Major adverse cardiac events after first time elective isolated coronary artery bypass grafting: A retrospective cohort study

Background

Major adverse cardiovascular events (MACE) are useful endpoints to evaluate cardiovascular outcomes after coronary artery bypass grafting (CABG). The aim of this study was to evaluate our results in concordance with the expected improvement of records with the use of the online Research Electronic Data Capture (REDCap) software.

Methods

This is a retrospective cohort study with two years follow-up of patients who benefited from first time elective isolated CABG at Ain-Shams University Main Hospital, in the period between April 2014 and April 2016. Incidence, risk factors and independent predictors for MACE were calculated including; mortality, the occurrence or re-hospitalization for: heart failure, recurrence of angina or myocardial infarction (MI), cerebrovascular stroke (CVS), need of coronary angiography (CA), repeat percutaneous intervention (PTCA) or CABG.

Results

607 cases met our inclusion criteria and 105 patients (18.7%) developed 184 MACE, including 45 hospital mortalities (7.4%), 13 late mortalities (2.1%) and 126 non-fatal events recorded in 47 patients (7.7%); forty patients (6.6%) had at least 3 non-fatal events. Two-years follow-up was complete for the 562 hospital survivors with a total of 1113 patient-years. The annualized incidence rates of ICU admission, repeated angina or MI, need for CA, PTCA, or CABG, development of CVS, heart failure, and late mortality were: 3.6%, 2.8%, 1.8%, 0.5%, 0.09%, 0.35%, 2% and 1.2% per patient-year; respectively.

Independent predictors of hospital mortality were: older age at surgery (OR 1.06: 1–1.12; P = 0.049), female sex (OR 3.4: 1.3–8.9; P = 0.01), prolonged durations of: cardiopulmonary bypass (CPB) (OR 1.02: 1.01–1.04; P < 0.001), mechanical ventilation (OR 1.07: 1.04–1.09; P < 0.001) positive inotropic support (OR 1.03: 1.02–1.05; P < 0.001) and ICU stay (OR 1.09: 1.07–1.11; P < 0.001). Independent predictors of overall MACE was older age at surgery (OR 1.04: 1.01–1.07; P = 0.011), prolonged durations of: aortic cross clamp (OR 1.09: 1.04–1.11; P = 0.003), CPB (OR 1.06: 1.04–1.08; P < 0.001) and mechanical ventilation (OR 1.02: 1.01–1.03; P < 0.001).

Conclusions

Our results suggested that more care should be given to females, elderly and to shorten and improve the quality of our operative time. The repetition of non-fatal MACE could be modified by closer observation of the patient, once developing his first event.