Prognosis of Early Outcomes after Isolated Coronary Bypass Surgery: Results of a Single-Center Cohort Study

Abstract

Background. The importance of predictors of adverse outcomes after coronary bypass surgery needs to be regularly review in view of changing standards of practice. Predicting complications will help reduce current mortality and morbidity among patients who have undergone coronary bypass surgery (CABG). Aims prediction and determination of independent predictors of in-hospital mortality after CABG based on the results of preoperative examination. Methods. In a retrospective cohort single-center study, we analyzed the results of 2239 patients who underwent isolated CABG for the period from September 2018 to August 2021. The primary endpoint of the study was hospital death after CABG. Also, the frequency of: non-fatal myocardial infarction, non-fatal stroke, acute heart failure, postoperative rhythm and conduction disorders, acute renal failure, multiple organ failure, infectious complications was analyzed. Next, we searched for independent predictors and built a prognostic model for assessing the risk of death after CABG. Results. Results. Hospital mortality among patients was 1.34% (n = 30). Independent predictors of death after CABG were: ejection fraction (OR 0.91; 95% CI: 0.880.93; p 0.001), body mass index (OR 0.90; 95% CI: 0.820.99; p = 0.035), glomerular filtration rate (OR 0.97; 95% CI: 0.960.99; p = 0.005), repeated CABG (OR 9.3; 95% CI: 2.7431.24; p 0.001), critical atherosclerotic lesion of the arteries of the lower extremities (OR 4.5; 95% CI: 1.93310.268; p 0.001). The model for predicting the probability of death after CABG had high quality metrics: ROC-AUC 0.838 (95% CI: 0.7470.929; p 0.001), sensitivity 72.4%, specificity 84%. The threshold value of the logistic function P at the cut-off point, which corresponded to the highest value of the Yuden index, was 0.015. The outcome was predicted when the value of the logistic function P was higher than or equal to this value. Conclusion. We have developed a model for predicting in-hospital mortality after CABG based on independent linear predictors: left ventricular ejection fraction, body mass index, glomerular filtration rate, repeated CABG, critical atherosclerotic lesion of the main arteries of the lower extremities.