.287; p=0.002), age increase (OR 1.029 for increase by every year 95%CI 1.003­1.059; p=0.033), and duration of cardiopulmonary bypass (OR 1.016 for increase by 1 min, 95%CI 1.010–1.022; р<0.001). Age and duration of cardiopulmonary bypass remained significant in multivariate analysis (p=0.044 and р<0.001, respectively). Probability of lethal outcome increased along with an increase in cardiopulmonary bypass duration (OR 1.035 for increase by 1 min, 95%CI 1.022–1.047, р<0.001), mitral regurgitation degree (OR 5.207; 95%CI 2.558–10.597, р<0.001), and decrease in left ventricular ejection fraction (LV EF) (OR 1.064 for decrease by 1%, 95%CI 1.013–2.184, р=0.012). Conclusions: In CABG surgery, the presence of MFA is associated with longer duration of cardiopulmonary bypass and surgery. The presence of MFA did not significantly increase the total number of complications and the lethality rate in CABG. Predictors of hospital complications are increase in age and duration of cardiopulmonary bypass and decrease in GFR; predictors of in­hospital lethality are duration of cardiopulmonary bypass, mitral regurgitation, and decrease in LV EF.